Dental Pain Algorithm for Providers
Standardized treatment protocol, best prescribing practices, and referral process for patients with non-traumatic dental pain from the Oral Health Coalition of Dane County.
After evaluation, if cause of dental pain is non-traumatic:
Evidence-Based Recommendations on Local Anesthetic, Oral Antibiotics, Non-Opioid Pain Control and Opioid Prescribing Practices
Local Anesthetic: Bupivicaine blocks or infiltration (1.7 ml minimum, 5.1 ml maximum) for 6-8 hours of localized pain relief.*
Antibiotics: Amoxicillin, 500 mg TID, or if Penicillin allergy, Clindamycin, 300 mg TID. If exudate or fluctuant present, ADD Metronidazole, 500 mg BID. (5-day minimum, 10-day maximum.
Non-Opioid Pain Control: 400 mg Ibuprofen PLUS 1000 mg Acetaminophen QID PRN for pain (3-day minimum, 5-day maximum)
Opioid Pain Control: Hydrocodone 5 mg/325 Acetaminophen, TID PRN for pain. (10 pill or 3-day maximum) Explain to patient there will be no refills.
It is expected that all recommendations are subject to provider modification based on patient need and protocols for pain and infection control. Providers should make treatment decisions based on their assessment of patient health history and clinical circumstance.
* It is recommended that providers receive training on local anesthetics and injection technique prior to giving local dental anesthetic.
- In-depth teaching is covered in the WI-DHS webinar: Management of Dental Pain in the Emergency Room
- Providers can also consult Malamed instructional videos for additional guidance on appropriate landmarks and technique for maxillary and mandibular blocks and infiltrations. Videos can be accessed by searching Malamed Injections on YouTube or by typing in the following: