Opioids are efficacious analgesics for severe acute pain and are widely used for this purpose. However, opioids do not have anti‐inflammatory properties, so non‐opioid analgesics (e.g., NSAIDs) can be a better first choice for pain relief.  In addition, opioids carry many risks, including physical tolerance, dependence, addiction, and overdose.

Prudent practice encourages the prevention of pain, where possible, by administering non‐opioid analgesics before pain occurs. Efficacy is seen with preemptive and concurrent use of NSAIDs and acetaminophen, around the clock for as many days as necessary. In some studies, analgesic regimens using NSAIDs and acetaminophen have demonstrated pain relief comparable to hydrocodone/acetaminophen 5/325mg.

If use of an opioid for acute pain is warranted, it is recommended that clinicians should prescribe the lowest effective dose of immediate‐release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.  The specific recommendation for adolescents and young adults is
based on emerging evidence that two thirds of all patients receiving opioids for third molar extractions are 14 to 24 years old, there is a three‐fold variation in the amounts prescribed, and substantial proportions are left unused and available for subsequent misuse.4,9 Because the developing brain is at increased risk for addiction, limiting opioid exposure to the shortest duration is very important in this population. 

Providers should be aware that the Food and Drug Administration approved tramadol and single‐ingredient codeine only for use in adults. Both opioid containing products are contraindicated in children younger than 12 years due to the risk of serious breathing problems in some children with ultra‐rapid metabolism.  Providers should also limit use in adolescents between 12 and 18.

Dentists write approximately 31% of opioid prescriptions for patients between 10 to 19 years. An estimated 56 million tablets of 5 mg hydrocodone are prescribed after third molar extractions each year in the United States. High schoolers who receive an opioid
prescription are 33% more likely than those who do not receive a prescription to misuse opioids between the ages of 18 and 23 years.  Data shows an upsurge in heroin‐related
deaths among 18 to 25 year olds. Therefore, dental providers could play a critical role in minimizing opioid exposure for vulnerable young people by reducing the number of opioid tablets prescribed for common procedures such as extractions.

Dr. Paul Moore, speaking for the American Dental Association said, “For dental practitioners, the importance of these recommendations should be carefully considered . . . Every year, millions of adolescents receive their first introduction to opioids following the extraction of their third molars. Many of these young adults may have never
received these centrally‐acting analgesics before in their lives. We have a special responsibility to counsel them about their dangers and educate them about their safe use of opioids when taken for acute postoperative pain.”