A new study from Rutgers Health indicates that a combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) is more effective at managing pain following wisdom tooth removal compared to opioid-based painkillers. The randomized trial, involving over 1,800 patients, revealed that the acetaminophen and ibuprofen combination led to reduced pain, better sleep quality, and increased patient satisfaction. These findings, published in The Journal of American Dental Association, could significantly alter how dentists approach post-surgical pain management.
The research directly compared the efficacy of hydrocodone with acetaminophen to a combination of acetaminophen and ibuprofen in patients undergoing surgical removal of impacted wisdom teeth. This procedure commonly results in moderate to severe pain, making it an ideal model for assessing analgesic effectiveness. Patients self-reported their pain levels and sleep quality over the week following the surgery.
The results indicated that the non-opioid combination provided superior pain relief, particularly during the peak-pain period in the first two days after surgery. Furthermore, patients in the acetaminophen and ibuprofen group reported better sleep quality on the first night and experienced less interference with their daily activities throughout the recovery period. Notably, patients receiving the non-opioid combination were half as likely to require additional "rescue" pain medication, and they expressed higher overall satisfaction with their pain treatment.
According to Cecile Feldman, dean of Rutgers School of Dental Medicine and lead author of the study, "We feel pretty confident in saying that opioids should not be prescribed routinely and that if dentists prescribe the non-opioid combination, their patients are going to be a lot better off." Feldman emphasized that the study's findings suggest there is little justification for prescribing opioids routinely for post-dental surgery pain, except in specific cases where medical conditions preclude the use of ibuprofen or acetaminophen.
The study's robust design, including a large sample size across five clinical sites, strengthens the validity of its conclusions. The researchers also focused on real-world effectiveness, considering factors such as sleep quality and the ability to return to work, which are important to patients' overall recovery experience. As Feldman noted, "We were looking at the effectiveness – so how does it work in real life, taking into account what people really care about."
The findings align with recent recommendations from the American Dental Association to avoid opioids as a first-line treatment for pain. Given that dentists are among the leading prescribers of opioids, these results have significant implications for reducing opioid exposure, especially among young adults who may be undergoing their first experience with such medications. Janine Fredericks-Younger, study co-investigator, highlighted the risk of opioid introduction, stating, "There's an increased likelihood that they're going to eventually use them again, and then it can lead to addiction."
Researchers hope to expand their work to other dental procedures and pain scenarios, with ongoing investigations into the use of cannabinoids for managing dental pain. These efforts aim to refine dental care practices and improve the training of future dentists, ensuring they are equipped with the latest scientific evidence to provide optimal patient care.
