The University of Pittsburgh School of Dental Medicine is the first in the nation to establish opioid-free pain management guidelines for the vast majority of procedures performed in its clinics, according to the school.
Opioid pain relievers have been routinely prescribed for dental procedures for decades, including the surgical extraction of wisdom teeth, which often is the first exposure to opioids for many adolescents, the school says.
But current evidence shows that alternative, non-opioid medications generally work as well or even better for managing pain after dental work without the side effects of nausea, vomiting, constipation, and potential for misuse, says the school, which has updated its pain management guidelines to help practitioners make the best choices for their patients.
“It’s not a cookbook approach to how to take care of patients,” said Bernard J. Costello, DMD, MD, dean of the Pitt School of Dental Medicine. “This allows clinicians to make good choices based on what they know of the biology of the patient and the patient’s concerns.”
The Pitt Dental Medicine guidelines urge clinicians to prescribe non-opioid pain relievers first whenever possible. If a patient can’t tolerate opioid alternatives or requires additional pain relief as a rescue medication, the guidelines say, clinicians should:
- Choose the lowest potency possible
- Limit the prescription to a three-day supply
- Check the Pennsylvania Patient’s Prescription Drug Monitoring Program database
If the patient is already taking opioids for chronic pain or has a substance use disorder, additional opioids should not be prescribed without first consulting a pain management clinicians and formulating an alternative plan.
The Appalachian corridor, which includes Western Pennsylvania, is a hot zone for opioid addiction, the school reports. With deaths occurring every day from opioid abuse and costs of rehabilitation approaching $90,000 per hospitalization, deliberate strategies to minimize dental pain after treatment are now available to combat this public health crisis, the school says.
“Pitt Dental Medicine is leading the way with the adoption of this new protocol by teaching our students and residents the best way to manage pain effectively without the unnecessary risk of opioid dependence,” said Costello. “When these trainees move on to other practices, they’ll take these opioid-free guidelines with them.”
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