Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 2110 - Missouri Dental Board
Chapter 2 - General Rules
Section 20 CSR 2110-2.250 - Prescribing Opioids

(1) Dentists shall consider non-opioid medications and therapies for treatment of mild to moderate acute dental pain prior to prescribing an opioid controlled substance. Options for non-opioid treatments shall be discussed with the patient and the patient advised of the risks associated with opioid related treatments and the discussion documented in the patient's dental record.

(2) Before prescribing an opioid controlled substance to a patient experiencing dental pain, a dentist shall assess the patient for potential opioid use disorder. At a minimum, this should include collecting and maintaining a thorough medical history of the patient from the patient or their guardian including any history of substance abuse disorders, mental health conditions, or sleep-disordered breathing. Dentists shall thoroughly discuss with the patient or their guardian and document in the patient's record any medications the patient or their guardian discloses to the dentist they have received from any other healthcare providers.

(3) A dentist shall not issue an initial prescription for more than a seven- (7-) day supply of an initial prescription of an opioid con- trolled substance for treatment of a patient's acute pain. A dentist may not issue any renewal, refill, or new prescription for an opioid controlled substance for treatment of the same acute pain without first conducting a consultation with the patient to determine the need and appropriateness of the renewal, refill, or new prescription. For the purposes of this rule, a consultation shall include all of the requirements outlined in section (2) of this rule. Any appropriate renewals, refills, or new prescriptions of opioids for treatment of the same acute pain shall also be limited to a seven- (7-) day supply and shall be in compliance with the general provisions of Chapters 195 and 579, RSMo. If, in the professional judgment of the dentist, more than a seven- (7-) day supply is appropriate for the initial prescription or any renewals, refills, or new prescriptions of opioids to treat the patient's acute pain, the dentist may issue a prescription for the quan- tity needed to treat the patient, provided that the dentist shall document in the patient's dental record the reason for the necessity for more than a seven- (7-) day supply and that a nonopioid alternative was not appropriate to address the patient's condition.