The management of chronic pain in dental patients poses significant challenges, requiring a nuanced understanding of pain etiology, pharmacological interventions, safety considerations, and emerging innovations. This narrative review comprehensively explores the diverse landscape of chronic pain in dental practice, encompassing dental pain, temporomandibular joint disorders (TMD), neuropathic pain, orofacial myofascial pain, and systemic conditions contributing to orofacial pain. Pharmacological agents such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioids, local anesthetics, antidepressants, anticonvulsants, muscle relaxants, and topical analgesics are evaluated for their efficacy, safety profiles, and indications in dental pain management. Innovative approaches, including targeted drug delivery systems, combination therapies, non-pharmacological interventions (e.g., acupuncture, biofeedback), and emerging pharmacotherapies (e.g., cannabinoid-based treatments), are discussed for their potential to optimize pain relief and minimize adverse effects. Adverse effects, drug interactions, and the risk of addiction and dependence associated with pharmacological agents are reviewed, highlighting the importance of personalized treatment plans and multidisciplinary collaboration. Guidelines from the American Dental Association (ADA), the World Health Organization (WHO) Pain Relief Ladder, and best practices for pharmacological pain management are synthesized to provide evidence-based recommendations for clinical practice. Future directions in pain management technology, therapeutic targets, and areas for further research are identified, emphasizing the need for ongoing advancements to improve outcomes for dental patients with chronic pain.