New guidelines set safer standards for dental pain relief

Nonsteroidal anti-inflammatory drugs (NSAIDs) taken alone or along with acetaminophen are recommended as first-line treatments for managing short-term dental pain in adults and adolescents aged 12 or older, according to a new clinical practice guideline developed by the American Dental Association (ADA), the University of Pittsburgh School of Dental Medicine and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine. The guideline has been endorsed by the ADA and is now available in the February issue of The Journal of the American Dental Association.

Based on review of the available evidence, a 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 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.

It's important to take special consideration when prescribing any type of pain reliever, and now, dentists have a set of evidence-based recommendations to determine the best care for their patients. Patients are encouraged to discuss pain management expectations and strategies with their dentist so they can feel confident that they are receiving the safest, most effective treatment for their symptoms."

Dr. Paul Moore, D.M.D., Ph.D., M.P.H., the guideline's senior author and panel chair and professor emeritus at the University of Pittsburgh's School of Dental Medicine

In 2020, the U.S. Food and Drug Administration (FDA) awarded the University of Pittsburgh and the ADA Science & Research Institute (ADASRI) – now the ADA Forsyth Institute – a three-year $1.5 million grant to develop a clinical practice guideline for the management of acute pain in dentistry in children, adolescents and adults. A group of researchers and methodologists from ADASRI, University of Pittsburgh School of Dental Medicine, Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine, McMaster University and The Art of Democracy worked together to develop the guideline.

"Providing prescribing guidelines for acute dental pain management is an important step towards improving patient treatment and outcomes," said Dr. Marta Sokolowska, Ph.D., deputy center director for substance use and behavioral health at the FDA's Center for Drug Evaluation and Research. "We hope this clinical practice guideline will reduce the risk of opioid addiction, overdose and diversion."

This is the second of two guidelines on acute dental pain management. A previous set of recommendations for pediatric patients was published in 2023. Both guidelines can be found at ada.org/painmanagement.