28 February 2023

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What is the most effective drug treatment to control tooth extraction pain?

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A study published Jan. 11, 2023, in the Journal of Dental Research (JDR) compared the effectiveness of 10 pharmacological interventions in developing guidelines for the management of acute pain after tooth extraction in adults.

North America is in the midst of an opioid crisis, which is a major public health and safety concern. In dentistry, many patients are prescribed opioids for the first time to manage acute postoperative pain after dental impaction surgery, often resulting in the prescription of an excessive amount of opioid pills, increasing the risk of misuse, abuse and addiction. Of more than half a million patient dental visits between 2011 and 2015, 29% of prescribed opioids exceeded the morphine equivalent recommended for the appropriate treatment of acute pain and more than half exceeded recommended supply days.

The study, led by Anna Miroshnychenko of McMaster University's School of Health Sciences and colleagues, involved a systematic review and a network meta-analysis to assess the comparative effectiveness of 10different pharmacological interventions for pain management following simple and surgical tooth extraction. and pain associated with pulpitis or its complications.

The systematic review was conducted to inform the 2022 evidence-based clinical practice guidelines produced by the American Dental Association (ADA) Council on Scientific Affairs, the ADA Research and Science Institute and the University of Pittsburgh and University of Pennsylvania schools of dentistry medicine in collaboration with the U.S. Food and Drug Administration for the treatment of acute dental pain.

The researchers concluded that, based on moderate- and high-certainty evidence, in individuals undergoing surgical tooth extractions, the interventions ranked as the most effective for pain relief were ibuprofen 200-400 mg plus acetaminophen 500-1,000 mg, acetaminophen 650 mg plus oxycodone 10 mg, ibuprofen 400 mg, and naproxen 400-440 mg.

In addition, NSAIDs with or without acetaminophen produce better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo. Future research should focus on the evaluation of 200 mg ibuprofen plus 5 mg hydrocodone, 5 mg hydrocodone plus 300-325 mg acetaminophen and 37.5 mg tramadol plus 325 mg acetaminophen through randomized clinical trials.

This article originally appeared on Odontologia33. 

A. Miroshnychenko et al. "Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis." Journal of Dental Research. (2023). DOI: 10.1177/00220345221139230