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SmileCon course covers dental pain management with opioid, nonopioid analgesics

October 11, 2021

Crowd gathers at Dental Central for CE.  Learning: A crowd listens to Thomas Viola discuss opioid prescriptions Oct. 11 during a continuing education course. Photo by EZ Event Photography. 

Las Vegas — When it comes to managing dental pain, a combination of ibuprofen and acetaminophen works best, pharmacist Thomas Viola told participants of Prescribing Non-Opioids and Opioids for Dental Pain Management (1108) during SmileCon.

“I’ve got a great anti-inflammatory that sucks as a pain reliever. What should I do? Add a pain reliever that sucks as an anti-inflammatory,” said Mr. Viola, founder and president of Pharmacology Declassified.

When taken together at the appropriate dosage, ibuprofen and acetaminophen have been shown to work better than opioids for treating dental pain.

“Opioids are not anti-inflammatory, so all you’re really doing is treating the symptom of pain, not the cause of it,” he said.

An anti-inflammatory like ibuprofen is the first step to minimizing dental pain because it addresses the pain source. Ibuprofen is the preferred option specifically for dental pain because it is fast acting.

“If you haven’t figured it out by now, without an NSAID, you’re pretty much out of luck,” Mr. Viola said.

However, he said there will always be a place for opioids in dentistry when that is the best option.

“Not prescribing an opioid to a patient who truly needs one is doing them harm,” he said.

Building on earlier policy indicating that dentists should consider nonsteroidal anti-inflammatory analgesics — like ibuprofen — as the first-line therapy for acute pain, the American Dental Association adopted a policy on opioids in 2018 that supports prescription limits and mandatory continuing education for dentists. The policy is believed to be one of the first of its kind from a major professional health organization.

The ADA Practical Guide to Substance Use Disorders and Safe Prescribing assists dental practitioners with identifying and treating patients with drug addiction, preventing drug diversion and properly managing and prescribing controlled substances.

For more information on how the ADA is working to combat opioid abuse, visit