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| Introduction |
| The American Dental Association (ADA), developed evidence-based guidelines which focuses on temporary pharmacologic management of acute dental pain: |
| Toothache (symptomatic pulpitis [i.e. reversible or symptomatic irreversible pulpitis with or without symptomatic apical periodontitis] or pulp necrosis with symptomatic apical periodontitis or acute apical abscess) in, adults, and older adults. |
| Recommendations: |
| For the temporary management of toothache before definitive dental treatment in , adults, and older adults: |
| The panel suggests the use of a short-acting local anesthetic (eg, 2% lidocaine plus 1:100,000 epinephrine or 4% articaine plus 1:100,000 epinephrine) for immediate pain relief (conditional, very low certainty). |
| The panel recommends the post visit use of nonopioid analgesics as first-line therapy instead of opioid analgesics (conditional, low certainty). |
| For the extended temporary management of toothache before definitive dental treatment in adults and older adults: |
| The panel suggests the supplemental use 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 (conditional, very low certainty). |
| For the short-term temporary management of toothache before definitive dental treatment in, adults, and older adults: |
| The panel suggests the use of 10% or 20% topical benzocaine compared with not using topical benzocaine (conditional, low certainty). |
| Clinical pathway for the temporary pharmacologic management of acute dental pain: |
| Step |
Recommendation |
| Toothache Condition |
Symptomatic pulpitis (reversible/irreversible) with/without symptomatic apical periodontitis, pulp necrosis, or acute apical abscess in adults. |
| Is definitive dental treatment available? |
| Yes: Proceed to definitive treatment (e.g. endodontic treatment, tooth extraction). |
| No: Implement temporary management of toothache. |
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| Temporary Management |
| 1. Short-acting local anesthetics (optional): 2% lidocaine + epinephrine or 4% articaine + epinephrine. |
| 2. PLUS: First-line analgesic therapy. |
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| First-Line Analgesic Therapy |
| Option 1: NSAID alone (e.g., 400 mg ibuprofen or 440 mg naproxen sodium). |
| Option 2: Combination NSAID + acetaminophen (500 mg). |
| 3. PLUS: Supplemental local anesthetics (Optional) (e.g., 0.5% bupivacaine+epinephrine by block or infiltration injection or 4% articaine +epinephrine by infiltration injection). |
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4. PLUS: Topical anesthetic (Optional) (10–20% benzocaine). |
| If Pain Persists Despite First-Line Therapy |
| Replace therapy with: |
| Option1: 1 tablet of 325 mg acetaminophen |
| PLUS: 1 tablet of combination acetaminophen + opioid (e.g., 5-7.5mg hydrocodone or 5mg oxycodone) |
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| If Pain Persists Despite First-Line Therapy |
Use acetaminophen at full therapeutic dose (e.g., 1,000 mg) or OR 1 tablet of 325 mg acetaminophen PLUS: acetaminophen + opioid combination. |
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| GGI-CO-A1-AQS-300023454-APPEMC-L24-0152 |
| 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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