According to a review of more than 460 previous studies, ibuprofen and other nonsteroidal anti-inflammatory drugs alone or in combination with paracetamol (acetaminophen) are better at easing dental pain.
Opioid medication and medication combinations are not among the most effective or long lasting of the options available for relief of acute dental pain. Image credit: Wonderlane / Alan Carr / CC BY 2.0.
“What we know is that prescribing narcotics should be a last resort,” said study co-author Dr. Anita Aminoshariae, from the Department of Endodontics in the School of Dental Medicine at Case Western Reserve University.
According to the National Institutes of Health, each day, more than 115 Americans die as a result of an opioid overdose.
“No patient should go home in pain. That means that opioids are sometimes the best option, but certainly should not be the first option,” Dr. Aminoshariae said.
“The goal of the systematic review was to summarize data — using five in-depth studies — of the effectiveness of oral-pain medications.”
“The best available data suggests that the use of nonsteroidal medications, with or without paracetamol, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.”
“The national opioid epidemic is one of many reasons why health-care providers should take note of the findings.”
The scientists found that, for adults, a combination of 400 mg of ibuprofen and 1,000 mg of paracetamol was superior to any opioid-containing medications studied.
They also found that opioids or drug combinations that included opioids accounted for the most adverse side effects — including drowsiness, respiratory depression, nausea/vomiting and constipation — in both children and adults.
“Our aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making,” Dr. Aminoshariae said.
The review paper was published in the April 2018 issue of the Journal of the American Dental Association.
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Paul A. Moore et al. 2018. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. Journal of the American Dental Association 149 (4): 256-265; doi: 10.1016/j.adaj.2018.02.012
