A new clinical practice guideline for managing acute dental pain in adolescents and adults has been released, recommending nonsteroidal anti-inflammatory drugs (NSAIDs) taken alone or with acetaminophen as first-line treatments for managing short-term dental pain. The guideline was developed by Penn Dental Medicine's Center for Integrative Global Oral Health (CIGOH), the American Dental Association (ADA), and the University of Pittsburgh School of Dental Medicine. Dr. Alonso Carrasco-Labra, Associate Professor and Director of the Cochrane Oral Health Collaborating Center at Penn Dental Medicine, and Olivia Urquhart, an epidemiologist and instructor within CIGOH, co-led its development. Published in the February 2024 issue of JADA, the guideline has been endorsed by the ADA.
Based on a review of the best available evidence, the guideline panel concluded that, when used as directed, NSAIDs like ibuprofen and naproxen alone or in combination with acetaminophen can effectively manage pain after having a tooth removed or when experiencing a toothache when dental care is not immediately available.
"The recommended approach is to use nonopioid analgesics as the primary treatment instead of opioid analgesics," says Carrasco-Labra. "This is due to their effectiveness and lower risk profile."
The guideline also offers clinicians recommendations for prescribing opioid medications in the limited circumstances in which they may be appropriate. These include avoiding "just in case" prescriptions, engaging patients in shared decision-making, and exerting extreme caution when prescribing opioids to adolescents and young adults. When prescribing opioids, the guideline suggests advising patients on proper storage and disposal and considering any risk factors for opioid misuse and serious adverse events.
"Clinicians are encouraged to have conversations with their patients where they inform them to anticipate some level of discomfort and explain what it will feel like," adds Carrasco-Labra. "The prescribed analgesics should make the pain manageable but also align with what the patient seeks in terms of associated risks. If they're coming in for a procedure that will likely result in some mild discomfort, they need to be in the driver's seat in determining the appropriate pain-management strategy."
This is the second of two guidelines on acute dental pain management from this research team. A previous set of recommendations for pediatric patients was published in 2023. Both guidelines are can be found at ada.org/painmanagement.
