The opioid crisis has reshaped the landscape of pain management, and with it, the responsibilities of healthcare providers, including dentists. Although dental professionals often prescribe opioids for short-term pain relief, especially after procedures like extractions or surgeries, they are increasingly under regulatory scrutiny. Dental opioid prescriptions can unintentionally contribute to misuse or diversion, making it essential for providers to understand the full scope of their legal and ethical obligations.
Regulatory bodies like the DEA and state dental boards have implemented stricter guidelines and requirements to ensure that prescribers stay informed and compliant. Failing to follow these regulations can lead to serious consequences, including fines, license suspension, or criminal liability. That’s why understanding the rules — from clinical guidelines to state-specific laws and patient risk assessment — is non-negotiable.
In this blog, we’ll walk through the key elements every dentist should know: recommended dosage limits and how prescribing laws vary by state. We’ll also offer guidance on staying compliant with DEA requirements for dentists. You’ll also learn how TITAN Group supports dental practices with DEA compliance readiness tools, risk mitigation strategies, and audit preparedness so you can prescribe responsibly and protect your practice.
To prescribe responsibly and stay compliant, dentists must first understand the clinical guidelines that govern opioid use in dental care.
Opioids may be appropriate in dentistry for managing moderate to severe acute pain that cannot be controlled with non-opioid medications — most commonly after surgical procedures such as wisdom tooth extractions, implant placements, or extensive oral surgeries. These prescriptions should be short-term, carefully justified, and used only when alternative treatments are ineffective or insufficient.
Both the CDC and the American Dental Association (ADA) recommend prescribing the lowest effective dose of immediate-release opioids for the shortest duration possible, typically no more than a three-day supply for acute dental pain. Longer prescriptions are rarely necessary and increase the risk of misuse or diversion. Dentists should also avoid refills unless clinically justified and well-documented.
Thoroughly documenting the clinical justification for prescribing morphine and other opioids is essential for both patient safety and regulatory compliance. Clear notes should explain why opioids were chosen over non-opioid alternatives, detail the dosage and duration, and outline the patient’s pain management plan. This supports quality care and protects the provider in the event of a DEA or state board audit.
Dosage Limits: No specific dosage limits; however, schedule II controlled substances (opioids) cannot be refilled, and a new prescription must be issued.
PDMP Requirement: Prescribers must review the Prescription Drug Monitoring Program (PDMP) when prescribing opioids exceeding 30 Morphine Milligram Equivalents (MME) per day.
Dosage Limits: Initial opioid prescriptions are limited to a 7-day supply for adults and minors.
Exceptions: Longer prescriptions are allowed for chronic pain, cancer, palliative care, or if access to a prescriber is limited.
Documentation: Must document the condition necessitating the extended prescription and why non-opioid alternatives are inadequate.
Dosage Limits: Initial prescriptions limited to a 5-day supply; 14-day supply permitted post-surgery.
MME Limits: Prescribers should avoid exceeding 90 MME/day unless justified.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
Mandatory Prescription Drug Education: Healthcare providers in Arkansas are required to undergo training on proper opioid prescribing practices and safe opioid use as part of continuing education requirements.
PDMP Requirement: Mandatory PDMP checks before prescribing morphine and other opioids.
Dosage Limits: No specific state-imposed limits; however, guidelines recommend caution when exceeding 90 MME/day.
PDMP Requirement: Mandatory use of CURES (California's PDMP) before prescribing Schedule II-IV substances.
Dosage Limits: Initial opioid prescriptions are limited to a 7-day supply, with a possible second 7-day refill.
PDMP Requirement: Mandatory PDMP check before the second fill.
Dosage Limits: Initial prescriptions limited to a 7-day supply for adults and a 5-day supply for minors.
PDMP Requirement: Mandatory PDMP check before prescribing Vicodin or any other opioid in more than a 72-hour supply.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Informed Content: Obtaining informed consent from the patient.
Dosage Limits: Initial prescriptions for acute pain are limited to a 3-day supply; a 7-day supply is permissible with proper documentation and the "Acute Pain Exception" notation.
PDMP Requirement: Mandatory PDMP check before prescribing controlled substances.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply. However, if a dental patient is having outpatient surgery at a hospital or ambulatory surgery center, the prescription is for no more than a 10-day supply and no more than 40 pills.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
Exceptions: Longer prescriptions are allowed for chronic pain, cancer, palliative care, or hospice patients.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply for both adults and minors.
ILPMP: Clinicians are strongly encouraged to use the Illinois Prescription Monitoring Program (ILPMP). ILPMP data can help determine if a patient is already receiving other prescriptions for opioids or sedating medications such as benzodiazepines.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply for adults and minors.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Dosage Limits: No specific state-imposed limits on opioid prescriptions.
PDMP Requirement: Mandatory PDMP check before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP, called K-TRACS, checks before prescribing Vicodin or any other opioids.
Non-Opioid Options: Prescribers must also consider naloxone co-prescribing based on specific criteria.
Dosage Limits: Initial prescriptions for acute pain are limited to a 3-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing Schedule II or III controlled substances.
Dosage Limits: Prescriptions should not exceed 90 MME per day.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply; chronic pain prescriptions are limited to a 30-day supply; no more than 100 MME per day.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Prescriptions must be based on evidence-based clinical guidelines appropriate for the patient’s condition.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Prescribers should prescribe the lowest effective dose and duration for acute pain.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Prescribers must review the PDMP at each encounter when prescribing opioids for acute or chronic non-cancer/non-terminal pain.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply unless documented medical necessity for a longer duration.
PDMP Requirement: Missouri has implemented a statewide PDMP; prescribers are encouraged to check it before prescribing.
Dosage Limits: For opioid-naive patients, prescriptions are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 7-day supply, not exceeding 50 MME per day.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Prescribers must adhere to the initial prescription days’ supply and daily MME requirements.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: No prescription shall be filled for more than a 34-day supply upon any single filling for controlled drugs of schedules II or III.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial prescriptions for acute pain are limited to a 5-day supply at the lowest effective dose of an immediate-release formulation.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 5-day supply; a 7-day supply is permitted post-surgery.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: No specific state-imposed limits on opioid prescriptions.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply for adults and a 5-day supply for minors.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Dentists are advised to prescribe opioids for no more than 3 days or 10 tablets for acute pain.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Opioid prescriptions in emergency settings are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain cannot exceed 30 MMEs per day for a maximum of 20 doses. Long-acting or extended-release opioids, including methadone, must not be prescribed for acute pain.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 5-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 3-day supply and should not exceed 180 MME.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 10-day supply with no refills.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Opioid prescriptions for acute pain should not exceed 3 days or 72 MME.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply; a 14-day supply is permitted post-surgery. Prescribers must consider non-opioid pain management options before prescribing opioids and document their rationale for exceeding certain dose limits (50 MME per day).
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply at the lowest effective dose.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Consent: The provider must explain the associated risks. In addition, the provider must document the patient’s medical history, conduct and document a physical examination, develop a treatment plan, and access relevant prescription monitoring information under the Controlled Substance Monitoring Program Database.
Dosage Limits: Initial opioid prescriptions for acute pain are limited to a 7-day supply.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Dosage Limits: Initial opioid prescriptions to a maximum of 7 days; prescriptions can exceed seven days for certain circumstances like cancer pain, chronic pain, and palliative care.
PDMP Requirement: Mandatory PDMP checks before prescribing opioids.
Not sure if you're fully up to speed on your state's opioid prescribing regulations? Take our Compliance Readiness Quiz to assess how well you understand the requirements that apply to your dental practice. It’s a quick and informative way to identify any knowledge gaps — and take the first step toward strengthening your compliance strategy.
TITAN Group supports dentists in meeting DEA requirements by delivering custom compliance strategies designed specifically for dental practices. Our team helps providers navigate DEA audits and state board inspections with confidence, ensuring all documentation and procedures align with current regulations. We offer comprehensive staff training, assist in policy development, and provide risk mitigation services to address vulnerabilities before they lead to violations. With ongoing monitoring and real-time regulatory updates, TITAN Group ensures your practice stays informed, compliant, and prepared year-round.
As legal and ethical scrutiny around dental opioid prescribing continues to grow, staying compliant is no longer optional — it’s essential. With evolving regulations, tighter enforcement, and increasing accountability, dental professionals must take a proactive approach to prescribing practices. When you’re ready to strengthen your compliance posture, contact TITAN Group to schedule a personalized consultation. We’ll help you navigate regulations, protect your practice, and deliver patient care with confidence.