New Evidence-Based Guideline for Managing Acute Dental Pain Issued

USA: The University of Pennsylvania’s School of Dental Medicine, in collaboration with the American Dental Association (ADA) and the University of Pittsburgh, has issued a new evidence-based guideline for managing acute dental pain in adolescents, adults, and older adults. 

This guideline represents a significant shift in the approach to dental pain management, focusing on personalized strategies while mitigating risks, particularly for vulnerable populations such as adolescents.

Recommendations for Pain Management

According to Associate Professor Alonso Carrasco-Labra (pictured) from the Department of Preventive & Restorative Sciences, the guideline recommends clinicians use nonsteroidal anti-inflammatory drugs (NSAIDs) taken alone or with acetaminophen as the first line of treatment for managing short-term dental pain. 

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He states, “For managing acute postoperative dental pain in adolescents, adults, and older adults after surgical tooth extractions, the recommended approach is to use nonopioid analgesics as the primary treatment instead of opioid analgesics.”

Carrasco-Labra further explains, “The initial management should start with an NSAID, such as ibuprofen or naproxen, alone or combined with acetaminophen for enhanced pain relief.” In cases where pain control is insufficient with NSAIDs alone, a combination of acetaminophen with a low-dose opioid may be considered, but this should be limited to the shortest duration necessary, typically not exceeding three days.

Patient-Centered Approach

A key aspect of the new guideline is its emphasis on patient-centered care. Carrasco-Labra notes, “Clinicians are also encouraged to have conversations with their patients where they inform them to anticipate some level of discomfort and explain what it will feel like. 

The prescribed analgesics should make the pain manageable but also align with what the patient seeks in terms of associated risks. If they’re coming in for a procedure that will likely result in some mild discomfort, they need to be in the driver’s seat in determining the appropriate pain-management strategy.”

NSAIDs and Acetaminophen Recommended as First-Line Dental Pain Relief

The development of these recommendations followed a rigorous evidence-based approach. Carrasco-Labra, who has expertise in evidence-based medicine and guideline development, explains, “We conducted a primary study to characterize patients’ values and preferences regarding acute dental pain management strategies across different levels of pain intensity.” This study informed the creation of a values-and-preference statement, which was then used to guide the development of recommendations by a panel that included a patient partner.

Future Directions

The guideline’s currency will depend on the emergence of new evidence or the introduction of new analgesic options. Carrasco-Labra notes that future research will likely focus on the global application and local adaptation of such guidelines, ensuring they can be effectively implemented in diverse healthcare settings worldwide.

This project was supported by the U.S. Food and Drug Administration of the United States Department of Health and Human Services.

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