Dental Opioid Stewardship & Acute Pain Management

The IHS Division of Oral Health has approved clinical recommendations to support safe, evidence-based management of acute dental pain, with an emphasis on patient-specific medical considerations. These guidelines, meant for adolescent and adult patients, promote optimal use of non-opioid pain management strategies while supporting and streamlining quality prescribing practices and opioid stewardship. The IHS guidelines augment the following:

• Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain Exit Disclaimer: You Are Leaving www.ihs.gov 
• American Dental Association (ADA) Guidelines and Clinical References for Pharmaceutical Management of Acute Dental Pain Exit Disclaimer: You Are Leaving www.ihs.gov 
• National Maternal and Child Oral Health Resource Center (NMCH OHRC) Best Practices for Dental Pain Prescribing for Children Exit Disclaimer: You Are Leaving www.ihs.gov .

Additionally, many dental specialists and professional organizations, such as the American Association of Pediatric Dentistry (AAPD) Exit Disclaimer: You Are Leaving www.ihs.gov  and the American Association for Oral & Maxillofacial Surgeons (AAOMS Exit Disclaimer: You Are Leaving www.ihs.gov ), also have their own dental pain prescribing guidelines and chairside clinical references.

IHS, State, and Federal Requirements:

The IHS currently requires that all IHS Federal dentists, and contract dentists that spend >50% of their clinical time with the Federal Government, complete:

• Essential Training on Pain & Addiction - upon hire
• Essential Training on Pain & Addiction Refresher Course - every 3 years
• Opioid Overdose Reversal Training (Naloxone) - annually
• Naloxone Demonstration Supplemental Video - annually
• Opioid Stewardship Overview Supplemental Video – annually

Many states have their own requirements for dental prescribers to promote opioid stewardship. Check with the State Dental Board (for the state in which you are licensed) to ensure you comply with any state-specific prescribing requirements such as Prescription Drug Monitoring Program (PDMP) / Prescription Monitoring Program (PMP) use, required training, etc.

The MATE Act of 2023 Exit Disclaimer: You Are Leaving www.ihs.gov  requires all DEA-registered dentists to complete 8 hours of training (one-time, not annual) focused on the treatment and management of patients with opioid use disorders (OUD) and other SUDs. Most state dental boards and dental schools will provide you with a list of CDE / trainings that may satisfy this requirement. The mandatory IHS Essential Training on Pain & Addiction course satisfies 3 of the 8 required hours.

Additional Resources:

IHS - Acute Dental Pain Management Guidelines, CDE, and Required Trainings

• Guidelines for Management of Acute Dental Pain I Adolescents & Adults – Acute Dental Pain Management Guidelines (2025)
• IHS DOH Continuing Dental Education – IHS CDE on Dental Pain Management, Naloxone, and Caries Management of SUD Medication Patients

CDC - Dental Pain Guidelines for Dental Providers

• Dental Pain Management Guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  – Dental Pain Prescribing Recommendations (2022 CDC Guidelines + CDC Dental Prescribing Living Resource)

ADA - Acute Dental Pain Management Guidelines, Clinical References, CDE, and SUD Medication Caries Management Strategies

Adolescent & Adults (age 12+)

• Guidelines for Pharmacologic Management of Acute Dental Pain I Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  - Acute Dental Pain Management Guidelines (ADA 2024)
• Toothaches - Acute Dental Pain Management Guidelines | Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  - Toothache Pain Management Guidelines (ADA Living Guidelines)
• Toothaches - Acute Dental Pain Management Chairside Reference I Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  - Toothache Rx Chairside Guide (2024)
• Toothaches - Rx Dosing Guide I Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  – Toothache Rx Dosing Guide (ADA 2024)
• Post-Extraction - Acute Dental Pain Management Guidelines | Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  - Post-Extraction Pain Management Guidelines (ADA Living Guidelines)
• Post-Extraction - Acute Dental Pain Management Chairside Reference I Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  – Post-Extraction Rx Chairside Guide (2024)
• Post-Extraction - Rx Dosing Guide I Adolescents & Adults Exit Disclaimer: You Are Leaving www.ihs.gov  - Post-Extraction Rx Dosing Guide (ADA 2024)

Pediatrics / Children (age <12)

• Guidelines for Pharmacologic Management of Acute Dental Pain I Pediatrics Exit Disclaimer: You Are Leaving www.ihs.gov  – Acute Dental Pain Management Guidelines (ADA 2023)
• Toothaches - Acute Dental Pain Management Chairside Reference I Pediatrics Exit Disclaimer: You Are Leaving www.ihs.gov  - Toothache Rx Chairside Guide (2024)
• Toothaches - Rx Dosing Guide I Pediatrics Exit Disclaimer: You Are Leaving www.ihs.gov  - Toothache Rx Dosing Guide (ADA 2023)
• Post-Extraction - Acute Dental Pain Management Chairside Reference I Pediatrics Exit Disclaimer: You Are Leaving www.ihs.gov  - Post-Extraction Rx Chairside Guide (2024)
• Post-Extraction - Rx Dosing Guide I Pediatrics Exit Disclaimer: You Are Leaving www.ihs.gov  - Post-Extraction Rx Dosing Guide (ADA 2023)

Additional ADA References and Continuing Dental Education

• Dental Management of Patients with SUD & MAT Patients Exit Disclaimer: You Are Leaving www.ihs.gov  - Management of SUD Patients & Caries Strategies for Patients using SUD Meds (ADA 2023)
• CDE Course - ADA's Acute Dental Pain Management Guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  - CDE Course (ADA 2024)
• References & Key Points for Management of Acute Dental Pain Exit Disclaimer: You Are Leaving www.ihs.gov  – Additional References / Key Points for Acute Dental Pain (ADA Living Resources)

NMC OHRC - Best Practices for Dental Pain Prescribing for Children

• Opioid Prescribing - Evidence-Based Best Practices I Pediatrics & Adolescents Exit Disclaimer: You Are Leaving www.ihs.gov  – Best Practice Prescribing Recommendations (NMH -OHRC 2022)