Oral Analgesics for Acute Dental Pain
Acute pain is pain that is provoked by disease or injury, and is associated with musculoskeletal spasm and nervous system activation. While acute pain often resolves, pain that lasts longer than 3 months is considered to be chronic. Acute orofacial pain can result from pathological conditions, underlying disease processes, and/or their treatment. Pain can be attributed to conditions affecting the hard tissues such as caries of the enamel, dentin, and cementum, or it can be due to soft tissue conditions such as gingivitis and periodontitis.
Selecting an Acute Pain Management Strategy
Various medications and medication combinations can be considered for the management of acute dental pain, and there is no specific regimen that is guaranteed to produce a high level of pain relief in all individuals. Additionally, certain treatments may be more suitable than others depending on the degree of postprocedural pain. Controlling postprocedural pain can be achieved by targeting the source of the pain (inflammation), which NSAIDs are able to achieve. Opioid drugs on the other hand interfere with the perception of pain and do not target inflammation. An overview of systematic reviews in JADA including data on over 58,000 patients following third-molar extractions found that when comparing the pain-reducing efficacy of NSAIDs and opioid analgesics, the combination of 400 mg ibuprofen with 1,000 mg acetaminophen was more effective than any opioid-containing regimen and was also associated with a lower risk of adverse events. Additionally, in 2016, the ADA House of Delegates adopted a statement that reads, “Dentists should consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.”