Prescribing, Controlled Substances, and Prescription Monitoring
Authority and limits
A dental license plus a valid DEA registration permits prescribing within the scope of dentistry. Every prescription requires a patient evaluation, a documented diagnosis, and a legitimate dental purpose. Prescribing to yourself or immediate family, prescribing from an internet questionnaire, and "covering" for a colleague outside an established relationship are all high-risk and commonly disciplinary. Schedule II drugs cannot be refilled, quantities must match the clinical need, and pre-signing blank prescriptions is prohibited.
Opioids and the PMP
Minnesota limits initial opioid prescriptions for acute dental pain to a short supply, requires electronic prescribing of controlled substances with limited exceptions, and obligates prescribers to check the Minnesota Prescription Monitoring Program in specified circumstances before prescribing opioids. Document the PMP review. Consider non-opioid and multimodal analgesia, discuss disposal, and use the smallest effective quantity - dental opioid supply is a recognized source of diversion.
Records, security, and stewardship
Keep a biennial inventory where required, secure stock, report theft or significant loss, and dispose of expired drugs properly. Antibiotics and analgesics are prescribed only when indicated; prophylaxis regimens follow current guidelines rather than habit.
Traps
Treating tramadol as non-controlled (it is a controlled substance); delegating prescribing decisions to staff; assuming a phone refill of a Schedule II drug is acceptable; forgetting that the PMP check itself must be documented.
Worked example: A patient calls after hours with pain and a request for "the same pills as last time." Without an evaluation or a documented indication, prescribing is unsafe and unprofessional. Rule of thumb: before any controlled substance leaves the office, document why this drug, this dose, this quantity, and why now.