Photo: Rattankun
As previously mentioned, a common theme of the 2024 AAOMS Annual Meeting included a key focus on non-opioid options for acute pain management. Although unrelated to the AAOMS meeting, recent research was published online at Journal of Dental Research reviewed the effectiveness of pharmacological treatments to develop guidelines for the management of acute pain after tooth extraction.
The study systematically reviewed randomized clinical trials (RCTs) evaluating the effectiveness of various pain management medications for acute pain after tooth extractions. Given the ongoing opioid crisis, especially in North America, and the dangers associated with opioids in dental practice, there is an urgent need to establish guidelines that reduce opioid dependence in favor of safer alternatives. This review, which incorporated data from 82 RCTs involving 9,095 participants, evaluated 10 analgesic treatments, including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. Study analysis focused on several primary outcomes, including pain relief, total pain relief (TOTPAR), cumulative pain intensity difference (SPID), overall efficacy, need for additional analgesia (rescue), and adverse events.
The findings showed that NSAIDs, particularly when combined with acetaminophen, were the most effective options for pain relief. A combination of ibuprofen (200–400 mg) with acetaminophen (500–1,000 mg) emerged as the most effective intervention, followed by acetaminophen (650 mg) with oxycodone (10 mg), ibuprofen (400 mg) alone, and naproxen (400–440 mg). These treatments consistently outperformed placebo on multiple measures, including scales of pain relief. However, opioids, specifically lower doses of oxycodone (5 mg) and codeine (60 mg), showed little or no advantage over placebo for pain relief, highlighting the limited role of these drugs in the management of postoperative dental pain.
The review looked further at side effects, finding that most treatments, especially non-opioid NSAIDs and acetaminophen options, did not cause more harm than placebo, based on low- and very-low-certainty evidence. However, opioid-containing medications were associated with a higher risk of side effects. This is consistent with previous research highlighting the safety and efficacy of NSAIDs and acetaminophen over opioids in the management of acute dental pain.
This research is relevant given the potential misuse and public health risks associated with opioids. The findings echo previous evidence suggesting that NSAIDs, alone or in combination with acetaminophen, provide adequate pain control while reducing the need for opioids. The American Dental Association (ADA), the ADA Science & Research Institute (ADASRI), and academic institutions in collaboration with the FDA commissioned this study as part of a larger effort to establish evidence-based guidelines for the management of acute dental pain. Current dental guidelines often lack reliable evidence, making this study essential to inform safer, more effective practices in the management of acute pain after dental procedures.
In conclusion, NSAIDs, particularly when combined with acetaminophen, are the preferred choice for pain management after tooth extractions, providing significant pain relief with fewer risks than opioids. As opioid abuse remains a critical issue, these data support a shift toward safer analgesics in dental care, highlighting the need for continued research into alternatives such as ibuprofen with hydrocodone or other non-opioid options. By prioritizing NSAIDs and minimizing opioid use, dentistry can better address pain while contributing to broader efforts to combat opioid abuse and addiction.
