Opioids or Non-Opioids: Which is Better For Tooth Removal?

Tooth removal is a common dental procedure. It is usually due to extensive decay on a molar, or a wisdom tooth due to overcrowding.

Tooth removal can be a painful procedure, and as a result, painkillers are commonly prescribed. These are often in the form of opioid medicines.

But at a time when the opioid epidemic is raging on, there have been calls to lessen the number of prescriptions written for opioids, in favour of over-the-counter medicines.

Now, research has been carried out to look at what is most effective for post-tooth removal pain – opioids or non-opioids [1].

Background

As mentioned, tooth removal is very common. Extensive tooth decay or wisdom tooth problems are the normal causes of this.

Extractions are normally carried out under local anaesthetic, but still commonly cause pain for a few days post-surgery.

Painkillers can largely be grouped into two areas – opioids and non-opioids. Non-opioids are typically available over the counter in supermarkets, convenience stores and pharmacies.

Typical non-opioids include paracetamol and ibuprofen. They are very cheap, and treat numerous ailments, from bad throats to headaches.

Meanwhile, opioids are high-strength painkillers. Well-known opioids include Morphine, Heroin, Hydrocodone and Oxycodone.

While opioids are effective for dealing with pain, there are a range of side effects attributed to them.

A significant issue is that while non-opioids are non-addictive, painkillers are addictive, with tolerance and dependence common. Furthermore, withdrawal symptoms are often seen.

Statistics regarding the opioid epidemic are concerning. Indeed, research has shown that the mortality rate of opioid addicts is up to 20 times higher than that of the general population [2].

Due to the potential harm of opioids, health organisations around the world have tried to lessen the number opioid prescriptions.

The Research

To carry out the research, a study was set up which involved over 1,800 patients [1]. These patients had all had a wisdom tooth removed.

Half of the patients were given a prescription for paracetamol and ibuprofen – with this group being the “non-opioid” group [1].

The other half were given a combination of hydrocodone and paracetamol [1]. Hydrocodone is an opioid. Therefore, this group was the “opioid” group.

The two groups were asked a range of questions regarding the first week post-removal. These questions were based around pain levels, sleep quality and general satisfaction.

The results showed that the non-opioid group had the best results [1]. The non-opioid group experienced the least pain in the 48 hours following the surgery – which is usually the most painful time.

Moreover, those in the non-opioid group had better sleep, and higher satisfaction with treatment. The results were conclusively in favour of non-opioids.

Overall, the results suggest that opioids are not necessary for post-tooth removal care. Due to the risks involved with opioids, this is quite a positive finding.

Non-opioids have a much lower risk profile, and do not risk addiction. Such research results may influence prescribing patterns for dentists going forward.

Summary

It is interesting to see such results. With the potential danger of opioids, it is positive to see evidence that safer alternatives are more effective.

The findings of the research were published in the highly respected Journal of the American Dental Association.

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