A recent study has compared the effectiveness of ten pharmacological interventions. Based on their findings, the authors aim to develop guidelines for acute pain management after tooth extraction in adults.
North America is amid an opioid crisis, a leading 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, which often results in prescription of an excess number of opioid pills, thereby increasing the risk of misuse, abuse, and addiction. Of over half a million dental patient visits between 2011 and 2015, 29 % of prescribed opioids exceeded the recommended morphine equivalent for appropriate management of acute pain and over half exceeded the recommended days of supply.
The current clinical practice guidelines lack evidence-based guidance on effective management of acute dental pain. The National Academies’ report entitled “Framing Opioid Prescribing Guidelines for Acute Pain”, highlighted the need to formalize evidence-based alternatives to opioid analgesics in a clinical practice guideline.
The study by Anna Miroshnychenko from McMaster University Faculty of Health Sciences and colleagues involved systematic review (SR) and network meta-analysis (NMA) to assess the comparative effectiveness of ten different pharmacological interventions for the management of pain subsequent to simple and surgical tooth extraction, and pain associated with pulpitis or its complications. This SR was conducted to inform the 2022 evidence-based clinical practice guidelines for the management of acute dental pain.
The study concluded that, based on moderate and high certainty evidence, in individuals undergoing surgical tooth extractions, the interventions classified 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. Further, NSAIDs with or without acetaminophen result in 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 assessment of ibuprofen 200 mg plus hydrocodone 5 mg, hydrocodone 5 mg plus acetaminophen 300-325 mg and tramadol 37.5 mg plus acetaminophen 325 mg through randomized clinical trials.
This article is based on a press release by the International Association for Dental Research. You can find the original publication here and by following the link in our text.
Image source: Kev Bation, Unsplash
