New ADA guideline recommends NSAIDs to manage dental pain in adults, adolescents

Association previously published guidance on pediatric pain management

A new clinical practice guideline from the American Dental Association recommends nonsteroidal anti-inflammatory drugs taken with or without acetaminophen as first-line treatments for managing acute dental pain in adults and adolescents 12 and older.

The guideline, developed by the ADA with 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, is the cover story of the February issue of The Journal of the American Dental Association.

When used as directed, NSAIDs, such as ibuprofen and naproxen, on their own or in combination with acetaminophen can effectively manage pain after a tooth extraction or during a toothache when dental care is not immediately available, according to the guideline.

The guideline also offers recommendations for prescribing opioid medications in the limited circumstances in which they may be appropriate. These include avoiding “just in case” prescriptions, engaging patients in shared decision-making and exercising extreme caution when prescribing opioids to adolescents and young adults. The guideline also suggests clinicians advise patients on proper storage and disposal and consider any risk factors for opioid misuse and serious adverse events when prescribing opioids.

“It’s important to take special consideration when prescribing any type of pain reliever, and now, dentists have a set of evidence-based recommendations to determine the best care for their patients,” said Paul A. Moore, D.M.D., Ph.D., guideline senior author, chair of the guideline panel and professor emeritus at the University of Pittsburgh School of Dental Medicine. “Patients are encouraged to discuss pain management expectations and strategies with their dentist so they can feel confident that they are receiving the safest, most effective treatment for their symptoms.”

In 2020, the U.S. Food and Drug Administration awarded the ADA Science & Research Institute — now the ADA Forsyth Institute — and the University of Pittsburgh a three-year, $1.5 million grant to develop a clinical practice guideline for the management of acute dental pain in children, adolescents and adults. This guideline for adolescents and adults is the second of two guidelines. A previous set of recommendations for pediatric patients was published in the September 2023 issue of JADA. Both guidelines are available at ADA.org/painmanagement.

“Providing prescribing guidelines for acute dental pain management is an important step towards improving patient treatment and outcomes,” said Marta Sokolowska, deputy center director for substance use and behavioral health at the FDA’s Center for Drug Evaluation and Research. “We hope this clinical practice guideline will reduce the risk of opioid addiction, overdose and diversion.”

The ADA adopted a policy on opioids in 2018 that supports prescription limits and mandatory continuing education for dentists and builds on an earlier policy recommending dentists consider NSAIDs as the first-line therapy for acute pain. For more information on how the ADA is working to combat opioid abuse while continuing to help patients manage dental pain, visit ADA.org/opioids.

Other articles in the February issue of JADA discuss women in dental leadership positions, quality of dental care during pregnancy and postoperative pain after single-visit endodontic treatment.

Every month, JADA articles are published online at JADA.ADA.org in addition to appearing in the print publication. ADA members can access JADA content with their ADA username and password.

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