UMEM Educational Pearls

Category: Misc

Title: Acute Pain Management in Dental Pain

Keywords: dental pain, ibuprofen, acetaminophen (PubMed Search)

Posted: 4/6/2018 by Michael Bond, MD (Emailed: 4/7/2018)
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Takeaways

Bottom Line:
 
A recent review in the Journal of the American Dental Association found that Ibuprofen 400mg plus acetaminophen 1000mg was the best regimen for the relief of postoperative dental pain when compared to any opioid-containing regimen.

In-Depth

The Details:
 
This was a systematic review that ultimately found 5 articles that were included. Maximum pain relief was associated with combination of ibuprofen and acetaminophen, while combination with opioids were associated with more frequent adverse events.
 
The review noted that from a risk-benefit analysis the combination of ibuprofen/acetaminophen should be first line therapy and that opioids should be avoided.
 
The American Dental Association also recently released a policy that Dentists should not be prescribe opioids for more than 7 days.
 
Now in the emergency department we do not see a lot of post-operative pain, instead with see dental pain from fractured teeth, infections, and general dental decay. Nevertheless, this study suggests that we should lean away from opioid pain medications especially in light of the current opioid epidemic.  We should also limit our prescribing to only a few days. 
 
You can find the article at http://jada.ada.org/article/S0002-8177(18)30117-X/fulltext

References

Moore, Paul A. et al. Benefits and harms associated with analgesic medications used in the management of acute dental pain .The Journal of the American Dental Association , Volume 149 , Issue 4 , 256 - 265.e3