Research shows that with an initial 10-day opioid prescription, which can be fairly common amongst health care practitioners, about 1 in 5 patients become a long-term user of opioids.2 “When a patient receives a one-day opioid prescription, the likelihood that they end up using opioids for a year or longer is 6%,” says Dr. Donaldson. “So clearly we need to move away from our dependence on opioids.” Dr. Donaldson says older guidelines recommended opioids for moderate to severe oral pain in children. “The use of these kinds of analgesics for postoperative pain or toothache has been contraindicated since 2017 by the Food and Drug Administration,”3 he says. “A report that same year showed that codeine and tramadol should not be given to children.”4 The recent ADA guideline was sponsored by 31 different governing bodies in dentistry, medicine and pediatrics. It gives recommendations for the pharmacological management of postoperative pain after one or more surgical or simple tooth extractions in children and recommendations for temporary pharmacological management of children’s toothaches. “Acetaminophen is an excellent analgesic,” says Dr. Donaldson. “NSAIDs, nonsteroidal anti‑inflammatory drugs, with ibuprofen as the most ubiquitous, are also outstanding for pain management. The third medication category that is recommended in some circumstances is corticosteroids, like dexamethasone, methylprednisolone and prednisone.” The first line treatment for both postoperative pain and toothache is ibuprofen. The second best is naproxen, though not for children under age 2. For those patients for whom a NSAID is contraindicated, acetaminophen is recommended.1 “Sometimes a combination of ibuprofen and acetaminophen is the best option,” says Dr. Donaldson. “They work on Access the full JADA guideline at: bit.ly/3U4fmGk different pain receptors and appear to have synergistic effects when used together.5” Both ibuprofen and acetaminophen are available in liquid formulations too, so they can be easily administered to children via a medi-cup or oral syringe. Dosing for these medications is weight-based and the new guideline evaluates doses of acetaminophen and NSAIDs that may differ from the dosing printed on overthe-counter packages. “I encourage dentists to read the ADA guideline,” Dr. Donaldson says. “It’s short, to the point, and, most importantly, a nice refresher on the benefits of what you may already be doing.” References 1. Carrasco-Labra A, Polk DE, Urquhart O, Aghaloo T, Claytor JW Jr, Dhar V and others. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children. J Am Dent Assoc. 2023 Sep;154(9):814-825.e2. 2. Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015 CDCWeekly March 17, 2017. 66(10);265–69. 3. FDA drug safety communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. US Food and Drug Administration. April 20, 2017. 4. FDA Drug Safety Podcast: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. US Food and Drug Administration. April 20, 2017. 5. Donaldson M, Goodchild JH. Utilizing synergism to maximize therapeutic effects of postoperative analgesics. Gen Dent. 2023 Jan-Feb;71(1):6–11. Watch a video conversation with Dr. Donaldson on CDA Oasis: bit.ly/3So6qul Sometimes a combination of ibuprofen and acetaminophen is the best option. They work on different pain receptors and appear to have synergistic effects when used together. 19 Issue 1 | 2024 | News and Events
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