More than 8.9 million opioid prescriptions were issued by dentists in 2022. Wisdom tooth extractions are often the first opioid exposure for young adults. Time to rethink pain management!
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) act better together to reduce pain following wisdom tooth extraction than opioids, which may alter how dentists manage pain following surgery.
The non-opioid combination provided greater relief from pain during the two days following surgery when the pain was at its worst(1✔ ✔Trusted Source
Nonopioid vs opioid analgesics after impacted third-molar extractions
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More than 1,800 patients participated in the trial, and those who received ibuprofen and acetaminophen reported better sleep, less discomfort, and greater pleasure than those who had
An extraction of a wisdom tooth is often the first time a young adult is exposed to opioid drugs. More than 8.9 million opioid prescriptions were issued by dentists in 2022, making them one of the country’s top prescribers of the drug.
Superior Pain Relief Without Addiction Risks
“We think this is a landmark study,” said Cecile Feldman, dean of Rutgers School of Dental Medicine and lead author of the study. “The results came in even stronger than we thought they would.”
“There are studies out there to show that when young people get introduced to opioids, there’s an increased likelihood that they’re going to eventually use them again, and then it can lead to addiction,” said study co-investigator Janine Fredericks-Younger, adding that opioid overdoses kill more than 80,000 Americans each year.
To compare opioid and non-opioid pain relief, the researchers conducted a randomized trial on patients undergoing surgical removal of impacted wisdom teeth, a common procedure that typically causes moderate to severe pain.
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Half the patients received hydrocodone with acetaminophen. The other half got a combination of acetaminophen and ibuprofen. Patients rated their pain levels and other outcomes, such as sleep quality, over the week following surgery.
Results in The Journal of American Dental Association showed the non-opioid combination provided superior pain relief during the peak-pain period in the two days after surgery. Patients taking the non-opioid medications also reported better sleep quality on the first night and less interference with daily activities throughout recovery.
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Over-The-Counter Medications Deliver Better Pain Relief
Patients who received the over-the-counter combo were only half as likely as the opioid patients to require additional “rescue” pain medication. They also reported higher overall satisfaction with their pain treatment.
“We feel pretty confident in saying that opioids should not be prescribed routinely and that if dentists prescribe the non-opioid combination, their patients are going to be a lot better off,” Feldman said.
The study’s size and design make it particularly notable. With more than 1,800 participants across five clinical sites, it’s one of the largest studies of its kind. It also aimed to reflect real-world medication use rather than the tightly controlled conditions of many smaller pain studies.
“We were looking at the effectiveness – so how does it work in real life, taking into account what people care about,” said Feldman, referring to the study’s focus on sleep quality and the ability to return to work.
The findings align with recent recommendations from the American Dental Association to avoid opioids as first-line pain treatment. Feldman said she hopes they will change prescribing practices.
“For a while, we’ve been talking about not needing to prescribe opioids,” Feldman said. “This study’s results are such that there is no reason to be prescribing opioids unless you’ve got those special situations, like medical conditions preventing the use of ibuprofen or acetaminophen.”
Members of the research team said they hope to expand their work to other dental procedures and pain scenarios. Other researchers at the school are testing cannabinoids for managing dental pain.
“These studies not only guide us on how to improve current dental care,” said Feldman, “but also on how we can better train future dentists here at Rutgers, where we constantly refine our curriculum the light of science.”
Reference:
- Nonopioid vs opioid analgesics after impacted third-molar extractions- (https:linkinghub.elsevier.com/retrieve/pii/S0002817724006391)
Source-Eurekalert
