Acute Dental Pain

Overview

When a child or youth needs dental treatment, they may sometimes require opioids afterwards. When 60-95% of opioids prescribed to children and youth for pain related to a dental procedure remain unused*, this creates a large amount of medication available for potential non-indicated usage. 
^{*Dyson et al. 2022. https://doi.org/10.1002/emp2.12822} 

Dentists have an opportunity to reduce nonindicated opioid use by decreasing the quantity of opioids they prescribe. Dental treatment-related pain should be managed with non-opioid analgesia whenever possible. When needed for moderate to severe dental pain, judicious use of opioids can help reduce children’s discomfort, improve their satisfaction with care, and prevent long-term negative consequences of untreated pain. This toolkit section includes resources for safer and responsible prescribing and administering opioids for acute dental pain in children and youth.

When opioids are prescribed and administered for acute dental pain, there are several considerations to ensure safer therapeutic use:

• Physical (e.g., salt water rinses, cold drinks) and psychological (e.g., distraction) treatments should be used for all children and youth with acute dental pain
• Non-opioid medications (e.g., acetaminophen, ibuprofen, other NSAIDs) should be used as first-line pharmacologic therapies
• Ibuprofen and acetaminophen can be combined for relief of moderate pain; this combination provides relief similar to many oral opioid medications, without opioid side effects, and may alleviate the need to prescribe opioids
• Opioids should be combined with a non-opioid medication to reduce the total amount of opioid needed and lessen the occurrence of adverse events
• Three days (or 5-10 doses) of an oral opioid medication is almost always enough to manage acute dental pain at home
• Indicate the quantity of opioid doses on the prescription, and note “no refills”
• Children and their families should always be counselled about the potential side effects of opioid medications
• Opioid risk assessment should be performed for all families receiving a prescription for opioids, using a validated risk assessment tool

Opioids should be prescribed and administered in a culturally safe way.

Also consider risks for opioid use disorder, higher-risk opioid use, child age, and preexisting mental health diagnoses.

However, even when these risks are present, children with severe pain have the right to adequate pain management, which may include the use of opioids. Children and their families should share the decision making about whether opioid analgesia is appropriate for them with their healthcare provider.

Have feedback? Visit linktr.ee/youthinpain or kidsinpain.ca/youth-in-pain to learn more about this toolkit. For content suggestions please e-mail contact@kidsinpain.ca

Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.