Evidence-based Comparisons of Opioid and NSAID Analgesics for Post-operative Dental Pain

Safe and effective pain management is an essential goal of compassionate, responsible dental care. While opioid prescriptions to control pain associated with dental visits are common place, studies have shown that non-steroidal, anti-inflammatory drugs (NSAIDs) are effective in managing pain with significantly fewer adverse effects compared with opioid pain medication.^71-73 A recent study demonstrated that the combination of acetaminophen and ibuprofen taken at regular intervals has proven to be more effective than opioids with fewer adverse effects following third-molar extractions.⁷⁴ It has also been noted that pre-emptive and preventative NSAIDs can reduce both patient pain perception and post-operative opioid consumption.⁷⁵ In particular, minor and outpatient surgical procedures demonstrated more benefit to pre-emptive NSAID delivery.⁷⁵ Given these findings, it has been established that opioid pain medications should not be considered first-line therapy for dental pain.⁷⁶ Preprocedural dosing with NSAIDs and utilization of optimal dosages of NSAIDs at regular time intervals has been proven effective for pain management without many of the adverse side effects seen with opioid medications.^75,77 Opioids may be considered if pain persists after optimal NSAID dosages have been achieved.^77,78