Overview of opioid use in dentistry

In combination with nonopioid analgesics and nonpharmacological measures (eg dental treatment), an opioid may be used for acute severe nociceptive dental pain in adults (eg pain associated with major trauma, severe postoperative pain). Opioids should not be used for pain that is chronic, neuropathic or nociplastic, or for pain in children, except by specialists.

Safe prescribing of opioids in dentistry requires the practitioner to:

• be familiar with the indications for which opioid use is appropriate
• be familiar with the suitability of opioid use in specific populations (eg elderly or frail patients, opioid-tolerant patients) because there is significant interpatient variability in the response to opioids
• weigh potential benefits of opioid use in an individual against potential harms
• be familiar with the opioids suitable for use in dentistry and the formulations in which they are available (see Choice of opioid in dentistry)
• know how to manage potential drug interactions and adverse effects, and provide appropriate verbal and written education to patients about sedative effects (see Harms of opioids used in dentistry)
• prescribe the lowest dose for the shortest duration possible, because long-term opioid use often starts with the use of opioids to treat acute pain
• consider the legislation about prescriptions and prescribing drugs of dependence.