Growing Evidence Supports Non-Opioid Analgesics for Post-Dental Surgery Pain

By Genni Burkhart, Incisor Editor

A recent study published in the Journal of American Dental Association (JADA) titled, "Nonopioid vs opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial¹" adds to the growing evidence that over-the-counter (OTC) pain relievers such as acetaminophen and ibuprofen are more effective at pain management than opioids after dental surgery.

A 2019 study published in JAMA Network Open found that dentists are among the most frequent prescribers of opioids in the United States, second only to family physicians². Balancing effective pain management with mitigating drug abuse in patients has become somewhat of a high-wire act for dentists. Because of this, it's important to examine studies that address safer, effective alternatives to opioids for post-operative dental pain.

Over-the-Counter Combo

According to a Rutgers Health study led by Dr. Cecile Feldman, DMD, dean of the Rutgers School of Dental Medicine, a combination of ibuprofen and acetaminophen is more effective than opioids at controlling pain after wisdom tooth removal. This study was funded by the National Institutes of Health's (NIH) National Institute of Dental and Craniofacial Research.

The Rutgers Health study involved over 1,800 patients and demonstrated that a combination of OTC drugs provides superior pain relief, better sleep, and higher satisfaction than a combination of hydrocodone and acetaminophen. Patients using the non-opioid combination were also less likely to require additional medication and experienced fewer disruptions in daily activities.

In a press release, Dr. Feldman reported the results of the study were much stronger than anticipated and because of this, they strongly suggest not routinely prescribing opioids for dental pain. Instead, patients who are prescribed a non-opioid drug combination are going to be much "better off."

Results from the study published in JADA also showed the OTC non-opioid combination as providing superior pain relief during the peak-pain period of two days post-op.

Additional Supporting Evidence 

Several dental procedures have been studied for non-opioid pain relief, with a focus on comparing the efficacy of non-opioid analgesics to opioids. The most extensively researched procedures include:

• Dental extractions (general): Research³ has demonstrated that non-opioid analgesics, particularly NSAIDs, are superior to opioids for pain relief following routine and surgical dental extractions.
• Minor dental surgeries: Center for Disease Control (CDC) guidelines⁴ indicate that non-opioid therapies are much more effective than opioids for pain related to minor surgeries typically associated with minimal tissue injury, such as simple dental extractions.
• Postoperative dental pain: Meta-analyses⁵ have shown that NSAIDs are more successful than opioid combinations (e.g., acetaminophen with codeine) in relieving postoperative dental pain in general.

While these studies cover a range of dental procedures, research has consistently shown non-opioid alternatives to be more effective at managing dental pain.

The primary focus of these studies has been on demonstrating the superiority or equivalent effectiveness of non-opioid options, rather than studying specific procedures in isolation.

Findings Across Studies:

• Non-opioid combinations (ibuprofen + acetaminophen) consistently outperform opioids in managing dental surgery pain.
• Patients using non-opioids report better sleep quality and fewer disruptions in daily life.
• Reducing opioid prescriptions for dental procedures could mitigate risks of addiction and misuse while still effectively treating pain.

In Conclusion

Based on the most recent data from 2023, approximately 222 people die every day from opioid overdoses in the United States⁶. While this is a welcome decrease from the year before, research from the National Institutes of Health (NIH) suggests that 75% of opioid abuse is attributed to the introduction of opioids through prescriptions. The same research also concluded that more than half of 14- to 17-year-olds receive opioid prescriptions following wisdom tooth extractions.

As studies continue to demonstrate the effectiveness of non-opioid pain relievers, their benefits are increasingly evident. These OTC alternatives improve patient outcomes, reduce the risk of opioid addiction, and align with the American Dental Association's (ADA) recommendations. By adopting these practices, dentists can help minimize side effects, promote better sleep, healing, and recovery for patients, and reduce the broader negative impact of opioids on their communities.

For those looking for more information on prescribing analgesics over opioids for pain management, Dr. Leslie Fang offers an online course titled "Drugs You Need To Know, & Optimizing Use Of Analgesics To Avoid Opioids."

This is MODULE ONE in a 13-module video lecture series, UCS Companion Video Series, developed and presented by Dr. Leslie Fang.

This module is worth 1 Credit Hour. Receive significant savings when purchasing the full series.

Author: With over 15 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.

References:

1. Cecile A. Feldman, Janine Fredericks-Younger, Paul J. Desjardins, Hans Malmstrom, Michael Miloro, Gary Warburton, Brent B. Ward, Vincent B. Ziccardi, Patricia Greenberg, Tracy Andrews, Pamela B. Matheson, Rafael Benoliel, Daniel H. Fine, Shou-En Lu, Nonopioid vs opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial, The Journal of the American Dental Association, 2025,ISSN 0002-8177, https://doi.org/10.1016/j.adaj.2024.10.014.
2. Suda KJ, Durkin MJ, Calip GS, et al. Comparison of Opioid Prescribing by Dentists in the United States and England. JAMA Netw Open. 2019;2(5):e194303. doi:10.1001/jamanetworkopen.2019.4303
3. Huang Q, Rasubala L, Gracely RH, Khan J, Eliav E, Ren Y. Comparison of Analgesic Prescriptions for Dental Pain and Patient Pain Outcomes Before vs After an Opioid Reduction Initiative. JAMA Netw Open. 2022;5(8):e2227219. doi:10.1001/jamanetworkopen.2022.27219
4. Centers for Disease Control and Prevention. (n.d.). Dental Pain Care. Retrieved January 28, 2025, from https://www.cdc.gov/overdose-prevention/hcp/clinical-care/dental-pain-c…
5. Ahmad N, Grad HA, Haas DA, Aronson KJ, Jokovic A, Locker D. The efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis. Anesth Prog. 1997 Fall;44(4):119-26. PMID: 9481955; PMCID: PMC2148941.
6. Centers for Disease Control and Prevention. (2024, May 15). Provisional Drug Overdose Death Counts. National Center for Health Statistics. Retrieved January 28, 2025, from https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.ht…