Dental Surgery

SUPPORTING LITERATURE

Akinbade et al. 2022 (Level 1 evidence)

• DOI: 10.1403/njcp.ncjp_544_18
• RCT with 90 patients undergoing impacted third molar extraction randomized to receive either tramadol or celecoxib.
• Greater pain control and tolerability with celecoxib than with tramadol.

Freilich et al. 2020 (Level 3 evidence)

• DOI: 10.1016/j.joms.2020.02.032
• Survey was sent to 118 oral and maxillofacial surgeons and collected self-reported data on opioid prescribing patterns for dental extractions.
• 92% of respondents do not regularly prescribe opioids to their patients; opioids are prescribed regularly in small amounts (8-12 doses) for a select few invasive procedures, such as the placement of 6 or more dental implants.

Resnick et al. 2019 (Level 3 evidence)

• DOI: https://doi.org/10.1016/j.joms.2019.02.011
• Prospective cohort study of 81 patients who had asymptomatic third molars extracted at a single institution from June 2018- October 2018.
• Average number of oxycodone tablets used was 0.04 ± 0.24.
• Highest daily use of opioids was on POD2 (1.0 ± 0.0 tablet).
• Only 6 patients (7%) used opioids during the postoperative period (average of 3.3 tablets per patient).
• 93% used no postoperative opioids; 466 prescribed tablets remained unfilled or unused.
• Ibuprofen 600 mg was used by 89% for a mean of 4.6 ± 2.2 PODs; Highest daily use on POD2 (mean of 2.8 ± 0.8 tablets).
• Acetaminophen 650 mg was used by 86% for a mean of 3.4 ± 1.9 PODs; Highest daily use on POD2 (mean of 4.2 ± 1.8 tablets).
• Female patients took 8.9 times more postoperative analgesic medication than male patients.

Nalliah et al. 2020 (Level 3 evidence)

• DOI: 10.1001/jamanetworkopen.2020.0901
• Analyzed data from 329 patients who underwent a routine (174) or surgical (155) dental extraction procedure at a single institution between 1 June 2017- 31 December 2017.
• Routine extraction = required no conjunctive removal of bone of extraction of soft tissue because teeth were visible an above gum line.
• Surgical extraction = required an incision into the connective tissue to expose teeth.
• Surgical extraction: 70.3% were prescribed opioids and 51.6% used opioids after surgical extraction.
• Routine extraction: 49.4% were prescribed opioids and 39.1% used opioids after routine extraction.
• Opioid users were younger and more likely to be female.
• Of those that did not take an opioid, 61.3% used medications such as ibuprofen, celecoxib, or naproxen sodium and 33.3% used acetaminophen or NSAIDS to treat pain after leaving the dental clinic.
• Opioid group reported higher pain levels.
• No difference in satisfaction scores between opioid and nonopioid group.