Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Abstract

AbstractObjectiveTo evaluate long-term changes in pain management strategies and assess the outcomes of opioids and non-opioid combination analgesics after dental extractions.MethodsThis is a cross-sectional study of patients who received dental extractions and analgesic prescriptions in a large dental urgent care center in two 12-month periods: January 2012 to December 2012 (Year-2012) and March 2021 to February 2022 (Year-2022). Data extracted from electronic records include type of dental extractions, analgesics prescribed, and follow-up visits. The primary outcome was failure rate measured by the proportions of patients who returned to the clinic for management of pain after receiving dental extractions and analgesic prescriptions.ResultsA total of 3,357 patients in Year-2012 and 3,785 patients in Year-2022 received analgesic prescriptions in conjunction with dental extractions. Combination analgesics were significantly higher in Year-2022 (62.5%) than in Year-2012 (34.9%) (RR=1.79, 95% CI 1.70-1.89. p<0.0001). Combinations analgesics were almost exclusively opioids and 1,166 patients, or 34.7%, received opioids in Year-2012, compared to none received opioids, 49.4% received ibuprofen/ acetaminophen and 13.1% received gabapentin combinations in Year-2022. After surgical extractions, a majority were prescribed opioids (52.4%), followed by ibuprofen (46.2%) in Year-2012. In contrast, a majority received ibuprofen/acetaminophen (56.2%) or gabapentin combinations (17.3%) in Year-2022. Ibuprofen/acetaminophen had a failure rate (2.2%) lower than gabapentin combinations (4.4%) (RR=0.50, 95%CI 0.31-0.83. p=0.01), or opioid combinations (21.4%) (RR=0.10, 95%CI 0.08-0.14. p<0.0001). Failure rate for gabapentin combinations was lower than opioids (RR=0.21, 95%CI 0.14-0.31. p<0.0001).Conclusions and RelevanceThis study showed a paradigm shift from opioids and single medication analgesics to non-opioids and combination analgesics with ibuprofen, acetaminophen and gabapentin as components in prescribing for pain after dental extractions, which presents an opportunity to minimize or eliminate our reliance on opioids for dental pain.