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 patients should NOT receive rescue opioid therapy? Taking CNS medications or current opioids Young adults Minor procedures Elderly only 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.” 2 / 30 What special precaution is needed for pregnant/nursing patients? No restrictions Monitor only Avoid codeine/tramadol while breastfeeding Reduce dose Breastfeeding not recommended when taking codeine or tramadol due to serious risks. [ADA Guidelines 2024] “breastfeeding is not recommended when taking codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants.” 3 / 30 How is local anesthetic effectiveness affected by infection? Faster onset Enhanced effect No effect 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.” 4 / 30 What is the key principle for opioid prescribing in dentistry? Reserve for when first-line insufficient First-line treatment Never prescribe Always prescribe Opioids should be reserved for when first-line therapy insufficient; avoid routine “just-in-case” prescribing. [ADA Guidelines 2024] “The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain.” 5 / 30 What should be done if NSAIDs are contraindicated? Acetaminophen 1,000mg Reduce dose Skip analgesics Use opioids 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).” 6 / 30 What is recommended for extended pain control post-procedure? Mepivacaine Lidocaine only Bupivacaine/articaine with epinephrine 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.” 7 / 30 When should breakthrough pain be reevaluated? Return on day 2-3 if pain persists One week No follow-up needed First day 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.” 8 / 30 What documentation is required for local anesthesia? Technique only Just type Type and dosage Just dose Must include type and dosage of local anesthetic administered. [ADA Guidelines 2024] “Documentation also includes specific information relative to the administration of local anesthetics. This would include, at a minimum, the type and dosage of local anesthetic administered.” 9 / 30 What defines a “high-risk” opioid prescription? Just duration Just drug interactions Just dosage Exceeding 3 days, ≥50 MME, or benzo overlap 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.” 10 / 30 What special documentation is needed for minors? Standard notes No special requirements Parent/guardian informed consent for opioids Basic consent Informed consent must be obtained from parent/guardian for opioids. [ADA Guidelines 2024] “obtain informed consent from the patient (or the parent or guardian in the case of minors) with detailed information about potential opioid undesirable effects.” 11 / 30 What is the main concern with opioids in adolescents? Increased risk of substance use disorder after single exposure Cost concerns Just pain control Only side effects 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.” 12 / 30 What is the correct ibuprofen dosing for dental pain? 400mg 200mg 600mg 800mg 400mg ibuprofen with maximum daily dose of 2,400mg. [ADA Guidelines 2024] “To minimize adverse effects, analgesic prescriptions should follow the principle of minimum effective dosage… The maximum daily dose is 2,400 mg of ibuprofen.” 13 / 30 Why might mandibular infiltration be effective in children? Faster metabolism Higher drug dose Less dense bone allowing better diffusion Different technique Child’s mandibular bone less dense than adult’s, allowing better diffusion. [ADA Guidelines 2024] “The mandibular cortical bone of a child is less dense than that of an adult, permitting more rapid and complete diffusion of the injected anesthetic.” 14 / 30 For simple extractions, what pain management is recommended? Local anesthetic only Combination therapy Opioids Nonopioid analgesics only 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.” 15 / 30 What medication modification is needed for nursing mothers? No changes Reduce dose Standard protocol Avoid codeine/tramadol while breastfeeding Breastfeeding not recommended when taking codeine or tramadol due to 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.” 16 / 30 A nursing mother requires pain management after surgical extraction. Which medication is CONTRAINDICATED? Local anesthetic Ibuprofen Codeine Acetaminophen 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.” 17 / 30 What documentation is required for post-extraction pain management? Medication only Complete documentation including medications and instructions Basic notes only Procedure only 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.” 18 / 30 The maximum daily dose of ibuprofen for dental pain is: 2,000mg "The maximum daily dose is 2,400 mg of ibuprofen." 2,400mg 3,200mg 1,600mg Maximum daily dose is 2,400mg ibuprofen. [ADA Guidelines 2024] “The maximum daily dose is 2,400 mg of ibuprofen.” 19 / 30 What storage/disposal counseling is required? Written only No counseling Storage and disposal counseling Basic instructions Must counsel regarding appropriate storage and disposal if opioids prescribed. [ADA Guidelines 2024] “if opioids are prescribed, counsel patients regarding appropriate storage and disposal.” 20 / 30 What contraindications exist for pregnant patients? Only opioids All anesthetics Caution with vasoconstrictors in hypertensive conditions No restrictions 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).” 21 / 30 What is the recommended naproxen sodium dosing? 660mg 220mg 550mg 440mg 440mg naproxen sodium with maximum daily dose of 1,100mg. [ADA Guidelines 2024] “440 mg of naproxen sodium… The maximum daily dose is… 1,100 mg of naproxen sodium.” 22 / 30 What is the recommended NSAID dosing for post-extraction pain? 600mg ibuprofen/660mg naproxen 400mg ibuprofen/440mg naproxen 800mg ibuprofen/880mg naproxen 200mg ibuprofen/220mg naproxen 400mg ibuprofen or 440mg naproxen sodium, with maximum daily doses of 2400mg and 1100mg respectively. [ADA Guidelines 2024] “using an NSAID alone (eg, 400 mg of ibuprofen or 440 mg of naproxen sodium)” 23 / 30 What is the maximum duration recommended for post-extraction opioid prescriptions if needed? 3 days or less 7 days 5 days 10 days Opioids should be prescribed at lowest effective dose for shortest duration, rarely exceeding 3 days. [ADA Guidelines 2024] “The opioid prescription should consider the lowest effective dose, fewest tablets, and the shortest duration, which rarely exceeds 3 days.” 24 / 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.” 25 / 30 How should breakthrough pain be handled? Phone consultation More medication New prescription Return to clinic first 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.” 26 / 30 What percentage of dental prescriptions were classified as high risk in 2019? 30% 20% 39.50% 50% 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.” 27 / 30 What contraindications require modification of standard pain protocol? Age only Medical contraindications to NSAIDs Pain level Procedure type 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.” 28 / 30 When should opioids be considered after surgical extraction? Routine use First-line treatment Preventive 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…” 29 / 30 What communication is needed for substance use disorder patients? No special care Denial of care Standard care Special care and provider communication Special care and communication with patient’s other healthcare providers required. [ADA Guidelines 2024] “Special care should be taken when prescribing opioids to a patient with a substance use disorder, including communication with the patient’s other health care providers.” 30 / 30 How should pain expectations be managed? Expect some manageable pain Minimal effect 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.” 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
