Objectives: To synthesize evidence on anesthetic and pharmacologic strategies for acute dental pain in emergency settings and to outline how dentists, pharmacists, and emergency physicians can collaborate to provide opioid-sparing care. Methods: We conducted a systematic review following PRISMA 2020. Databases were searched for primary studies and systematic reviews on management of acute dental or odontogenic pain in hospital emergency departments, urgent-care services, or dental emergency clinics. Eligible primary studies reported at least one outcome related to pain, rescue medication, adverse events, or opioid prescribing. Data were extracted and summarized narratively. Results: Ten primary studies and eight systematic reviews/meta-analyses met the inclusion criteria. Most primary studies were observational analyses of emergency-department prescribing or single-centre interventions, while the secondary evidence mainly evaluated non-opioid regimens after dental procedures. Across settings, acute dental pain was often treated with opioids despite evidence that non-steroidal anti-inflammatory drugs, acetaminophen, selective COX-2 inhibitors, and multimodal combinations provide equal or superior analgesia with fewer harms. Guideline-based protocols and multimodal regimens were associated with reductions in opioid use without loss of pain control. Conclusion: Evidence supports NSAID-based and multimodal non-opioid strategies as first-line options for acute dental pain, with opioids reserved for selected cases within interprofessional, guideline-directed emergency care pathways.