A combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) may change the way dentists treat post-operative pain, according to a Rutgers Health study.
The trial of more than 1,800 patients found that those taking the ibuprofen and acetaminophen combination experienced less pain, better sleep, and higher satisfaction than those taking the opioids hydrocodone and acetaminophen.
Dentists are among the top opioid prescribers in the U.S., writing more than 8.9 million opioid prescriptions in 2022. For many young people, a dental procedure like wisdom tooth removal is their first exposure to opioids.
“There are studies showing that when young people are exposed to opioids, they are more likely to use again, and then that leads to addiction,” said Janine Fredericks-Younger, a co-investigator on the study, adding that opioid overdoses kill more than 80,000 Americans each year.
To compare the pain relief of opioids and non-opioids, researchers conducted a randomized trial of patients undergoing surgery to remove impacted wisdom teeth, a common procedure that often causes moderate to severe pain.
Half of the patients took hydrocodone and acetaminophen. The other half took a combination of acetaminophen and ibuprofen. Patients rated their pain levels and other outcomes, such as sleep quality, for a week after surgery.
The non-opioid combination provided superior pain relief during the peak pain period two days after surgery, according to the findings in the Journal of the American Dental Association. Patients taking the non-opioids also reported better sleep quality on the first night and less disruption to their daily activities throughout recovery.
Patients who received the over-the-counter combination were only half as likely to need additional “rescue” pain medication as those who received opioids. They also reported greater overall satisfaction with their pain treatment.
“We can say with very high confidence that opioids should not be routinely prescribed, and that their patients fare much better if dentists prescribe a non-opioid combination,” Feldman said.
The study’s size and design are particularly striking. With more than 1,800 participants from five clinical centers, it’s one of the largest studies of its kind. It was also designed to reflect real-world medication use, rather than the tightly controlled conditions of many small pain studies.
“We looked at effectiveness—how it works in real life, taking into account issues that people really care about,” Feldman said, referring to the study’s focus on sleep quality and the ability to return to work.
The findings align with recent recommendations from the American Dental Association to avoid using opioids as first-line pain relievers. Feldman said she hopes they’ll change prescribing habits.
“For a while, we’ve been talking about not needing to prescribe opioids,” Feldman said. “The takeaway from this study is that unless you have a special situation, such as a medical condition that prevents you from taking ibuprofen or acetaminophen, it is not necessary to prescribe opioids.”
Members of the research team said they hope to expand the study to other dental procedures and pain conditions. Other researchers at the school are testing the role of cannabinoids in managing toothache.
“These studies guide us not only on how to improve current dental care, but also on how we can better train future dentists at Rutgers, where we are constantly improving our curriculum based on the science,” Feldman said.
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