Opioids are not among the most effective—or longest lasting—options available for relief from acute dental pain, a new examination of the results from more than 460 published studies has found.
Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University.
The study examining relief of acute pain in dentistry—recently featured on the cover of The Journal of the American Dental Association—evaluated the safety and efficacy of dozens of pain-relief options.
“What we know is that prescribing narcotics should be a last resort,” said Anita Aminoshariae, an associate professor in the dental school’s Department of Endodontics and one of the study’s authors.
She cited the national opioid epidemic as one of many reasons why health-care providers should take note of the findings. Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health.
“No patient should go home in pain,” Aminoshariae said. “That means that opioids are sometimes the best option, but certainly should not be the first option.”
What we know about the opioid crisis
- 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
- 8 to 12 percent of opioid users develop a disorder.
- 4 to 6 percent who misuse prescription opioids transition to heroin.
- About 80 percent of heroin users first misused prescription opioids.
- Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.
- The Midwest region saw opioid overdoses increase 70 percent from July 2016 through September 2017.
- Opioid overdoses in large cities increase by 54 percent in 16 states.
Information from the National Institutes of Health
Aminoshariae said the goal of the systematic review was to summarize data—using five in-depth studies—of the effectiveness of oral-pain medications.
“The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events,” she said.
The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied.
“Our aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making,” Aminoshariae added.
The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effects—including drowsiness, respiratory depression, nausea/vomiting and constipation—in both children and adults.
Joining Aminoshariae in the research were: Paul Moore, a professor in the Departments of Dental Anesthesiology and Dental Public Health, School of Dental Medicine at the University of Pittsburgh; Kathleen Ziegler, a manager in Scientific Information, Science Institute, American Dental Association; Ruth Lipman, the director of Scientific Information, Science Institute, American Dental Association; Alonso Carrasco-Labra, the director, Center for Evidence Based Dentistry, Science Institute, American Dental Association; and Angelo Mariotti, the chair of the Division of Periodontology in the College of Dentistry at Ohio State University.
For more information, contact Colin McEwen at colin.mcewen@case.edu.
This article was originally published April 17, 2018.