2024 Top Story in Clinical Dentistry: The Recommended Analgesics Dentists Should Prescribe to Manage Dental Pain

Dental pain caused by oral diseases or dental procedures is a significant concern for our patients. Analgesics are the most common medications prescribed by dentists. Opioid analgesics were frequently prescribed because many dentists believed opioids were more effective than other analgesics. Once patients take opioids for a certain period, they may experience physical dependence and tolerance to opioids. Some patients may even have problems with opioid abuse and addiction. Although dentists may not prescribe opioids for the long-term, some individuals may visit dentists to obtain opioid prescriptions for abuse or addiction.

Recently, mounting evidence showed that NSAIDs or acetaminophen are more effective than opioids in dental pain management. However, the prescription of opioids by dentists is still common. It was critical that the American Dental Association Science and Research Institute and other institutions formed a panel to conduct systematic reviews and meta-analyses and formulate evidence-based recommendations for the pharmacologic management of acute dental pain after extractions and toothache associated with pulp and periapical diseases in adolescents, adults, and older adults.¹

Overall, the evidence indicates that nonopioid medications are more beneficial than opioid medications. NSAIDs, whether used alone or in combination with acetaminophen (eg, 400 mg of ibuprofen or 440 mg of naproxen sodium alone or in combination with 500 mg of acetaminophen), likely offer better pain relief and a better safety profile than opioids. It is recommended that the use of opioids should be reserved for clinical situations when the first-line therapy (NSAIDs or acetaminophen) is insufficient to reduce pain intensity or there is a contraindication for use.

Clinicians should refrain from routinely prescribing “just-in-case” opioids and exercise significant caution when prescribing them to adolescents and young adults. Governments and dental associations should promote this guideline and increase the use of prescription drug–monitoring programs to reduce unnecessary prescriptions of opioids.