Research reveals an attractive option for managing post-tooth extraction pain that could potentially replace opioids, according to the Eastman Institute's recent study.

In an effort to combat the ongoing opioid epidemic, researchers at the University of Rochester Medical Center's Eastman Institute for Oral Health (EIOH) have proposed a novel approach to managing acute dental pain. The study, published in JAMA Network Open, was led by Dr. Yanfang Ren, DDS, PhD, MPH, professor and clinical chief at Howitt Urgent Dental Care.

The study compared two groups of patients who had dental extractions at the Institute's Howitt Urgent Dental Care clinic in Rochester, New York. The first group, consisting of 3,300 patients, was treated with ibuprofen or acetaminophen for mild pain and opioid combinations including hydrocodone, oxycodone or codeine for moderate to severe pain in 2012. In contrast, the second group, consisting of nearly 3,800 people who had extractions from March 2021 through February 2022, received no opioids whatsoever.

For mild pain in the second group, acetaminophen or ibuprofen was prescribed. For moderate to severe pain, higher doses of ibuprofen or an ibuprofen and acetaminophen combination were prescribed. For patients unable to take ibuprofen or acetaminophen due to health issues or potential interactions, a gabapentin combination was used as a non-opioid alternative in 2022, replacing opioid combinations used in 2012.

The strategy of using a combination of non-opioid pain medications and adding gabapentin to the mix for pain is proposed as an effective method to minimize or eliminate opioids for dental pain. The results of the study showed promising effectiveness when evaluated using a real-world measure of proportion of patients returning for additional pain treatment.

Dr. Ren emphasized the American Dental Association's recommendation of nonsteroidal anti-inflammatory drugs for managing pain, but noted that dentists often prescribe opioids for dental pain due to the lack of alternatives. Dr. Eli Eliav, DMD, PhD, the director of EIOH and a pain expert, stated that this study is part of ongoing efforts to minimize the use of opioids for dental pain.

However, additional studies, preferably randomized controlled clinical trials, are needed to confirm the safety and effectiveness of the approach. Prescription opioid-involved death rates increased by more than 16% from 2019 to 2020, highlighting the urgency of finding alternatives to opioids for pain management.

The opioid epidemic continues during the COVID-19 pandemic, making the need for effective, non-opioid pain management strategies more pressing than ever. Other authors on the study include Qirong Huang, DDS, MS, Linda Rasubala, DDS, PhD, Richard H. Gracely, PhD, Junad Khan, BDS, MSD, MPH, PhD, and Eli Eliav, DMD, PhD. The search results do not provide information about the authors of the study on non-opioid alternatives for sharp tooth pain published by the Eastman Institute for Oral Health at the University of Rochester Medical Center.