Departmental Papers (Dental)
Date of this Version
Journal of Dental Research
Postsurgical dental pain is mainly driven by inflammation, particularly through the generation of prostaglandins via the cyclooxygenase system. Thus, it is no surprise that numerous randomized placebo-controlled trials studying acute pain following the surgical extraction of impacted third molars have demonstrated the remarkable efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium, etodolac, diclofenac, and ketorolac in this prototypic condition of acute inflammatory pain. Combining an optimal dose of an NSAID with an appropriate dose of acetaminophen appears to further enhance analgesic efficacy and potentially reduce the need for opioids. In addition to being on average inferior to NSAIDs as analgesics in postsurgical dental pain, opioids produce a higher incidence of side effects in dental outpatients, including dizziness, drowsiness, psychomotor impairment, nausea/vomiting, and constipation. Unused opioids are also subject to misuse and diversion, and they may cause addiction. Despite these risks, some dental surgical outpatients may benefit from a 1- or 2-d course of opioids added to their NSAID regimen. NSAID use may carry significant risks in certain patient populations, in which a short course of an acetaminophen/opioid combination may provide a more favorable benefit versus risk ratio than an NSAID regimen. © International & American Associations for Dental Research 2020.
acute pain, analgesics, inflammation, opioid abuse, prostaglandins, randomized controlled clinical trials, Analgesics, Opioid, Anti-Inflammatory Agents, Non-Steroidal, Diclofenac, Humans, Pain, Postoperative, Pharmaceutical Preparations, diclofenac, drug, narcotic analgesic agent, nonsteroid antiinflammatory agent, human, postoperative pain
Hersh, E. V., Moore, P. A., Grosser, T., Polomano, R. C., Farrar, J. T., Saraghi, M., Juska, S. A., Mitchell, C. H., & Theken, K. N. (2020). Nonsteroidal Anti-Inflammatory Drugs and Opioids in Postsurgical Dental Pain. Journal of Dental Research, 99 (7), 777-786. http://dx.doi.org/10.1177/0022034520914254
Dental Materials Commons, Oral and Maxillofacial Surgery Commons, Oral Biology and Oral Pathology Commons
Date Posted: 10 February 2023
This document has been peer reviewed.