Provider-directed analgesia for dental pain

ABSTRACT

Introduction

Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry.

Areas covered

This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain.

Expert opinion

Substantial evidence-based literature shows a combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) where a short-course opioid prescription is appropriate in select patients, for which a 2–3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.

KEYWORDS:

• Acetaminophen
• analgesia
• dental pain
• gabapentin
• ibuprofen
• non-steroidal anti-inflammatory drugs
• opioids
• third molar extraction

Article highlights

• Surgical extraction of impacted third molars is a frequent procedure conducted by dentists, and a common postoperative complication is acute pain that is often treated with a single agent or combination of analgesics.

• Here, we discuss the clinical pharmacology of established, alternative, and emerging therapies for treating acute postoperative dental pain.

• Evidence-based literature suggests that a combination of a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, and acetaminophen performs superior to either agent alone or opioid combinations in the third molar impaction pain model.

• Opioid prescribing following third molar extractions has come under intense scrutiny in lieu of the current opioid epidemic, with judicious use recommended for only several days of therapy in a select patient population.

• Alternative treatments for acute postoperative dental pain continue to be evaluated, with the majority of studies reporting at least some degree of clinical efficacy with the gabapentinoids, caffeine, low-dose local ketamine, phytotherapies, and low-level laser therapy.

• The administration of preemptive therapies (e.g. NSAIDs, corticosteroids) prior to molar teeth extractions can reduce post-surgery analgesic consumption and potentially lessen the need for opioid-based therapies.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that over the last 5 years their institution has received grant funding from Bayer Pharmaceuticals for studying the analgesic efficacy and effects on inflammatory biomarkers of naproxen sodium and acetaminophen after dental implant surgery. They also declare that their institution has received grant funding from the American Association of Oral and Maxillofacial Surgeons for a study looking at biomarkers that effect individual variability in the analgesic response to ibuprofen. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.