by Sharon M. Gordon, D.D.S., M.P.H., Ph.D.
July 23, 2024

When patients experience significant pain, they might think that an opioid is the most appropriate remedy. Like all dental professionals, I am concerned about the impact of these medications on a patient’s overall health.

That’s why I was honored to co-author a set of evidence-based clinical practice guidelines on safe and effective management of acute dental pain. The American Dental Association Science & Research Institute (now ADA Forsyth Institute), 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 convened an expert panel to develop these guidelines for dentists and other clinicians.

The two guidelines provide dental professionals with clear counsel for managing acute dental pain from extraction or a toothache in pediatric patients and adolescents, adults and older adults. Because these conditions both involve inflammatory pain, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, alone or in combination with acetaminophen, are appropriate, effective first-line therapies for patients of all ages. Other modalities, such as the local anesthetics bupivacaine or articaine, are additive to the use of NSAIDs alone or in combination with acetaminophen. These treatments have no abuse potential, making them a safe alternative to opioid medications.

The recommendations also offer clinicians best practices for prescribing opioids in the limited circumstances in which they may be appropriate. In most instances, they should be prescribed at the lowest effective dose, with the fewest tablets and for a short duration. The use of deferred prescribing (i.e., “just-in-case” opioid prescription for breakthrough pain) is not recommended. Clinicians should consider factors that could result in dependence or contribute to opioid misuse when prescribing opioids. Patients should also be instructed on proper storage and disposal of opioids and on the availability of naloxone for overdose.

Both guidelines are endorsed by the ADA and expand recommendations from the Centers for Disease Control and Prevention and the FDA Report on Evidence-based Opioid Analgesic Prescribing Guidelines.

To view both guidelines and additional downloadable resources, such as dosing guides, visit ada.org/painmanagement.

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Acknowledgement:

Development of the guidelines was in part supported by grant # U01FD007151 from the FDA and the Department of Health and Human Services (HHS) to Dr. Deborah E. Polk of the University of Pittsburgh School of Dental Medicine, the ADA Science and Research Institute, the ADA Council on Scientific Affairs and the Center for Integrative Global Oral Health at the University of Pennsylvania.

The contents of the guideline are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, the FDA, HHS or U.S. government.

Sharon M. Gordon, D.D.S., M.P.H., Ph.D., is professor and the inaugural associate dean for academic affairs and research at the Kansas City University College of Dental Medicine. She is a consultant to the ADA’s Council on Scientific Affairs and councilor for the Missouri Section of the American Association for Dental Oral and Craniofacial Research (AADOCR) where she coordinates judging for the AADOCR/DENTSPLY Student Clinician Research Program (SCADA).