A new clinical practice guideline developed and endorsed by the ADA recommends NSAIDs such as ibuprofen taken on their own or with acetaminophen as first-line treatments for managing short-term dental pain in adults and adolescents age 12 and over.
Similar in scope to the guideline the ADA released in August 2023 on pain management in pediatric patients, the newly released guideline recommends that when used as directed, acetaminophen, NSAIDs, or a combination of the two can effectively manage pain after a tooth extraction or during a toothache when dental care is not immediately available for adults or adolescents.
But unlike the pediatric guideline, which states that “the use of codeine and tramadol in children for managing acute pain is contraindicated,” the adult and adolescent guideline includes clinical recommendations for prescribing opioids “in the limited circumstances” where opioids could be needed.
According to a press release from the ADA, clinicians are advised to avoid writing “just in case” opioid prescriptions, to engage patients in shared decision-making, and to exert “extreme caution when prescribing opioids to adolescents and young adults.”
If prescribing opioids, notes the press release, clinicians are also encouraged to advise patients about proper storage and disposal and consider risk factors for opioid misuse and serious adverse events.
“Providing prescribing guidelines for acute dental pain management is an important step toward improving patient treatment and outcomes,” said Marta Sokolowska, PhD, deputy center director for substance use and behavioral health at the FDA's Center for Drug Evaluation and Research, in the press release. “We hope this clinical practice guideline will reduce the risk of opioid addiction, overdose, and diversion.”
You might also be interested in: "Progress is slowing": The pandemic's effect on dental opioid prescribing rates
The adult and adolescent pain management guideline, published in The Journal of the American Dental Association (JADA), is the second of two pain management guidelines developed by the American Dental Association Science & Research Institute (ADASRI), the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine.
Both guidelines came about from a grant awarded by the FDA to ADASRI and the University of Pittsburgh in 2020 to develop a clinical practice guideline for the management of acute pain in dentistry in children, adolescents, and adults.