Dentists regularly prescribe opioid pain relievers following surgery to remove wisdom teeth, but a new article reports that over-the-counter drugs are safer and more effective. About 3.5 million young adults have surgery each year to remove wisdom teeth, also known as third molars. For several days after surgery, most people experience some amount of pain, swelling, and bleeding that requires pain medication.
The most commonly recommended pain medication following dental surgery is Vicodin—a combination of acetaminophen (the active ingredient in Tylenol and many other medications) and the opioid pain medication hydrocodone. Vicodin was introduced in the United States in 1978; similar medications like Norco, Lortab, and Zydone followed. Not only are these types of drugs the most commonly prescribed pain medications, they are also the most frequently abused prescription drugs in the US.
In an effort to determine if opioid-containing medications were really the best option for treating dental pain, researcher Paul A. Moore, DMD, PhD, MPH of the University of Pittsburgh School of Dental Medicine and his colleagues reviewed results from more than 460 published studies and found that a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen provided better pain relief than any opioid-containing medications studied. In addition to being more effective at controlling pain, ibuprofen and acetaminophen also have fewer side effects, are less expensive and more convenient to purchase, and perhaps most importantly, are not addictive.
In a previous commentary, Dr. Moore and his team sought to explain why opioid medications continue to be routinely prescribed for dental surgery patients despite the potential for abuse and lack of evidence to support opioid pain management. One factor is that Vicodin was in use before the benefits of NSAIDs were widely known, and it became difficult to change the “traditional thinking” taught in dental schools. Another explanation is that although only about 20% of patients experience severe discomfort, physicians tend to prescribe based on the “worst possible scenario.” Therefore, sending a patient home with an opioid prescription seems reasonable, and may help to avoid an after-hours emergency. Lastly, the authors note that patients often expect or even demand opioid pain relievers, and that not prescribing the requested medication can result in low patient satisfaction and poor online ratings and reviews. While the authors acknowledge that opioid pain relievers will always have a place in dental medicine for some patients, they should only be prescribed when absolutely necessary.
Interested in dental research? Visit the Pitt+Me Mouth and Teeth studies page.