Pain ManagementDentistry MCQs Pharmacology MCQs 0% Navigate to Report a question What’s wrong with this question? You cannot submit an empty report. Please add some details. 123456789101112131415161718192021222324252627282930 Pain Management Question Bank 1 / 30 What is the recommended maximum duration for opioid prescriptions? 5 days 7 days 10 days 3 days or less Shortest duration needed, rarely exceeding 3 days. [ADA Guidelines 2024] “lowest effective dose, fewest tablets, and the shortest duration, which rarely exceeds 3 days.” 2 / 30 What contraindications exist for pregnant patients? No restrictions Only opioids All anesthetics Caution with vasoconstrictors in hypertensive conditions Caution with vasoconstrictors, especially in hypertensive conditions like preeclampsia. [ADA Guidelines 2024] “caution is indicated in the use of local anesthetics with vasoconstrictor for pregnant women, particularly those with hypertensive conditions (e.g., preeclampsia).” 3 / 30 What is the first-line therapy recommended for post-extraction pain? NSAIDs alone or with acetaminophen Local anesthetic Opioids Steroids NSAIDs alone or in combination with acetaminophen are first-line therapy due to superior efficacy and safety profile. [AAPD Guidelines 2023] “NSAIDs alone (ie, ibuprofen or naproxen sodium) or in combination with acetaminophen are more effective in reducing postoperative pain than opioid medications.” 4 / 30 What patients should NOT receive rescue opioid therapy? Young adults Elderly only Taking CNS medications or current opioids Minor procedures Patients taking gabapentinoids, CNS active medications, or already taking opioids. [ADA Guidelines 2024] “This option should not be offered to patients taking gabapentinoids and central nervous system active medications or patients already taking opioids for other medical reasons.” 5 / 30 What contraindications require modification of standard pain protocol? Pain level Medical contraindications to NSAIDs Procedure type Age only NSAIDs contraindicated in certain conditions; requires alternative pain management strategy. [ADA Guidelines 2024] “When NSAIDs are contraindicated, the panel suggests the postprocedural use of acetaminophen alone at full therapeutic dose.” 6 / 30 A patient reports breakthrough pain on day 2 after extraction despite following prescribed NSAID regimen. The MOST appropriate next step is to: Have patient return to evaluate for complications Increase NSAID dose Call in opioid prescription Switch to different NSAID "A patient with breakthrough pain on the second or third day after simple extraction(s)… should return to the clinic so the provider can rule out other clinical conditions." Patient should return to clinic to rule out complications before new prescription. [ADA Guidelines 2024] “A patient with breakthrough pain on the second or third day after simple extraction(s)… should return to the clinic so the provider can rule out other clinical conditions.” 7 / 30 What is unique about prescribing for adolescents? Adult protocols High risk after single exposure – use extreme caution No special concerns Standard dosing Increased risk of substance use disorder even after single opioid exposure; requires extreme caution. [ADA Guidelines 2024] “Adolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.” 8 / 30 What defines a “high-risk” opioid prescription? Just drug interactions Just duration Exceeding 3 days, ≥50 MME, or benzo overlap Just dosage Prescriptions exceeding 3-day supply, daily dosage ≥50 MME, or having benzodiazepine overlap. [ADA Guidelines 2024] “prescriptions to opioid-naïve patients exceeding a 3-day supply, prescriptions with daily opioid dosage 50 morphine milligram equivalents, opioid prescriptions with benzodiazepine overlap.” 9 / 30 What documentation is required for behavior management billing? Technique Complete documentation with reason and necessity Basic notes Duration only Must document reason, technique type, duration, and medical necessity. [ADA Guidelines 2024] “the patient record must include the reason (narrative of medical necessity), the type of technique or therapies used, and the duration of the services provided.” 10 / 30 What is recommended for extended pain control post-procedure? Bupivacaine/articaine with epinephrine Mepivacaine Lidocaine only Short-acting only 0.5% bupivacaine plus 1:200,000 epinephrine by block/infiltration or 4% articaine plus 1:100,000/1:200,000 epinephrine by infiltration. [ADA Guidelines 2024] “use of 0.5% bupivacaine plus 1:200,000 epinephrine by block or infiltration injection or 4% articaine plus 1:100,000/1:200,000 epinephrine by infiltration.” 11 / 30 How should breakthrough pain be handled? More medication Return to clinic first New prescription Phone consultation Patient should return to clinic to rule out other conditions before new prescription. [ADA Guidelines 2024] “A patient with breakthrough pain… should return to the clinic so the provider can rule out other clinical conditions responsible for the pain.” 12 / 30 For simple extractions, what pain management is recommended? Opioids Nonopioid analgesics only Local anesthetic only Combination therapy Nonopioid analgesics only; opioids are not recommended for simple extractions. [ADA Guidelines 2024] “For simple tooth extraction, the panel suggests initiating the pain management using an NSAID alone or in combination with acetaminophen.” 13 / 30 What documentation is required for post-extraction pain management? Basic notes only Medication only Procedure only Complete documentation including medications and instructions Must document type and dosage of local anesthetic, any medications prescribed, and post-op instructions. [ADA Guidelines 2024] “Documentation should include specific information relative to the administration of local anesthetics. This would include, at a minimum, the type and dosage of local anesthetic administered.” 14 / 30 What is the maximum daily acetaminophen dose? 4,000mg 2,500mg 3,000mg 2,000mg Maximum daily dose of acetaminophen is 4,000mg. [ADA Guidelines 2024] “The maximum daily dose is… 4,000 mg of acetaminophen.” 15 / 30 What is the contraindication for rescue opioid therapy? Patient on CNS active medications Extraction type Pain level Age under 18 "This option should not be offered to patients taking gabapentinoids and central nervous system active medications or patients already taking opioids." Patients taking gabapentinoids, CNS active medications, or current opioids. [ADA Guidelines 2024] “This option should not be offered to patients taking gabapentinoids and central nervous system active medications or patients already taking opioids.” 16 / 30 What age restriction exists for articaine? Under 2 years Under 3 years Under 4 years Under 5 years Not recommended for patients under 4 years old. [ADA Guidelines 2024] “Use in pediatric patients under four years of age is not recommended.” 17 / 30 A nursing mother requires pain management after surgical extraction. Which medication is CONTRAINDICATED? Local anesthetic Acetaminophen Codeine Ibuprofen Codeine and tramadol contraindicated during breastfeeding due to serious risks to infant. [ADA Guidelines 2024] “breastfeeding is not recommended when taking codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants.” 18 / 30 How is local anesthetic effectiveness affected by infection? Enhanced effect No effect Faster onset Delayed onset and possible ineffectiveness Infection lowers pH, delaying onset and possibly making anesthesia ineffective. [ADA Guidelines 2024] “If a local anesthetic is injected into an area of infection, its time to onset may be prolonged or anesthesia may be ineffective.” 19 / 30 What is the recommended rescue therapy ( additional medication to relieve pain) combination? Just opioids Increase NSAID dose 325mg acetaminophen plus opioid combination Double acetaminophen Add 325mg acetaminophen plus combination of 325mg acetaminophen with opioid (5-7.5mg hydrocodone or 5mg oxycodone). [ADA Guidelines 2024] “addition to the previous first-line therapy prescription of 325 mg of acetaminophen plus a combination of 325 mg of acetaminophen with an opioid.” 20 / 30 What is the main concern with opioids in adolescents? Only side effects Cost concerns Increased risk of substance use disorder after single exposure Just pain control Adolescents are at increased risk of developing opioid use disorder even after single exposure. [ADA Guidelines 2024] “Adolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.” 21 / 30 What should be done if NSAIDs are contraindicated? Reduce dose Skip analgesics Use opioids Acetaminophen 1,000mg Use acetaminophen alone at full therapeutic dose (1,000mg). [ADA Guidelines 2024] “When NSAIDs are contraindicated, the panel suggests the postprocedural use of acetaminophen alone at full therapeutic dose (eg, 1,000 mg).” 22 / 30 Which local anesthetic regimen is MOST appropriate for extended post-operative pain control? 2% lidocaine only 3% mepivacaine Plain bupivacaine Bupivacaine or articaine with epinephrine 0.5% bupivacaine plus 1:200,000 epinephrine or 4% articaine plus 1:100,000/1:200,000 epinephrine recommended. [ADA Guidelines 2024] “0.5% bupivacaine plus 1:200,000 epinephrine by block or infiltration injection or 4% articaine plus 1:100,000/1:200,000 epinephrine by infiltration.” 23 / 30 Under what circumstances should “just in case” opioid prescriptions be given? Complex extractions Young patients Not recommended All cases Routine use of delayed “just-in-case” opioid prescriptions is not recommended. [ADA Guidelines 2024] “avoid the routine use of delayed (ie, just-in-case prescription for breakthrough pain) opioid prescriptions” 24 / 30 When combining NSAIDs with acetaminophen, what dose is recommended? NSAID plus 500mg acetaminophen Higher acetaminophen NSAIDs only Double NSAID dose NSAIDs (400mg ibuprofen/440mg naproxen) plus acetaminophen (500mg). [ADA Guidelines 2024] “combination NSAID (eg, 400 mg of ibuprofen or 440 mg of naproxen sodium) plus acetaminophen (eg, 500 mg).” 25 / 30 What percentage of dental prescriptions were classified as high risk in 2019? 30% 39.50% 50% 20% 39.5% of opioid prescriptions by dentists were classified as high risk. [ADA Guidelines 2024] “In 2019, 39.5% of all opioid prescriptions written by dentists were classified as high risk.” 26 / 30 How should pain expectations be managed? Minimal effect Expect some manageable pain No pain Complete relief Counsel patients to expect some pain; analgesics should make pain manageable. [ADA Guidelines 2024] “advise clinicians to counsel patients that they should expect some pain and the analgesics should make their pain manageable.” 27 / 30 When should breakthrough pain be reevaluated? First day One week No follow-up needed Return on day 2-3 if pain persists Patient with breakthrough pain on second/third day should return for evaluation of other conditions. [ADA Guidelines 2024] “A patient with breakthrough pain (pain that persists after implementing initial pain management strategy) on the second or third day…should return to the clinic.” 28 / 30 What is required before prescribing rescue opioids? Detailed informed consent about risks Basic consent Written warning Verbal warning Informed consent with detailed information about opioid risks, particularly critical in adolescents. [ADA Guidelines 2024] “obtain informed consent from the patient with detailed information about potential opioid undesirable effects.” 29 / 30 When should opioids be considered after surgical extraction? Preventive use First-line treatment Routine use When first-line therapy inadequate Only when first-line therapy (NSAIDs/acetaminophen) proves inadequate for pain control. [ADA Guidelines 2024] “In the rare instances when postprocedural pain control using NSAIDs alone is inadequate…” 30 / 30 What key counseling must be provided to patients? Expect some pain, analgesics make manageable Minimal effect Complete relief No pain Patients should be counseled to expect some pain and that analgesics should make pain manageable. [ADA Guidelines 2024] “counsel patients that they should expect some pain and the analgesics should make their pain manageable.” Your score is 0% Restart quiz References: Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. The Journal of the American Dental Association, 155(2), 102-117.e9. https://doi.org/10.1016/j.adaj.2023.10.009
