A patient with a known opioid use disorder presents wanting extensive restorative treatment. What is the MOST appropriate approach?

Correct answer: A. Provide counselling and referral for the substance use disorder, then proceed with the dental treatment plan

• A. CORRECT. Substance use disorder is a chronic medical condition, and the dentist's obligation is the same as for any other comorbidity: acknowledge it, address it, and adapt the plan around it. That means a non-judgmental conversation, referral to appropriate treatment resources, a check of the state prescription drug monitoring programme, and a pain-management plan built on NSAIDs and acetaminophen with long-acting local anesthesia. Treatment then proceeds — the patient's oral disease does not pause while the addiction is treated.
• B. Dismissing the patient after emergency care alone is discriminatory; substance use disorder is a recognised medical condition, not grounds for exclusion from a practice.
• C. Refusing all care until rehabilitation is complete abandons a patient with active disease and is neither ethically nor clinically defensible. It also removes one of the few healthcare contacts many such patients still have.
• D. Prescribing opioids to a patient with a known opioid use disorder without any modification of plan directly enables relapse and constitutes a failure of non-maleficence.

Note: Non-opioid analgesia is not a compromise here: the combination of ibuprofen with acetaminophen outperforms most opioid-containing combinations for acute dental pain, so the clinically superior choice is also the safer one for this patient.