J Am Dental Assoc

ADA releases guidance for acute dental pain management in adolescents and adults

February 9, 2024

Key recommendations for the pharmacological management of acute dental pain in adolescents, adults, and older adults:

Surgical tooth extractions

• The panel suggests using an NSAID alone (eg, ibuprofen 400 mg or naproxen sodium 440 mg) or in combination with acetaminophen (eg, 500 mg).
• In the rare cases when postprocedural pain control using NSAIDs alone is inadequate, the panel suggests adding acetaminophen 325 mg plus a combination of acetaminophen 325 mg with an opioid (eg, hydrocodone 5-7.5 mg or oxycodone 5 mg) at the lowest effective dose, fewest tablets, and shortest duration, which rarely exceeds 3 days.
• In the rare cases when postprocedural pain control using NSAIDs plus acetaminophen is inadequate, the panel suggests replacing the initial first-line therapy with an NSAID (eg, ibuprofen 400 mg or naproxen sodium 440 mg) and acetaminophen 325 mg plus a combination of acetaminophen 325 mg with an opioid (eg, hydrocodone 5-7.5 mg or oxycodone 5 mg), at the lowest effective dose, fewest tablets, and shortest duration, which rarely exceeds 3 days.
• When NSAIDs are contraindicated, the panel suggests acetaminophen alone at full therapeutic dose (eg, 1,000 mg) or acetaminophen 325 mg plus a combination of acetaminophen 325 mg with an opioid (eg, hydrocodone 5-7.5 mg or oxycodone 5 mg) at the lowest effective dose, fewest tablets, and shortest duration, which rarely exceeds 3 days.
• The panel also suggests the postprocedural use (ie, before patient is discharged) of bupivacaine 0.5% plus epinephrine 1:200,000 by block or infiltration injection or articaine 4% plus epinephrine 1:100,000/1:200,000 by infiltration injection instead of lidocaine 2% plus epinephrine 1:100,000 or mepivacaine 3%.
• The panel suggests against adding oral, submucosal, or IM corticosteroids to standard analgesic therapy.

Simple tooth extractions

• The panel recommends the use of nonopioid analgesics only and recommends against the use of opioid analgesics.
• Initiate an NSAID alone (eg, ibuprofen 400 mg or naproxen sodium 440 mg) or in combination with acetaminophen (eg, 500 mg).
• When NSAIDs are contraindicated, the panel suggests acetaminophen alone at full therapeutic dose (eg, 1,000 mg).
• The panel also suggests the postprocedural use (ie, before patient is discharged) of bupivacaine 0.5% plus epinephrine 1:200,000 by block or infiltration injection or articaine 4% plus epinephrine 1:100,000/1:200,000 by infiltration injection instead of lidocaine 2% plus epinephrine 1:100,000 or mepivacaine 3%.

Source:

Carrasco-Labra A, et al. (2024, February). J Am Dental Assoc. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. https://pubmed.ncbi.nlm.nih.gov/38325969/