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When opioids must be utilized as a primary or rescue medication , the lowest potency opioid should be chosen to help relieve the patient ’ s pain . Therapy duration should be estimated based upon the severity of the procedural insult and the nature of the procedure .
Opioids should not be prescribed to a patient who is already prescribed opioid medications by another provider for chronic pain or substance abuse disorder ( related or unrelated to the current problem ) without consultation with the pain management physician and a plan that is documented in the electronic medical record .
When opioid prescriptions are provided , they should be limited to a three-day supply unless otherwise indicated for unusual circumstances .
Strategies for Anticipating the Level of Post-Procedure Pain in Outpatients
While pain tolerance is variable in individuals , most procedures can be classified with potential pain levels as mild , moderate , or high when the surgical disruption is typical for the procedure performed . Individual variations may necessitate modifying the guidelines .
MILD
Simple extractions , anterior teeth , periodontal-diseased teeth , asymptomatic teeth requiring an extraction ( i . e ., extractions for orthodontic purposes with no periapical pathology ), elective root canal therapy , simple periodontal procedures .
MODERATE
Surgical extractions , difficult posterior teeth , mild to moderately symptomatic teeth ( i . e ., periapical pathology ), apicoectomies , periodontal surgery in several areas , most autogenous bone grafting procedures .
HIGH
Very difficult surgical extractions , some completely impacted teeth , some severely symptomatic teeth ( i . e ., significant periapical pathology ), some urgent or emergent root canal therapies where extensive inflammation is not relieved .
See the Guidelines for prescribing pain medication at dental . pitt . edu / prescribing-guidelines
MARCH / APRIL 2022 | PENNSYLVANIA DENTAL JOURNAL 23