Relieving Pain After Tooth Extraction: Which Drug is Effective?

Of over half a million dental patient visits between 2011 and 2015, 29% of prescribed opioids exceeded the recommended morphine equivalent for appropriate management of acute pain, and over half exceeded the recommended days of supply.

The current clinical practice guidelines lack evidence-based guidance on the effective management of acute dental pain. This recent report highlighted the need to formalize evidence-based alternatives to opioid analgesics in a clinical practice guideline.

What is the Drug of Choice for Pain After Tooth Extraction?

The study involved systematic review (SR) and network meta-analysis (NMA) to assess the comparative effectiveness of ten different pharmacological interventions for the management of pain after simple and surgical tooth extraction, and pain associated with pulpitis or its complications.


The study concluded that, based on moderate and high certainty evidence, in individuals undergoing surgical tooth extractions, the interventions classified as the most effective for pain relief were ibuprofen 200-400 mg plus acetaminophen 500-1,000 mg, acetaminophen 650 mg plus oxycodone 10 mg, ibuprofen 400 mg, and naproxen 400-440 mg.

Further, NSAIDs with or without acetaminophen result in better pain-related outcomes than opioids with or without acetaminophen (except acetaminophen 650 mg plus oxycodone 10 mg) or placebo.

Future research should focus on the assessment of ibuprofen 200 mg plus hydrocodone 5 mg, hydrocodone 5 mg plus acetaminophen 300-325 mg, and tramadol 37.5 mg plus acetaminophen 325 mg through randomized clinical trials.

Source: Eurekalert

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