NSAIDs and Acetaminophen Preferred Over Opioids for Dental Pain Save

A systematic review in the Journal of the American Dental Association evaluated the safety and efficacy of analgesics and foundp opioids less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen when treating dental pain.

A metanalysis narrowed down to 5 eligible studies, 2 included a pediatric population. The data suggests that NSAIDs, with or without acetaminophen, offers the best efficacy and safety, especially when compared to opioids. This is for magnitude and duration of pain relief.

Medication and medication combinations with the longest duration of action, meaning that they had the longest time before rescue remedication was requested, was 10.9 hours for 1,000 mg of diflunisal, 9.9 hours for 650 mg of acetaminophen and 10 mg of oxycodone, 9.8 hours for 500 mg of diflunisal, and 8.9 hours for 500 to 550 mg of naproxen. The medications and medication combinations that provided the shortest duration of pain relief were 3.5 hours for 600 to 650 mg of acetaminophen, 3.1 hours for 25 mg of diclofenac potassium, 2.7 hours for 60 mg of codeine, and 2.4 hours for 250 mg of gabapentin.

By contrast studies show that opioids or opioid drug combinations had more acute adverse side effects--including drowsiness, respiratory depression, nausea/vomiting and constipation--in both children and adults.

From a risk: benefit perspective, these data make it hard to justify the use of opioids as first line analgesia for dental pain and procedures. Nonsteroidal anti-inflammatory drugs, with or without acetaminophen, is equal or superior to that provided by opioid-containing medications.