Opioids in Dentistry: Treating Pain or Treating Fear?

For centuries, opioids have played a powerful and complex role in medicine.

Derived from the resin of the poppy plant, these substances have been used to relieve pain, calm anxiety, and, unfortunately, have also contributed to widespread addiction and misuse. In modern dentistry, opioids still have a place—but perhaps not for the reasons many think.

As dental professionals, we recognize that pain management is one of the cornerstones of patient care.

However, the use of opioids in dentistry has shifted dramatically over the years. In fact, it could be argued that, more often than not, opioids are prescribed not to treat pain itself—but to address fear.

The Historical Role of Opioids in Medicine

Opioids, including familiar names such as oxycodone, hydrocodone, and codeine, have long been used to manage pain. Decades ago, controlled-release opioids like OxyContin began to be used more widely—even for short-term, acute pain. While these drugs were effective at reducing discomfort, their powerful effects and addictive potential led to what we now know as the opioid epidemic.

In dentistry, however, the story has taken a different turn. While chronic pain management in medicine often still involves opioids, dental pain is generally acute and inflammatory, making it more effectively treated by anti-inflammatory agents rather than narcotics.

Why Anti-Inflammatories Work Better for Dental Pain

Dental pain is unique. It’s typically localized, temporary, and inflammatory in nature—stemming from procedures like extractions, root canals, or soft tissue trauma. For that reason, ibuprofen and acetaminophen—either alone or in combination—are far more effective choices for most patients.

Recent studies, including those published as recently as early 2025, have confirmed that a combination of ibuprofen and acetaminophen provides superior pain relief compared to opioids. While opioids dull the brain’s perception of pain, anti-inflammatories address the source of it—reducing swelling and the body’s inflammatory response.

There is nothing anti-inflammatory about oxycodone, hydrocodone, or acetaminophen alone. That’s why the ibuprofen–acetaminophen pairing remains the gold standard for managing most dental discomfort.

Opioids and the Fear Factor

So why do opioids continue to appear in dental prescriptions? The answer may lie less in physical pain and more in psychological reassurance. Many patients experience significant anxiety before dental procedures. Knowing they have a “strong” medication available if needed can reduce fear—and in turn, reduce the perception of pain itself.

This “placebo effect” plays a larger role than many realize. Patients often fill their prescriptions but never take the medication, or even choose not to fill it at all. Simply having the prescription provides emotional comfort. And in some ways, that can be a positive outcome—provided the unfilled prescription doesn’t contribute to misuse elsewhere.

Responsible Prescribing in Dentistry

The responsibility to prescribe wisely lies with each clinician. Dentists are trained to evaluate each patient’s level of pain tolerance, the complexity of the procedure, and any history of substance use. For many patients, a simple recommendation to try ibuprofen and acetaminophen first is enough.

When opioids are deemed necessary, the dosages are generally low and prescribed for very short durations—often 5 mg of oxycodone or hydrocodone with 300 mg of acetaminophen, taken no more than two to three times daily for one or two days. If pain persists beyond that, it’s a signal to re-evaluate the underlying cause, not to increase the dose.

Safe Disposal of Unused Opioids

One ongoing challenge with opioid prescriptions is safe disposal. Unused pills left in medicine cabinets can easily find their way into the wrong hands. Regulations vary by region, but the best option is to use local or national DEA take-back programs, where medications can be safely returned and destroyed.

Flushing opioids or throwing them in the trash, even when mixed with coffee grounds or cat litter, is not ideal due to environmental risks. When in doubt, patients should contact their local health department or pharmacy to ask about proper disposal options.

Educating Patients About Opioid Risks

Every opioid prescription should come with a clear, compassionate conversation about safety. Patients must understand that:

• Opioids can cause respiratory depression, constipation, nausea, and skin sensitivity.
• They are not designed to eliminate pain entirely, but to make it tolerable.
• Tolerance develops quickly—the more you take, the more you’ll need to achieve the same effect.
• The combination of ibuprofen and acetaminophen should always be the first-line approach before turning to stronger medications.

Many dentists also find success with additional measures such as long-acting local anesthetics (like bupivacaine), ice therapy, and pre-dosing with anti-inflammatories before the procedure begins. These steps help keep patients comfortable without the need for narcotics.

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