Spotlighting the ADA’s Evidence-Based Clinical Practice Guideline for the Pharmacologic Management of Acute Dental Pain
Background:
In February 2024, a new evidence-based clinical practice guideline for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults was published in the Journal of the American Dental Association (JADA) Adolescent/Adult/Older Adult Guideline. A similar guideline focusing on acute dental pain management in children was published in the September 2023 issue of JADA Pediatric Guideline.
Both guidelines were developed by a panel of dental, medical, and pharmacological experts and included a patient partner that provided a patient’s perspective on experiencing acute dental pain. A methodological team from the American Dental Association Science and 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 guided the panel’s process in producing both guidelines.
Importance of the Adolescent / Adult / Older Adult Guidelines:
Based on the review of available evidence, the guideline panel recommended that the first line treatment approach is to use nonopioid analgesics instead of opioid analgesics due to nonopioid analgesics effectiveness and lower risk profile. This is especially important for vulnerable patient populations such as adolescents who are susceptible to opioid misuse. The guidelines go a step further and detail specific nonopioid first line treatments that clinicians can prescribe to their patients along with examples of dosages. These treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen taken alone or with acetaminophen. While the guidelines don’t exclude opioids entirely, they are to be considered only in limited circumstances like when nonopioid analgesic approaches are contraindicated. If prescribed, they should be limited to the shortest duration necessary, typically not exceeding three days. In addition, patients should be advised on proper storage and disposal and clinicians should consider any risk factors for opioid misuse and serious adverse events.
These guidelines stand out because they take into consideration not only alleviating short-term dental pain but doing so in alignment with the preferences and values of patients. Providers are encouraged to have conversations with their patients where they inform them to anticipate some level of discomfort as well as the risks and benefits of the various pain management approaches. When using this approach, providers can provide optimal care for their patients.
The contents of the guidelines are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, the FDA, U.S. Department of Health and Human Services or U.S. government.