11 February 2025

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School of Dentistry faculty and patients part of new study investigating opioid alternatives for post-surgical pain

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University of Michigan School of Dentistry faculty and patients participated in a new study that supports changes in how dentists and oral surgeons treat post-surgical pain.

The randomized clinical trial, led by the dental school at Rutgers University, followed about 1,800 patients who had surgeries to remove impacted third molars, also known as wisdom teeth. While opioids have long been prescribed to treat the pain associated with this type of surgery, the dangers of opioid addiction have become a national issue in the last decade. This study sought to determine if a combination of acetaminophen (such as Tylenol) and ibuprofen (such as Advil and Motrin) could control pain as well as the combination of the opioid hydrocodone (such as Vicodin) and acetaminophen.

The study found that patients who took the non-opioid combination experienced less pain, better sleep and higher satisfaction compared to those who received the opioid pain prescription.

The study has been accepted for publication in the Journal of the American Dental Association and was released in preprint form earlier this month. Dentists are among the leading prescribers of opioids, writing nearly 9 million opioid prescriptions in 2022. The study concludes: “Routine opioid prescribing after dental surgery is not supported. The results of this study confirmed the American Dental Association’s recommendations that ibuprofen and acetaminophen in combination should be the first-line therapy for acute pain management.”

The importance of the study centers on the addictive dangers of opioids, particularly among young adults, who frequently have wisdom teeth removed. The study cites research showing that young adults who receive opioid prescriptions are more likely than those who do not to eventually misuse opioids, contributing to an increase in deaths.

The study notes that unnecessary use of opioids to manage post-surgical pain is a significant contributor to the estimated 81,000 deaths per year caused by opioids in this country. “Finding effective analgesic alternatives to opioids is needed to quell the surge in opioid-related addiction and death,” the study states. “The belief that opioid analgesics are more effective than non-opioid alternatives influences patient requests for opioids and surgeon prescribing. Despite evidence to support the use of non-opioid alternatives, opioids are often prescribed by surgeons to preemptively address concerns about uncontrolled pain during the overnight and weekend hours when surgeons or follow-up care may not be readily available.”

Of the 1,800 patients in the study, 286 were treated at the U-M School of Dentistry from April 2021 through June 2023. In addition to Rutgers and U-M, other participating dental schools were at the University of Illinois at Chicago, the University of Maryland and the University of Rochester.

The U-M portion of the study was led by Dr. Brent Ward, the Chalmers J. Lyons Professor of Oral and Maxillofacial Surgery (OMS), Professor of Dentistry, and chair of the OMS/Hospital Dentistry Department at the time of the study. The surgeries were performed by OMS faculty and residents. As with patients across all study locations, patients were monitored post-surgery in several ways, including virtual interactive messaging and sleep-monitoring equipment, to gauge their pain levels, use of medication and sleeping patterns as they recovered.  Their high-tech pill bottles even sent signals to researchers to confirm the patients’ reports of when they took pills.

Ward said the findings validate what has been a growing discussion among healthcare providers about the need to reduce opioid prescriptions. “The American Dental Association had already come out strongly to encourage a reduction in opioids,” he said. “But a lot of times we may make statements but not have the data behind them. Now we have data. The data helps us to validate the discussion and allows us to look at this from a scientific perspective, not just an anecdotal recommendation.”

The study does not signal the end of prescribing opioids for post-surgery pain, Ward said, since some patients needed other pain relief than what worked for the large majority of oral surgery patients. Investigating why some patients, and perhaps certain types of surgery, require other pain medication will be examined more closely in the data from this study as well as in a follow-up genetics study currently underway. It could be that genetic markers might allow healthcare providers to better understand which patients need less pain medication and which need more. That distinction could ultimately allow for more precise prescribing and presumably less over-prescribing of opioids and other pain meds.

“This study was a good model that asked a good question, and it gave us a great answer from my perspective,” Ward said. “But like most good studies, you answer one question and you identify lots of new and interesting questions that you can explore moving forward.”

A summary of the findings is available on the website of Rutgers University.

The entire study, titled “Nonopioid vs. opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial,” is available on the website of the Journal of the American Dental Association.

Source: https://news.dent.umich.edu/