ADA Issues Guideline for Managing Acute Dental Pain in Adults and Adolescents

First-line treatment of acute dental pain in adults and adolescents aged 12 years and older should include a nonsteroidal anti-inflammatory drug (NSAID) with or without acetaminophen, according to new guidelines endorsed by the American Dental Association (ADA).

Funded by a Food and Drug Administration-provided grant, the new clinical practice guideline for adults and adolescents was developed by the American Dental Association Science & Research 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. This is the second guideline the ADA created for managing acute dental pain; recommendations for pediatric patients were published in 2023.

According to the guideline, following surgical tooth extraction, a nonopioid analgesic such as naproxen 440mg or ibuprofen 400mg either alone or in combination with acetaminophen 500mg should be used as first-line treatment for short-term dental pain. In rare cases when pain control is not attained with the use of an NSAID and acetaminophen, an opioid analgesic (1 tablet combination of acetaminophen 325mg plus hydrocodone 5-7.5mg or oxycodone 5mg) may be added at the lowest effective dose and for the shortest duration possible (eg, max of 3 days). In cases where an NSAID is contraindicated, the panel recommends acetaminophen at its full therapeutic dose (1000mg) or 1 tablet of acetaminophen 325 plus an acetaminophen 325mg/opioid (hydrocodone 5-7.5mg or oxycodone 5mg) combination. 

For simple tooth extraction, the panel recommends against the use of opioid analgesics, favoring only the use of NSAIDs (naproxen 440mg, ibuprofen 400mg) alone or in combination with acetaminophen 500mg. If NSAIDs are contraindicated, the full therapeutic dose of acetaminophen (1000mg) should be used. 

Additional good practice statements outlined in the guideline include:

• Reviewing patient records thoroughly prior to prescribing to avoid potential drug interactions or the possibility of overdose in patients who have reported prior illicit or recreational drug use.
• Writing prescriptions for the minimum effective dose and for the shortest duration possible; routine use of “just-in-case” prescribing of opioids should be avoided.
• Counseling patients on appropriate storage and  disposal of opioids.
• Reviewing the state’s prescription drug monitoring program to determine if the patient is already being prescribed a controlled substance.
• Prioritizing the use of nonopioid analgesics for patients receiving opioids to manage chronic pain.

“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 Dr Paul Moore, DMD, PhD, MPH, the guideline’s senior author and panel chair and professor emeritus at the University of Pittsburgh’s 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.”

The full guideline is available here.