Developing a Post-Operative Pain Management Protocol for Dental Extraction in Primary Care Settings in Niger State

Inadequate post-extraction pain management is a common complaint in Nigerian primary care dental settings, contributing to dental fear and delayed healing, and a standardised protocol addresses this quality gap in North Central Nigeria. This study developed a post-operative pain management protocol for dental extraction in primary healthcare dental units in Niger State, North Central Nigeria. A professional protocol development methodology was applied, drawing on patient complaint audit of 180 post-extraction cases at 10 PHC dental units in Minna, Bida, and Kontagora, structured consultations with 15 dental officers and 6 oral surgery specialists, and review of current best evidence on post-extraction analgesia, dry socket prevention, and patient instructions. Audit confirmed that verbal post-extraction instructions were given in only 61.1 percent of cases, that analgesic prescription was incomplete or inconsistent in 43.3 percent, and that dry socket management protocols were absent from all 10 units. The protocol developed covers four elements: pre-operative pain risk stratification, a standardised analgesic prescription ladder by extraction difficulty, a written post-extraction instruction sheet in English and Hausa, and a dry socket assessment and management guide. An emergency contact protocol for managing post-operative complications is included. Expert review by eight oral surgery and primary care specialists confirmed the protocol's clinical appropriateness. Recommendations include adopting the protocol as a mandatory standard of care at all Niger State dental units, providing training refreshers for dental officers on post-extraction management, and annual patient complaint review to assess protocol impact.