Nonsteroidal anti-inflammatory drugs and opioids in postsurgical dental pain
Open accessAbstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Opioids may not be the best approach to managing inflammation-related acute dental pain.
“First, evidence suggests that opioids may not be the best approach to managing what is often inflammation-related acute dental pain.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [8]
The observed efficacy of NSAIDs on postoperative pain consecutive to surgical extraction(s) can be attributed to its nature, mainly driven by inflammation, with prostaglandins playing a key role.
“The observed efficacy of NSAIDs on postoperative pain consecutive to surgical extraction(s) can be attributed to its nature, mainly driven by inflammation, with prostaglandins playing a key role.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [8]
NSAIDs target the source of inflammation-related acute dental pain, whereas opioids do not.
“Nonsteroidal anti-inflammatory drugs (NSAIDs) would target the source of the pain, whereas opioids would not.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [8]
Cites
Pain regulation by non-neuronal cells and inflammation
Ji, R.-R., Chamessian, A., & Zhang, Y.-Q. (2016) · Science · doi:10.1126/science.aaf8924 · Cited by 1,314 · see citing works
Relationship between Nonmedical Prescription-Opioid Use and Heroin Use
Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1508490 · Cited by 1,044 · see citing works
Colvin, L., Bull, F. A., & Hales, T. G. (2019) · The Lancet · doi:10.1016/s0140-6736(19)30430-1 · Cited by 565 · see citing works
Stein, C. (2015) · Annual Review of Medicine · doi:10.1146/annurev-med-062613-093100 · Cited by 493 · see citing works
Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews
Moore, R. A., Derry, S., Aldington, D., & Wiffen, P. J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008659.pub3 · Cited by 258 · see citing works
ARONOFF, D., OATES, J., & BOUTAUD, O. (2006) · Clinical Pharmacology & Therapeutics · doi:10.1016/j.clpt.2005.09.009 · Cited by 222 · see citing works
Schroeder, A. R., Dehghan, M., Newman, T. B., Bentley, J. P., & Park, K. T. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.5419 · Cited by 216 · see citing works
Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions
Moore, P. A., & Hersh, E. V. (2013) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2013.0207 · Cited by 215 · see citing works
Self-citationMaughan, B. C., Hersh, E. V., Shofer, F. S., Wanner, K. J., Archer, E., Carrasco, L., & Rhodes, K. V. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.08.016 · Cited by 202 · see citing works
Self-citationAdverse drug interactions involving common prescription and over-the-counter analgesic agents
Hersh, E. V., Pinto, A., & Moore, P. A. (2007) · Clinical Therapeutics · doi:10.1016/j.clinthera.2007.12.003 · Cited by 183 · see citing works
Self-citationBenefits and harms associated with analgesic medications used in the management of acute dental pain
Moore, P. A., Ziegler, K. M., Lipman, R. D., Aminoshariae, A., Carrasco‐Labra, A., & Mariotti, A. J. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.02.012 · Cited by 162 · see citing works
Self-citationOpioid receptor subtypes: fact or artifact?
Dietis, N., Rowbotham, D. J., & Lambert, D. G. (2011) · British Journal of Anaesthesia · doi:10.1093/bja/aer115 · Cited by 156 · see citing works
Benarroch, E. E. (2012) · Neurology · doi:10.1212/wnl.0b013e3182662098 · Cited by 152 · see citing works
Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars
Dionne, R. A., & Cooper, S. A. (1978) · Oral Surgery Oral Medicine Oral Pathology · doi:10.1016/s0030-4220(78)80004-8 · Cited by 145 · see citing works
Five Studies on Ibuprofen for Postsurgical Dental Pain
Cooper, S. A. (1984) · The American Journal of Medicine · doi:10.1016/s0002-9343(84)80022-4 · Cited by 138 · see citing works
The Changing Face of Teenage Drug Abuse — The Trend toward Prescription Drugs
Friedman, R. A. (2006) · New England Journal of Medicine · doi:10.1056/nejmp068010 · Cited by 133 · see citing works
Relative efficacy of oral analgesics after third molar extraction
Barden, J., Edwards, J. E., McQuay, H. J., Wiffen, P. J., & Moore, A. (2004) · BDJ · doi:10.1038/sj.bdj.4811721 · Cited by 125 · see citing works
Prevention of prescription opioid abuse
Denisco, R. C., Kenna, G. A., O’Neil, M. G., Kulich, R. J., Moore, P. A., Kane, W. T., Mehta, N. R., Hersh, E. V., & Katz, N. P. (2011) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2011.0268 · Cited by 123 · see citing works
Self-citationAnalgesic Efficacy of an Ibuprofen‐Codeine Combination
Cooper, S. A., Engel, J., Ladov, M., Precheur, H. V., Rosenheck, A., & Rauch, D. (1982) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/j.1875-9114.1982.tb04528.x · Cited by 117 · see citing works
Prostanoids and inflammatory pain.
Chen, L.-H., Yang, G.-R., & Grosser, T. (2013) · Prostaglandins & other lipid mediators · doi:10.1016/j.prostaglandins.2012.08.006 · Cited by 117 · see citing works
Self-citationGordon, S. M., Brahim, J. S., Rowan, J. S., et al. (2002) · Clinical Pharmacology & Therapeutics · doi:10.1067/mcp.2002.126501 · Cited by 116 · see citing works
Roszkowski, M. T., Swift, J. Q., & Hargreaves, K. (1997) · Pain · doi:10.1016/s0304-3959(97)00120-6 · Cited by 113 · see citing works
Vane, J. R., & Botting, R. M. (1995) · PubMed · Cited by 105 · see citing works
Comparative analgesic potency of aspirin and ibuprofen.
Cooper, S., Needle, S. E., & Kruger, G. O. (1977) · PubMed · Cited by 100 · see citing works
Kleinert, R., Lange, C., Steup, A., Black, P., Goldberg, J., & Desjardins, P. J. (2008) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31818881ca · Cited by 98 · see citing works
Cooper, S. A., Schachtel, B. P., Goldman, E., Gelb, S., & Cohn, P. D. (1989) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.1989.tb03273.x · Cited by 98 · see citing works
Mehlisch, D. R., Aspley, S., Daniels, S. E., & Bandy, D. P. (2010) · Clinical Therapeutics · doi:10.1016/j.clinthera.2010.04.022 · Cited by 95 · see citing works
Rasubala, L., Pernapati, L., Velasquez, X., Burk, J., & Ren, Y.-F. (2015) · PLoS ONE · doi:10.1371/journal.pone.0135957 · Cited by 91 · see citing works
Update on cyclooxygenase inhibitors: has a third COX isoform entered the fray?
Hersh, E. V., Lally, E. T., & Moore, P. A. (2005) · Current Medical Research and Opinion · doi:10.1185/030079905x56367 · Cited by 89 · see citing works
Self-citationDaniels, S. E., Goulder, M. A., Aspley, S., & Reader, S. (2011) · Pain · doi:10.1016/j.pain.2010.12.012 · Cited by 87 · see citing works
Opioid prescribing practices from 2010 through 2015 among dentists in the United States
Gupta, N., Vujicic, M., & Blatz, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.01.005 · Cited by 84 · see citing works
Evaluation of oxycodone and acetaminophen in treatment of postoperative dental pain
Cooper, S. A., Precheur, H., Rauch, D., Rosenheck, A., Ladov, M., & Engel, J. (1980) · Oral Surgery, Oral Medicine, Oral Pathology · doi:10.1016/0030-4220(80)90430-2 · Cited by 83 · see citing works
Ibuprofen liquigel for oral surgery pain
Hersh, E. V., Levin, L. M., Cooper, S. A., et al. (2000) · Clinical Therapeutics · doi:10.1016/s0149-2918(00)83027-1 · Cited by 76 · see citing works
Self-citationCyclooxygenase Inhibition: Pain, Inflammation, and the Cardiovascular System
Großer, T., Theken, K. N., & FitzGerald, G. A. (2017) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.794 · Cited by 75 · see citing works
Self-citationMoore, A., Derry, S., Aldington, D. J., & Wiffen, P. J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011407.pub2 · Cited by 74 · see citing works
Suppression of dental pain by the preoperative administration of flurbiprofen
Dionne, R. A. (1986) · The American Journal of Medicine · doi:10.1016/0002-9343(86)90110-5 · Cited by 69 · see citing works
Gordon, S. M., Brahim, J. S., Dubner, R. A., et al. (2002) · Anesthesia & Analgesia · doi:10.1097/00000539-200211000-00047 · Cited by 69 · see citing works
Kiersch, T. A., Halladay, S. C., & Hormel, P. C. (1994) · PubMed · Cited by 64 · see citing works
Dental therapeutic practice patterns in the U.S. II. Analgesics, corticosteroids, and antibiotics.
Moore, P. A., Nahouraii, H. S., Zovko, J., et al. (2006) · PubMed · Cited by 63 · see citing works
Self-citationHersh, E. V., Cooper, S. A., Betts, N. J., et al. (1993) · Oral Surgery Oral Medicine Oral Pathology · doi:10.1016/0030-4220(93)90034-2 · Cited by 62 · see citing works
Self-citationThe Safety Profile of Nonprescription Ibuprofen in Multiple‐Dose Use: A Meta‐Analysis
Kellstein, D. E., Waksman, J. A., Furey, S. A., et al. (1999) · The Journal of Clinical Pharmacology · doi:10.1177/009127009903900513 · Cited by 60 · see citing works
Dyke, T. E. V., Litkowski, L. J., Kiersch, T. A., Zarringhalam, N. M., Zheng, H., & Newman, K. (2004) · Clinical Therapeutics · doi:10.1016/j.clinthera.2004.12.002 · Cited by 59 · see citing works
Dose-ranging analgesic study of prosorb® diclofenac potassium in postsurgical dental pain
Hersh, E. V., Levin, L. M., Adamson, D., et al. (2004) · Clinical Therapeutics · doi:10.1016/s0149-2918(04)80033-x · Cited by 58 · see citing works
Self-citationLiposomal Bupivacaine Use in Third Molar Impaction Surgery: INNOVATE Study
Lieblich, S. E., & Danesi, H. (2017) · Anesthesia Progress · doi:10.2344/anpr-64-02-03 · Cited by 41 · see citing works
Moore, P. A., Crout, R. J., Jackson, D. L., Schneider, L. G., Graves, R. W., & Lh, B. (1998) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.1998.tb05794.x · Cited by 39 · see citing works
Self-citationOpioid Analgesics and Antagonists
Raffa, R. B., Ossipov, M. H., & Porreca, F. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-39307-2.00016-3 · Cited by 39 · see citing works
Ketoprofen in Oral Surgery Pain: A Review
Cooper, S. A. (1988) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.1988.tb05976.x · Cited by 38 · see citing works
Dionne, R. A., Snyder, J., & Hargreaves, K. (1994) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/s0278-2391(10)80068-0 · Cited by 36 · see citing works
Variability in analgesic response to non-steroidal anti-inflammatory drugs
Theken, K. N. (2018) · Prostaglandins & Other Lipid Mediators · doi:10.1016/j.prostaglandins.2018.10.005 · Cited by 36 · see citing works
Self-citationTheken, K. N., Hersh, E. V., Lahens, N. F., Lee, H. M., Li, X., Granquist, E. J., Giannakopoulos, H. E., Levin, L. M., Secreto, S. A., Grant, G. R., et al. (2019) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.1446 · Cited by 35 · see citing works
Self-citationRelative efficacy of oral analgesics after third molar extraction – a 2011 update
Derry, S., Wiffen, P. J., & Moore, R. A. (2011) · BDJ · doi:10.1038/sj.bdj.2011.905 · Cited by 33 · see citing works
A Look at the Safety Profile of Over‐the‐Counter Naproxen Sodium: A Meta‐analysis
Bansal, V., DEX, T. A., Proskin, H. M., et al. (2001) · The Journal of Clinical Pharmacology · doi:10.1177/00912700122009935 · Cited by 31 · see citing works
Multiple opioid prescriptions among privately insured dental patients in the United States
Gupta, N., Vujicic, M., & Blatz, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.02.025 · Cited by 30 · see citing works
Onset of Analgesia and Efficacy of Ibuprofen Sodium in Postsurgical Dental Pain
Brain, P., Leyva, R., Doyle, G., et al. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000142 · Cited by 28 · see citing works
Moore, P. A., Dionne, R. A., Cooper, S. A., & Hersh, E. V. (2016) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2016.05.005 · Cited by 28 · see citing works
Self-citationForbes, J. A., Kolodny, A., Beaver, W. T., et al. (1983) · PubMed · Cited by 25 · see citing works
Forbes, J. A., Kolodny, A., Beaver, W. T., et al. (1983) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1983.3.2p2.47 · Cited by 23 · see citing works
Comparison of etodolac, zomepirac, and placebo for relief of pain after oral surgery
Giglio, J. A., & Campbell, R. L. (1986) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/0278-2391(86)90150-3 · Cited by 18 · see citing works
Three Serious Drug Interactions that Every Dentist Should Know About.
Hersh, E. V., & Moore, P. A. (2015) · PubMed · Cited by 16 · see citing works
Self-citationDouble‐Blind, Single‐Dose Comparison of Bromfenac Sodium, Tramadol, and Placebo after Oral Surgery
Mehlisch, D. R. (1998) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.1998.tb04453.x · Cited by 10 · see citing works
Zuniga, J. R., Papas, A., Daniels, S. E., et al. (2018) · Pain Medicine · doi:10.1093/pm/pny294 · Cited by 4 · see citing works
The prescription opioid abuse crisis and our role in it.
Hersh, E. V., Saraghi, M., & Moore, P. A. (2019) · PubMed · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Dhar, V., Dionne, R. A., Espinoza, L., Gordon, S. M., Hersh, E. V., et al. (2024) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2023.10.009 · Cited by 62 · see citing works
Self-citationDistribution of opioid prescribing and high-risk prescribing among U.S. dentists in 2019
Chua, K.-P., Waljee, J. F., Gunaseelan, V., Nalliah, R. P., & Brummett, C. M. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.09.017 · Cited by 19 · see citing works
- Authors
- 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.
- Affiliations
- University of Pennsylvania (US)
- University of Pittsburgh (US)
- Jacobi Medical Center (US)
- Drexel University (US)
- Corresponding author
- Hersh, E.V.
- ORCID
- Venue
- Journal of Dental Research
- Publisher
- SAGE Publications
- Published
- 2020-04-14
- Volume
- 99
- Issue
- 7
- Pages
- 777-786
- ISSN
- 0022-0345 (ISSN-L)
- 1544-0591
- PMC
- PMC7313348
- OpenAlex
- W3015888304
- Cited by
- 106
- References
- 62
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 29 · 2023: 26 · 2022: 11 · 2021: 10 · 2020: 5
- FWCI
- 11.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Dental Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scholarly Commons (University of Pennsylvania) (submittedVersion)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- Funders
- perelman school of medicine, university of pennsylvania (Penn Center for Precision Medicine: Toward Predicting the Analgesic Response of Ibuprofen)
- health resources and services administration (University of Pittsburgh School of Dental Medicine)
- National Institute on Drug Abuse (“University of Pennsylvania Center for Excellence”)
- Topics
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Keywords
- nonsteroidal anti-inflammatory drugs, opioids, impacted third molar extraction, ibuprofen, naproxen, ketorolac, diclofenac, etodolac, paracetamol, analgesic combination therapy, opioid side effects, cyclooxygenase, prostaglandins, inflammatory pain
- MeSH terms
- Analgesics, Opioid, Anti-Inflammatory Agents, Non-Steroidal, Diclofenac, Pharmaceutical Preparations, Humans, Pain, Postoperative, Postoperative Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
