OBJECTIVE: In the United States, on average, every 15 s, someone visits a hospital emergency department (ED) for a dental condition. This commentary summarizes the recommendations from a 2024 clinical practice guideline for the pharmacological management of acute dental pain associated with tooth extractions and toothache applicable to ED settings, hospitals, and urgent care clinics where definitive dental treatment is not immediately available.
METHODS: A guideline panel convened by the American Dental Association, the ADA Science & Research Institute, the University of Pittsburgh School of Dental Medicine, and Penn Dental Medicine examined the effect of opioid and non-opioid analgesics; local anesthetics, including blocks; corticosteroids; and topical anesthetics on acute dental pain. The GRADE approach was used to assess the certainty of the evidence; the GRADE Evidence-to-Decision Framework was used to formulate 18 recommendations and six good practice statements.
RESULTS: A beneficial net balance favors the use of non-opioid medications compared with opioid medications. When not contraindicated, nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile compared with opioids.
CONCLUSION: NSAIDs with or without acetaminophen are first-line therapy for managing acute dental pain following tooth extraction(s) and temporarily managing toothache. Opioids should be reserved for clinical situations when first-line therapy is insufficient or contraindications to NSAIDs exist.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Special Interest - Pain -- Physician | |
| Emergency Medicine |  |
| Pediatric Emergency Medicine | |
This is useful information and confirms how I have manage patients with dental pain.
This article is a statement about managing dental pain in the ER or urgent care. They state strongly that since the pain is usually due to inflammation, anti-inflammatory agents and acetaminophen should be prescribed. One could also use long-acting analgesic injections to supplement the pain relief. They state that pain after 72 hours suggests an infection. They strongly state that opioids should be used only as a last resort.
This practice guideline does not discuss the pros and cons of recommending combination acetaminophen/opioid preparations compared with adding an opioid alone when pain control is inadequate.
Although I am not a dentist, these practice guidelines are useful for primary care.
It reiterates what is already practiced. A good reminder read.
