Benyamin R, Trescot AM, Datta S Opioid complications and side effects. Pain Physician. 2008; 11:S105-120
McNicol E, Horowicz-Mehler N, Fisk RA Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003; 4:231-256 https://doi.org/10.1016/s1526-5900(03)00556-x
Schroeder AR, Dehghan M, Newman TB Association of opioid prescriptions from dental clinicians for US Adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med. 2019; 179:145-152 https://doi.org/10.1001/jamainternmed.2018.5419
Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief. 2018; 329:1-8
Hersh EV, Kane WT, O'Neil MG Prescribing recommendations for the treatment of acute pain in dentistry. Compend Contin Educ Dent. 2011; 32:22-30
Cooper SA, Beaver WT. A model to evaluate mild analgesics in oral surgery outpatients. Clin Pharmacol Ther. 1976; 20:241-250 https://doi.org/10.1002/cpt1976202241
Moore PA, Hersh EV. Analgesic therapy in dentistry: from a letter to the editor to an evidence-base review. Dent Clin North Am. 2019; 63:35-44 https://doi.org/10.1016/j.cden.2018.08.004
Martin WJ, Ashton-James CE, Skorpil NE What constitutes a clinically important pain reduction in patients after third molar surgery?. Pain Res Manag. 2013; 18:319-322 https://doi.org/10.1155/2013/742468
Thornhill MH, Suda KJ, Durkin MJ, Lockhart PB. Is it time US dentistry ended its opioid dependence?. J Am Dent Assoc. 2019; 150:883-889 https://doi.org/10.1016/j.adaj.2019.07.003
Berterame S, Erthal J, Thomas J Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet. 2016; 387:1644-1656 https://doi.org/10.1016/S0140-6736(16)00161-6
Halling F, Heymann P, Ziebart T, Neff A. Analgesic prescribing patterns of dental practitioners in Germany. J Craniomaxillofac Surg. 2018; 46:1731-1736 https://doi.org/10.1016/j.jcms.2018.07.005
Hollingworth SA, Chan R, Pham J Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012. Community Dent Oral Epidemiol. 2017; 45:303-309 https://doi.org/10.1111/cdoe.12291
Gupta N, Vujicic M, Blatz A. Opioid prescribing practices from 2010 through 2015 among dentists in the United States: what do claims data tell us?. J Am Dent Assoc. 2018; 149:237-245 e236 https://doi.org/10.1016/j.adaj.2018.01.005
Vital signs: overdoses of prescription opioid pain relievers – United States, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011; 60:1487-1492
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, US, 2007–2012. Am J Prev Med. 2015; 49:409-413 https://doi.org/10.1016/j.amepre.2015.02.020
Guy GP, Zhang K, Bohm MK Vital signs: changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017; 66:697-704 https://doi.org/10.15585/mmwr.mm6626a4
Moore PA, Nahouraii HS, Zovko JG, Wisniewski SR. Dental therapeutic practice patterns in the U.S. II. Analgesics, corticosteroids, and antibiotics. Gen Dent. 2006; 54:201-207
Hersh EV, Ochs H, Quinn P Narcotic receptor blockade and its effect on the analgesic response to placebo and ibuprofen after oral surgery. Oral Surg Oral Med Oral Pathol. 1993; 75:539-546 https://doi.org/10.1016/0030-4220(93)90219-t
Derry S, Moore RA, McQuay HJ. Single dose oral codeine, as a single agent, for acute postoperative pain in adults. Cochrane Database Syst Rev. 2010; https://doi.org/10.1002/14651858.CD008099.pub2
Litkowski LJ, Christensen SE, Adamson DN Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg compared with those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model. Clin Ther. 2005; 27:418-429 https://doi.org/10.1016/j.clinthera.2005.04.010
Chang DJ, Fricke JR, Bird SR Rofecoxib versus codeine/acetaminophen in postoperative dental pain: a double-blind, randomized, placebo- and active comparator-controlled clinical trial. Clin Ther. 2001; 23:1446-1455 https://doi.org/10.1016/s0149-2918(01)80119-3
Chang DJ, Bird SR, Bohidar NR, King T. Analgesic efficacy of rofecoxib compared with codeine/acetaminophen using a model of acute dental pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:e74-80 https://doi.org/10.1016/j.tripleo.2005.04.026
Cooper SA, Firestein A, Cohn P. Double-blind comparison of meclofenamate sodium with acetaminophen, acetaminophen with codeine and placebo for relief of postsurgical dental pain. J Clin Dent. 1988; 1:31-34
Dionne RA, Snyder J, Hargreaves KM. Analgesic efficacy of flurbiprofen in comparison with acetaminophen, acetaminophen plus codeine, and placebo after impacted third molar removal. J Oral Maxillofac Surg. 1994; 52:919-924 https://doi.org/10.1016/s0278-2391(10)80068-0
Forbes JA, Beaver WT, White EH Diflunisal. A new oral analgesic with an unusually long duration of action. JAMA. 1982; 248:2139-2142 https://doi.org/10.1001/jama.248.17.2139
Forbes JA, Butterworth GA, Burchfield WH Evaluation of flurbiprofen, acetaminophen, an acetaminophen-codeine combination, and placebo in postoperative oral surgery pain. Pharmacotherapy. 1989; 9:322-330 https://doi.org/10.1002/j.1875-9114.1989.tb04144.x
Malmstrom K, Kotey P, Coughlin H, Desjardins PJ. A randomized, double-blind, parallel-group study comparing the analgesic effect of etoricoxib to placebo, naproxen sodium, and acetaminophen with codeine using the dental impaction pain model. Clin J Pain. 2004; 20:147-155 https://doi.org/10.1097/00002508-200405000-00004
Ziccardi VB, Desjardins PJ, Daly-DeJoy E, Seng GF. Single-dose vicoprofen compared with acetaminophen with codeine and placebo in patients with acute postoperative pain after third molar extractions. J Oral Maxillofac Surg. 2000; 58:622-628 https://doi.org/10.1016/s0278-2391(00)90154-x
Cooper SA, Breen JF, Giuliani RL. The relative efficacy of indoprofen compared with opioid-analgesic combinations. J Oral Surg. 1981; 39:21-25
Cooper SA, Kupperman A. The analgesic efficacy of flurbiprofen compared to acetaminophen with codeine. J Clin Dent. 1991; 2:70-74
Bentley KC, Head TW. The additive analgesic efficacy of acetaminophen, 1000 mg, and codeine, 60 mg, in dental pain. Clin Pharmacol Ther. 1987; 42:634-640 https://doi.org/10.1038/clpt.1987.211
Breivik EK, Barkvoll P, Skovlund E. Combining diclofenac with acetaminophen or acetaminophen-codeine after oral surgery: a randomized, double-blind single-dose study. Clin Pharmacol Ther. 1999; 66:625-635 https://doi.org/10.1053/cp.1999.v66.103629001
Toms L, Derry S, Moore RA, McQuay HJ. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev. 2009; https://doi.org/10.1002/14651858.CD001547.pub2
Moore PA, Ziegler KM, Lipman RD Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. J Am Dent Assoc. 2018; 149:256-265 e253 https://doi.org/10.1016/j.adaj.2018.02.012
Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD008659.pub3
Frame JW, Fisher SE, Pickvance NJ, Skene AM. A double-blind placebo-controlled comparison of three ibuprofen/codeine combinations and aspirin. Br J Oral Maxillofac Surg. 1986; 24:122-129 https://doi.org/10.1016/0266-4356(86)90007-0
Daniels SE, Bandy DP, Christensen SE Evaluation of the dose range of etoricoxib in an acute pain setting using the postoperative dental pain model. Clin J Pain. 2011; 27:1-8 https://doi.org/10.1097/ajp.0b013e3181ed0639
Sunshine A, Roure C, Olson N Analgesic efficacy of two ibuprofen-codeine combinations for the treatment of postepisiotomy and postoperative pain. Clin Pharmacol Ther. 1987; 42:374-380 https://doi.org/10.1038/clpt.1987.166
McQuay HJ, Carroll D, Watts PG Codeine 20 mg increases pain relief from ibuprofen 400 mg after third molar surgery. A repeat-dosing comparison of ibuprofen and an ibuprofen-codeine combination. Pain. 1989; 37:7-13 https://doi.org/10.1016/0304-3959(89)90147-4
Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD010107.pub3
Chang DJ, Desjardins PJ, King TR The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute postoperative pain model: a randomized, double-blind clinical trial. Anesth Analg. 2004; 99:807-815 https://doi.org/10.1213/01.ANE.0000133141.75831.57
Chang DJ, Desjardins PJ, Bird SR Comparison of rofecoxib and a multidose oxycodone/acetaminophen regimen for the treatment of acute pain following oral surgery: a randomized controlled trial. Curr Med Res Opin. 2004; 20:939-949 https://doi.org/10.1185/030079904125003863
Desjardins PJ, Black PM, Daniels SE A double-blind randomized controlled trial of rofecoxib and multidose oxycodone/acetaminophen in dental impaction pain. J Oral Maxillofac Surg. 2007; 65:1624-1632 https://doi.org/10.1016/j.joms.2006.06.268
Malmstrom K, Kotey P, McGratty M Dental impaction pain model as a potential tool to evaluate drugs with efficacy in neuropathic pain. J Clin Pharmacol. 2006; 46:917-924 https://doi.org/10.1177/0091270006289847
Malmstrom K, Ang J, Fricke JR The analgesic effect of etoricoxib relative to that of cetaminophen analgesics: a randomized, controlled single-dose study in acute dental impaction pain. Curr Med Res Opin. 2005; 21:141-149 https://doi.org/10.1185/030079904x17983
Daniels SE, Desjardins PJ, Talwalker S The analgesic efficacy of valdecoxib vs. oxycodone/acetaminophen after oral surgery. J Am Dent Assoc. 2002; 133:611-621 https://doi.org/10.14219/jada.archive.2002.0237
Cooper SA, Precheur H, Rauch D Evaluation of oxycodone and acetaminophen in treatment of postoperative dental pain. Oral Surg Oral Med Oral Pathol. 1980; 50:496-501 https://doi.org/10.1016/0030-4220(80)90430-2
Gaskell H, Derry S, Moore RA, McQuay HJ. Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009; https://doi.org/10.1002/14651858.CD002763.pub2
Edwards JE, McQuay HJ, Moore RA. Combination analgesic efficacy: individual patient data meta-analysis of single-dose oral tramadol plus acetaminophen in acute postoperative pain. J Pain Symptom Manage. 2002; 23:121-130 https://doi.org/10.1016/s0885-3924(01)00404-3
Moore RA, Derry S, Aldington D, Wiffen PJ. Adverse events associated with single dose oral analgesics for acute postoperative pain in adults – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD011407.pub2
Aminoshariae A, Kulild JC, Donaldson M, Hersh EV. Evidence-based recommendations for analgesic efficacy to treat pain of endodontic origin: A systematic review of randomized controlled trials. J Am Dent Assoc. 2016; 147:826-839 https://doi.org/10.1016/j.adaj.2016.05.010
Dionne RA, Gordon SM, Moore PA. Prescribing opioid analgesics for acute dental pain: time to change clinical practices in response to evidence and misperceptions. Compend Contin Educ Dent. 2016; 37:372-378
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States, 2016. JAMA. 2016; 315:1624-1645 https://doi.org/10.1001/jama.2016.1464
Maughan BC, Hersh EV, Shofer FS Unused opioid analgesics and drug disposal following outpatient dental surgery: a randomized controlled trial. Drug Alcohol Depend. 2016; 168:328-334 https://doi.org/10.1016/j.drugalcdep.2016.08.016
Ashrafioun L, Edwards PC, Bohnert AS, Ilgen MA. Nonmedical use of pain medications in dental patients. Am J Drug Alcohol Abuse. 2014; 40:312-316 https://doi.org/10.3109/00952990.2014.930152
Koppen L, Suda KJ, Rowan S Dentists' prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health. J Am Dent Assoc. 2018; 149:721-730 https://doi.org/10.1016/j.adaj.2018.04.027
Wong YJ, Keenan J, Hudson K Opioid, NSAID, and OTC analgesic medications for dental procedures: PEARL Network findings. Compend Contin Educ Dent. 2016; 37:710-718
Baker JA, Avorn J, Levin R, Bateman BT. Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000–2010. JAMA. 2016; 315:1653-1654 https://doi.org/10.1001/jama.2015.19058
Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallel-group, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain. 2011; 152:632-642 https://doi.org/10.1016/j.pain.2010.12.012
Mehlisch DR, Aspley S, Daniels SE, Bandy DP. Comparison of the analgesic efficacy of concurrent ibuprofen and paracetamol with ibuprofen or paracetamol alone in the management of moderate to severe acute postoperative dental pain in adolescents and adults: a randomized, double-blind, placebo-controlled, parallel-group, single-dose, two-center, modified factorial study. Clin Ther. 2010; 32:882-895 https://doi.org/10.1016/j.clinthera.2010.04.022
Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD010210.pub2
Gordon SM, Brahim JS, Dubner R Attenuation of pain in a randomized trial by suppression of peripheral nociceptive activity in the immediate postoperative period. Anesth Analg. 2002; 95:1351-1357 https://doi.org/10.1097/00000539-200211000-00047
Dionne RA, Cooper SA. Evaluation of preoperative ibuprofen for postoperative pain after removal of third molars. Oral Surg Oral Med Oral Pathol. 1978; 45:851-856 https://doi.org/10.1016/s0030-4220(78)80004-8
Dionne RA, Campbell RA, Cooper SA Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen, and acetaminophen plus codeine. J Clin Pharmacol. 1983; 23:37-43 https://doi.org/10.1002/j.1552-4604.1983.tb02702.x
Tatch W. Opioid prescribing can be reduced in oral and maxillofacial surgery practice. J Oral Maxillofac Surg. 2019; 77:1771-1775 https://doi.org/10.1016/j.joms.2019.03.009
Moore RA, McQuay H.Oxford: Oxford University Press; 2006
Barden J, Derry S, McQuay HJ, Moore AR. Bias from industry trial funding? A framework, a suggested approach, and a negative result. Pain. 2006; 121:207-218 https://doi.org/10.1016/j.pain.2005.12.011
Moore AR, Gavaghan D, Tramer RM Size is everything – large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain. 1998; 78:209-216 https://doi.org/10.1016/S0304-3959(98)00140-7
The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain Daniel Merrick Michael O'Sullivan Mary Clarke Dental Update 2024 48:10, 707-709.
Authors
DanielMerrick
BA, BDentSc, MFD RCSI
Junior House Officer, Dublin Dental University Hospital
Senior Lecturer/Consultant in Restorative Dentistry (Special Needs), Department of Restorative Dentistry and Periodontology Dublin Dental School, Dublin, Ireland
The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects.
CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.
Article
Analgesia is a key aspect in the management of post-operative dental pain. Pain is defined as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’.1 Pain is classified by intensity, physiology, tissue affected and time course, all of which influence pain management strategies in dental practice. Dental pain management should follow the three Ds of diagnosis, dental treatment and drugs, where drugs act as adjuncts to treatment.2
Analgesics diminish pain sensation without the loss of consciousness and can be classified as opioid or non-opioid, and can be used individually or in combination in pain management.3,4 Non-opioid analgesics encompass non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, which is known as acetaminophen in the US. NSAIDs inhibit the cyclo-oxygenase enzyme. The cyclo-oxygenase enzyme is necessary to synthesize prostanoids, which contribute to the development of pain, fever and inflammation.5 Paracetamol is believed to inhibit prostaglandin production in the central nervous system (CNS) and has little effect in the peripheral tissues.5 Opioids are any naturally occurring (codeine), semi-synthetic (oxycodone, hydrocodone and dihydrocodeine) or synthetic compounds (tramadol) that bind to opioid G protein-coupled receptors producing therapeutic and adverse effects.
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