Opioid Analgesics vs. Non-Opioid Analgesics For Post-Extraction Dental Pain 

A recent study, published in March 2020 in JAMA Network Open, sought to understand the differences in patient-reported outcomes between patients who used opioids and those who did not use opioids after dental procedures, in an effort to encourage the adoption of more conservative and appropriate prescribing practices in dentistry.

The study was conducted in the 14 dental clinics of the University of Michigan School of Dentistry and measured data from 329 adult patients, who had either a surgical (155 patients) or a routine (174 patients) extraction. Patients were surveyed about the type of extraction, use of opioid analgesics, use of non-opioid analgesics, pain levels, and overall satisfaction.
80 patients (51.6%) who had a surgical extraction and 68 (39.1%) who had a routine extraction reported that they used opioids after their procedure. In the surgical extraction group, 51 patients (64.6%) who used opioids reported moderate to severe pain, while only 34 patients (45.3%) who did not use opioids reported the same pain levels. In the routine extraction group, 44 patients (64.8%) who used opioids reported moderate to severe pain, while only 35 patients (33.0%) who did not use opioids also reported moderate to severe pain.

Thus, the study found that patients who used opioids for pain relief after tooth extraction reported significantly higher levels of pain as compared with patients who took other analgesics. However, the researchers found no statistically significant difference in overall patient satisfaction.

While the authors concluded that these findings would suggest non-opioid analgesics should be first-line for post-extraction pain relief, they did acknowledge inherent limitations in a retrospective study in which opioid prescribing was not randomized and in which patients were required to subjectively recall pain perception, satisfaction, and opioid use.

Nalliah, Romesh P., et al. “Association of Opioid Use With Pain and Satisfaction After Dental Extraction.” JAMA Network Open, vol. 3, no. 3, 2020, doi:10.1001/jamanetworkopen.2020.0901.

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