Ethics & Law · patient case question
A different patient asks for hydrocodone, saying it is the only drug that works for his chronic facial pain. He has been treated in the practice for years and there is no acute dental cause. What is the best action?
Patient case: The Last Patient of the Day
Patient: 37-year-old male, not a patient of record
Chief Complaint: “I'm in agony. Oxycodone is the only thing that touches it. I just need a prescription.”
Background: Walked in at closing time. Says he is from out of town, cannot name a regular dentist, declines to give a pharmacy. Becomes insistent when questioned.
Medications: “Nothing regular.”
Vital Signs: BP 132/84 mmHg · HR 84 bpm · RR 16 · T 98.6°F
Findings: Examination reveals no swelling, no caries into dentin, no periodontal defect, no percussion tenderness and no radiographic pathology corresponding to the area he indicates.
Show answer and explanation
Correct answer: B. Refer him to his physician for management of the chronic pain
- A. Saying nothing can be done abandons him. Something CAN be done — the referral, plus explanation of what has been excluded and why.
- B. CORRECT. Chronic pain with no identifiable dental cause is OUTSIDE the scope of dental practice. Chronic opioid therapy requires longitudinal assessment, monitoring and a single prescribing clinician — it is not something to be initiated or continued from a dental chair. Referring to his physician, with a clear note documenting that dental causes have been excluded, is both the correct clinical step and the correct professional one.
- C. A long-standing relationship does not create an indication. Prescribing an opioid without a dental diagnosis is inappropriate regardless of how well you know the patient, and fragmented prescribing across providers is precisely how patients are harmed.
- D. Antibiotics for pain without evidence of infection is inappropriate prescribing and contributes to resistance.
Note: Exclude the dental causes properly first: cracked tooth syndrome, atypical odontalgia, myofascial pain, trigeminal neuralgia and sinus disease can all masquerade as toothache. Then refer.