South Middlesex Times

A recent study conducted by Rutgers Health has found that a combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) is more effective in managing pain after wisdom tooth removal than opioids. This research could influence how dentists address post-surgical pain management.

The trial involved over 1,800 patients and revealed that those who received the non-opioid combination experienced less pain, improved sleep, and higher satisfaction compared to those given hydrocodone with acetaminophen. "We think this is a landmark study," said Cecile Feldman, dean of Rutgers School of Dental Medicine and lead author of the study. "The results actually came in even stronger than we thought they would."

Dentists are among the leading prescribers of opioids in the United States, with over 8.9 million prescriptions written in 2022. Many young adults encounter opioids for the first time during dental procedures such as wisdom tooth extraction. Study co-investigator Janine Fredericks-Younger noted that opioid overdoses result in more than 80,000 deaths annually in the U.S.

The researchers conducted a randomized trial on patients undergoing surgical removal of impacted wisdom teeth, which typically causes moderate to severe pain. Half of the participants received hydrocodone with acetaminophen while the other half were given a combination of acetaminophen and ibuprofen. Patients assessed their pain levels and other outcomes like sleep quality during the week following surgery.

Results published in The Journal of American Dental Association indicated that the non-opioid combination provided better pain relief during peak-pain periods within two days post-surgery. Additionally, patients reported better sleep quality on the first night and less interference with daily activities throughout recovery.

Patients who used the over-the-counter combo were only half as likely to need additional "rescue" pain medication compared to those who took opioids. They also expressed higher overall satisfaction with their treatment.

"We feel pretty confident in saying that opioids should not be prescribed routinely," Feldman stated, suggesting that dentists opt for non-opioid combinations for better patient outcomes.

The study's large size and design make it significant, involving more than 1,800 participants across five clinical sites. It aimed to reflect real-world medication use rather than controlled conditions typical of smaller studies. "We were looking at effectiveness – so how does it work in real life," said Feldman regarding their focus on sleep quality and return-to-work capability.

These findings support recent recommendations from the American Dental Association against using opioids as first-line treatment for pain relief. Feldman hopes this will change prescribing practices: "This study’s results are such that there is no reason to be prescribing opioids unless you've got those special situations."

Researchers aim to extend their work to other dental procedures and scenarios involving pain management. Other studies at Rutgers are exploring cannabinoids for dental pain relief.

“These studies not only guide us on how to improve current dental care,” said Feldman, “but also on how we can better train future dentists here at Rutgers."

The Opioid Analgesic Reduction Study was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research.