The opioid epidemic has touched nearly every corner of healthcare, and dentistry is no exception. For years, dentists prescribed opioids for post-operative pain, sometimes in larger quantities than patients truly needed. Decades ago, it was not unusual to see prescriptions written for 20 Percocet tablets for a single dental procedure, partly because drug companies distributed prescription pads with “20” already filled in. While those prescribing habits were often well-intentioned, we now understand the risks they posed. Today, dentists have both the responsibility and the opportunity to be part of the solution.
Understanding Addiction as a Disease
Addiction is not a choice — it’s a disease that changes the brain. About one in seven patients lives with a substance use disorder, whether related to alcohol, tobacco, opioids, or other substances. The numbers are staggering: nearly 178,000 deaths from alcohol and 480,000 from smoking occur each year in the U.S. alone. Addiction can also extend to newer habits such as vaping or gambling.
The takeaway is simple: addiction has biological, psychological, and social roots. Dentists don’t need to solve the epidemic alone, but they do play a role in prevention, awareness, and compassionate care.
Smarter Pain Management in Dentistry
Managing pain responsibly is one of the most effective ways dentists can reduce opioid risk. Post-operative pain depends on factors such as patient anxiety, procedure length, number of extractions, or whether surgical flaps are involved. With these variables in mind, dentists can follow structured approaches to provide comfort while minimizing opioid use.
Steps Dentists Can Take:
- Start with non-opioid medications
- Ibuprofen 600 mg every 6 hours
- Acetaminophen in between ibuprofen doses, as needed
- Consider prescribing both together for synergy
- Use long-lasting anesthetics
- Marcaine (bupivacaine) can extend numbness, giving oral pain relievers time to take effect before discomfort sets in.
- Tailor the plan to risk factors
- Higher risk: anxious patients, females under 35, procedures longer than 25 minutes, multiple extractions, or flap surgeries.
- Anticipate greater pain in these cases and plan accordingly with local anesthesia and patient counseling.
- Limit opioid prescriptions
- Prescribe the lowest effective dose for the shortest duration.
- Avoid “default” prescription sizes — even five tablets may be enough in some cases.
- Be mindful of drug interactions
- SSRIs and some antidepressants can reduce opioid effectiveness.
- Take a thorough medical history before deciding if opioids are appropriate.
- Set expectations with patients
- Explain the variability of dental pain.
- Reassure patients that ibuprofen and acetaminophen combinations are often more effective than opioids.
- Provide a clear post-op pain plan in writing.
The Role of Compassion in Dental Care
Beyond prescribing decisions, compassion plays a powerful role in dentistry. Dentists are often in a unique position to recognize when a patient may be struggling with substance use. Offering referrals to addiction treatment centers when appropriate can make a meaningful difference. Conversations about alcohol and tobacco cessation can also be integrated into patient care, helping to address two of the leading causes of preventable death.
Moving Forward: A Call to Action
The opioid epidemic is a complex public health challenge, but dentists have the ability to make a real impact. By combining evidence-based pain management strategies with empathy and careful prescribing, dental professionals can help protect their patients while contributing to the broader effort against substance use disorders.
As a dental professional, review your prescribing habits, adopt non-opioid pain strategies as your first line, and build compassion into every patient interaction. Together, these small steps can add up to a powerful role in fighting the opioid epidemic.