Pain relief without opioids was shown to be more effective after wisdom teeth removal

A combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) controls pain after wisdom teeth removal better than opioids, according to a Rutgers Health study that could change the way dentists treat postoperative pain.

The trial of more than 1,800 patients found that those who received a combination of ibuprofen and acetaminophen experienced less pain, better sleep and greater satisfaction compared to those who received the opioid hydrocodone with acetaminophen.

We believe this is a landmark study. The results were actually even stronger than we thought.”

Cecile Feldman, dean of Rutgers School of Dentistry and lead author of the study

Dentists, who rank among the nation’s top opioid prescribers, wrote more than 8.9 million opioid prescriptions in 2022. For many young adults, dental procedures such as wisdom tooth extractions are their first exposure to opioid medications.

“There are studies out there that show that when young people are introduced to opioids, there is an increased likelihood that they will use them again and then it can lead to addiction,” said co-researcher Janine Fredericks-Younger. , adding that opioid overdoses kill more than 80,000 Americans each year.

To compare pain relief with opioids and non-opioids, researchers conducted a randomized trial in patients undergoing surgical removal of impacted wisdom teeth, a common procedure that typically causes moderate to severe pain.

Half the patients received hydrocodone with acetaminophen. The other half took a combination of acetaminophen and ibuprofen. Patients rated pain levels and other outcomes, such as sleep quality, during the week after surgery.

Results in The Journal of American Dental Association showed that the non-opioid combination provided superior pain relief during the peak pain period at two days after surgery. Patients who received the non-opioid drugs also reported better sleep quality on the first night and less interference with daily activities during recovery.

Patients who received the over-the-counter combination were only half as likely as opioid patients to need additional “rescue” painkillers. They also reported higher overall satisfaction with their pain treatment.

“We feel pretty confident in saying that opioids should not be routinely prescribed, and that if dentists prescribe the opioid-free combination, their patients will be much better off,” Feldman said.

The size and design of the study make it particularly noteworthy. With more than 1,800 participants at five clinical sites, it is one of the largest studies of its kind. It also aimed to reflect real-world drug use rather than the tightly controlled conditions of many smaller pain studies.

“We looked at efficacy — so how it works in real life, taking into account what people really care about,” Feldman said, referring to the study’s focus on sleep quality and ability to return to work.

The findings align with the American Dental Association’s recent recommendations to avoid opioids as first-line pain treatment. Feldman said she hopes they will change prescribing practices.

“For a while now, we’ve been talking about not needing to prescribe opioids,” Feldman said. “The results of this study are such that there is no reason to prescribe opioids unless you are dealing with these special conditions, such as medical conditions that prevent the use of ibuprofen or acetaminophen.”

The research team members said they hope to expand their work to other dental procedures and pain scenarios. Other researchers at the school are testing cannabinoids to manage dental pain.

“These studies not only guide us in how to improve current dental care,” said Feldman, “but also in how we can better train future dentists here at Rutgers, where we continually improve our curriculum in light of of science”.

The Opioid Analgesic Reduction Study was funded by the National Institute of Dental and Craniofacial Research of the National Institutes of Health.