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.
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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]
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- 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
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