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Dental Opioid Guidelines

We convened a multidisciplinary consortium of dentists, periodontists, oral and maxillofacial surgeons, endodontists, and patients to develop ideal opioid prescribing patterns after common dental procedures utilizing a modified Delphi approach. Best prescribing practices are listed for post-operative narcotic naive patients at discharge. 

*For the above list of dental procedure-types, this expert panel recommended a range, with '0' (zero) as the starting point and up to the maximum number mentioned above. The type of opioid and amount prescribed should be customized for each patient by factoring the extent and complexity of the surgical procedure. These are not meant to substitute clinician's own assessment of the pain management needs of their individual patient. 

Download a PDF of these guidelines here

Please Note

All medications require a thorough evaluation for contraindications. Doses given are recommendations. Adjustments may be required for individual patients. In case of patient allergy to Oxycodone, replace 5mg Oxycodone with 2 mg Hydromorphone (Dilaudid).

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Some examples of relative contraindications:​

  1. Acetaminophen : contraindicated with liver disease or elevated LFTs

  2. NSAIDS: contraindicated with bleeding risks, GI ulcers and chronic kidney disease

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OUR EXPERT PANEL

Owais Farooqi, DDS, MDS, Dental Lead

R Bruce Templeton DMD, Oral and Maxillofacial Surgery

Albert Goerig, DDS, MS, Endodontics 

Diego Velasquez, DDS, MSD, Periodontics

Chad M. Novince, DDS, MSD, PhD, Periodontics

Anthony Lotesto, DMD, Oral and Maxillofacial Surgery

 Matthew Zieman, DMD, Oral and Maxillofacial Surgery

Joseph G Maloney, DMD, Periodontics

Martin Makary, MD, MPH, FACS, General Surgery

M. Kinon Lecholop DMD, FACS, Oral and Maxillofacial Surgery

Caroline Hezkial, BDS (Orofacial Pain)

Shaad Rizwi, MD, Patient Reprentative

Deborah Byrd, Patient Representative

Heidi Overton, MD, General Surgery

Christine Fahim, PhD, Research Team

William Bruhn, BS, Research Team

*Experts on this panel participated in their individual capacity. Their opinions were solely theirs, and do not necessarily reflect the opinion of their respective employer(s)/affiliated professional organization(s)/educational institution(s).

References

  1. Overton HN, Hanna MN, Bruhn WE, Hutfless S, Bicket MC, Makary MA; Opioid After Surgery Workgroup. Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus. J Am Coll Surg. 2018 Aug 2. pii: S1072-7515(18)31129-3. doi: 10.1016/j.jamcollsurg.2018.07.659

  2. Gupta N, Vujicic M, Blatz A. Opioid prescribing practices from 2010 through 2015 among dentists in the United States: What do claims data tell us? J Am Dent Assoc. 2018 Apr;149(4):237-245.e6. doi: 10.1016/j.adaj.2018.01.005

  3. Janakiram C, Chalmers NI, Fontelo P, Huser V, Lopez Mitnik G, Iafolla TJ, Brow AR, Dye BA. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc. 2018 Apr;149(4):246-255. doi: 10.1016/j.adaj.2018.02.010.

  4. McCauley JL, Leite RS, Gordan VV, Fillingim RB, Gilbert GH, Meyerowitz C, Cochran D, Rindal DB, Brady KT; National Dental Practice-Based Research Network Collaborative Group. Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. J Am Dent Assoc. 2018 May;149(5):353-362. doi: 10.1016/j.adaj.2017.11.031.

  5. Weiland BM, Wach AG, Kanar BP, Castele MT, Sosovicka MF, Cooke MR, Moore PA. Use of opioid pain relievers following extraction of third molars. Compend Contin Educ Dent. 2015 Feb;36(2):107-111; quiz 112, 114. 

  6. Larach DB, Waljee JF, Hu HM, Lee JS, Nalliah R, Englesbe MJ, Brummett CM. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2018 Jul 24. doi: 10.1097/SLA.0000000000002969. 

  7. Koppen L, Suda KJ, Rowan S, McGregor J, Evans CT. Dentists' prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health. J Am Dent Assoc. 2018 Aug;149(8):721-730. doi: 10.1016/j.adaj.2018.04.027 

  8. Mehlisch DR. The efficacy of combination analgesic therapy in relieving dental pain. J Am Dent Assoc. 2002 Jul;133(7):861-71. Review.

  9. Aminoshariae A, Kulild JC, Donaldson M, Hersh EV. Evidence-based recommendations for analgesic efficacy to treat pain of endodontic origin: A systematic review of randomized controlled trials. J Am Dent Assoc. 2016 Oct;147(10):826-39. doi: 10.1016/j.adaj.2016.05.010. Epub 2016 Jul 28. Review. 

  10. Okunseri C, Okunseri E, Xiang Q, Thorpe JM, Szabo A. Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey. J Public Health Dent. 2014 Fall;74(4):283-92. doi: 10.1111/jphd.12055 

  11. Dana R, Azarpazhooh A, Laghapour N, Suda KJ, Okunseri C. Role of Dentists in Prescribing Opioid Analgesics and Antibiotics: An Overview. Dent Clin North Am. 2018 Apr;62(2):279-294

  12. Buttar R, Aleksejūnienė J, Coil J. Antibiotic and Opioid Analgesic Prescribing Patterns of Dentists in Vancouver and Endodontic Specialists in British Columbia. J Can Dent Assoc. 2017 Sep;83:h8

  13. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013 Aug;144(8):898-908. Review.

  14. Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. J Am Dent Assoc. 2018 Apr;149(4):256-265.e3. doi: 10.1016/j.adaj.2018.02.012. Erratum in: J Am Dent Assoc. 2018 Jun;149(6):413.

  15. Keith DA, Kulich RJ, Bharel M, Boose RE, Brownstein J, Da Silva JD, D'Innocenzo R, Donoff RB, Factor E, Hutter JW, Shaefer JR, Karimbux NY, Jack H, Thomas HF. Massachusetts Dental Schools Respond to the Prescription Opioid Crisis: A Statewide Collaboration. J Dent Educ. 2017 Dec;81(12):1388-1394. doi: 10.21815/JDE.017.098.

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