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| Introduction |
| Acute dental pain, often caused by conditions like pulpitis or abscesses, can be intense and distressing. This guideline provides recommendations for the pharmacologic management of postoperative pain after simple and surgical tooth extraction(s) in, adults, and older adults. |
| Recommendations: |
| For the management of acute postoperative dental pain in, adults, and older adults: |
| Undergoing surgical tooth extraction(s), the panel recommends the postprocedural use of nonopioid analgesics as first-line therapy instead of opioid analgesics (conditional, low certainty). |
| Undergoing simple tooth extraction(s), the panel recommends the postprocedural use of nonopioid analgesics only and recommends against the use of opioid analgesics (conditional, low certainty). |
| Undergoing simple and surgical tooth extraction(s), the panel suggests the postprocedural use (ie, before patient discharge) of 0.5% bupivacaine plus 1:200,000 epinephrine by block or infiltration injection or 4% articaine plus 1:100,000/1:200,000 epinephrine by infiltration injection instead of 2% lidocaine plus 1:100,000 epinephrine or 3% mepivacaine (conditional, low certainty). |
| Clinical pathway for the pharmacologic management of acute dental pain: |
| Postoperative pain after simple and surgical tooth extraction(s) in adults (aged 17-65 years), and older adults (≥ 65 years) |
| Step |
Recommendation |
| |
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| Postoperative Acute Pain |
Adults, and older adults undergoing simple or surgical tooth extractions |
| Supplemental Local Anesthetics |
| 0.5% bupivacaine + 1:200,000 epinephrine (block or infiltration injection) |
| OR |
| 4% articaine + 1:100,000 or 1:200,000 epinephrine (infiltration injection) |
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| First-line Analgesic Therapy |
| Option1: NSAID alone (e.g., 400 mg ibuprofen or 440 mg naproxen sodium) |
| Option2: Combination NSAID (e.g., 400 mg ibuprofen or 440 mg naproxen sodium) + Acetaminophen (e.g., 500mg) |
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| NSAIDs Contraindicated? |
Yes: Proceed with alternative medications |
| Simple Extractions |
| Acetaminophen at full therapeutic dose (e.g., 1,000 mg) |
| OR 325 mg acetaminophen + 325 mg combination acetaminophen with opioid (e.g., 5–7.5 mg hydrocodone or 5 mg oxycodone) for up to 3 days. |
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| Surgical Extractions |
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| Inadequate Pain Control After First-line Therapy? |
| Add to the NSAID |
325 mg acetaminophen + combination 325 mg acetaminophen with opioid (e.g., 5–7.5 mg hydrocodone or 5 mg oxycodone) |
| Replace Initial Prescription |
| NSAID + 325 mg acetaminophen + combination 325 mg acetaminophen with opioid |
| Use lowest effective dose, fewest tablets, and shortest duration (rarely exceeds 3 days). |
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| Additional Notes |
| Routine delayed opioid prescription (e.g., for breakthrough pain) is not recommended. |
| Use caution with; caregiver consent is advised for high-risk groups. |
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| GGI-CO-A1-AQS-300023454-ELC-L24-0149 |
| For the use of a Registered Medical Practitioner, Hospital or Laboratory only. |
| Reference: |
| Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults Carrasco-Labra, Alonso et al. The Journal of the American Dental Association, Volume 155, Issue 2, 102 - 117.e9 Click here to view the original article |
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