Study finds opioids less effective after tooth extraction

Patients who took opioids for pain relief after tooth extraction reported higher levels of pain than patients who took other analgesics in a new study, published in JAMA Network Open. The findings suggest nonopioid analgesics should be the first-line pain relief for extractions.

The researchers also reported no difference in overall procedure satisfaction between patients who were given opioids and those who were not.

"This study found that after routine or surgical extractions, patients who used opioids reported

greater pain compared with those who did not use opioids," wrote the authors, led by Romesh Nalliah, BDS, the associate dean for patient services and a clinical professor of dentistry at the University of Michigan School of Dentistry in Ann Arbor (JAMA Netw Open, March 13, 2020).

A 2018 study in JAMA Surgery found that more than 22% of U.S. dental prescriptions were for opioids. Opioids are often prescribed to relieve pain after tooth extraction, the study authors noted. The goal of their study was to understand the differences in patient-reported outcomes between opioid users and nonusers to encourage dentists to adopt a more conservative and appropriate prescribing practice.

The researchers reached almost 330 patients who had either a routine (174 patients) or surgical (155 patients) extraction during the second half of 2017 at one of the 14 dental clinics of the University of Michigan School of Dentistry. The patients were asked how they would rate their pain during the first week after the extraction. More than 51% of patients with surgical extraction and almost 40% of patients with routine extraction used opioids after their procedure.

Patients who used opioids reported higher pain levels than those patients who did not, the researchers found.

Among the study cohort, 51 patients who used opioids during surgical extraction reported moderate to severe pain, while 34 patients who did not use opioids reported the same pain levels.

The same results were found in the routine extraction group, in which the 44 patients who used opioids reported moderate to severe pain, while 35 patients (33.0%) who did not use opioids reported moderate to severe pain.

The researchers found no statistically significant difference in overall patient satisfaction or telephone calls to report issues between patients who used opioids and those who did not.

The authors listed several limitations, including this being a retrospective study that required patients to recall pain perception, satisfaction, and opioid use. In addition, the opioid prescribing was not randomized, and there could be confounding characteristics that affected their use, they wrote. Other limitations were that data came from one academic medical center and that the researchers were unable to reach many patients with extractions.

While opioids have been used for decades to manage postoperative pain from extractions, evidence suggests that 400 mg of ibuprofen and 1,000 mg of acetaminophen taken concurrently may be more effective, the authors noted. The data also suggest that opioids are not needed to achieve high patient satisfaction.

"We recommend the use of nonopioid analgesics instead of opioids for most patients undergoing dental procedures," they concluded.