A combination of over-the-counter pain relievers is more effective than opioids in managing pain after wisdom tooth extraction, indicating a new standard treatment for dental and other pain. The Journal of the American Dental Association (JADA) published the largest and most comprehensive study comparing opioid and non-opioid pain medications.
Dr. Hans Malmstrom, president, EIOH General Dentistry
The University of Rochester’s Eastman Institute for Oral Health, Department of General Dentistry, was one of five field investigators in the NIH-funded study, led by Cecile Feldman, DDSdean, Rutgers School of Dental Medicine at Rutgers University.
More than 1,800 adults who had their wisdom teeth removed were given either a non-opioid combination of 400 mg of ibuprofen (Advil, Motrin) and 500 mg of acetaminophen (Tylenol), or an opioid combination of 5 mg of hydrocodone and 300 mg of acetaminophen.
Participants who received the non-opioid drugs reported significantly less pain during the first two days after surgery when pain is most severe and were more satisfied with pain management and slept better, compared to those who received opioids.
“In no way did hydrocodone outperform the non-opioid,” said Hans Malmstrom, DDS, EIOH principal investigator and chair of General Dentistry. “Fewer prescriptions for opioids means less chance for people to abuse them or become addicted. If more health care providers adopt this approach, it could significantly reduce the number of opioids circulating in communities.”
About 5 million young adults are exposed to opioids each year after drug addiction. Young adults who receive opioid prescriptions are more likely to eventually abuse opioids, contributing to the increase in deaths. An estimated 81,000 deaths each year are attributed to opioid use.
Dentists are among the top prescribers of opioid pain relievers, as are nurse practitioners, family medicine physicians, and physician assistants.
The Eastman Institute for Oral Health is an established leader in the effort to eliminate prescription opioids. A 2022 EIOH study led by Yanfang Ren, DDS, PhD, MPH and published in Jama Network Open showed that opioid alternatives were effective for people having tooth extractions. Other EIOH study in 2015 was one of the first evidence-based studies to measure the effectiveness of New York’s Prescription Drug Monitoring Program, designed to prevent multiple opioid prescriptions for the same person. EIOH Director Eli Eliav, DMD, PhD, served as the only dentist on a National Academies of Sciences panel that studied pain management, opioid abuse, and public health.
These findings support the American Dental Association’s recommendation to use non-opioid analgesics as the first choice for the management of acute dental pain. “By choosing non-opioid medications, patients can achieve better pain relief and reduce the risk of opioid-related side effects and potential addiction,” said Dr. Eliav.
In addition to Rutgers University and the University of Rochester, the other study sites were the University of Illinois at Chicago, the University of Maryland, and the University of Michigan.
