A Rutgers study shows acetaminophen and ibuprofen outperform opioids for pain relief after wisdom tooth removal, leading to better outcomes and supporting ADA guidance to avoid opioids as first-line treatment.
A study by Rutgers Health has found that a combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) is more effective at managing pain after wisdom tooth removal than opioids.
The trial, which included over 1,800 patients, revealed that those treated with the acetaminophen-ibuprofen combination reported less pain, improved sleep, and greater overall satisfaction compared to those who received hydrocodone with acetaminophen, an opioid-based pain relief option. This research could influence dentists to prioritize non-opioid pain management strategies for post-surgical care.
“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.”
Addressing Opioid Overprescription in Dentistry
Dentists, who rank among the nation’s leading prescribers of opioids, wrote more than 8.9 million opioid prescriptions in 2022. For many young adults, dental procedures such as wisdom tooth extraction are their first exposure to opioid medications.
“There are studies out there to show that when young people get introduced to opioids, there’s an increased likelihood that they’re going to eventually use them again, and then it can lead to addiction,” said study co-investigator Janine Fredericks-Younger, adding that opioid overdoses kill more than 80,000 Americans each year.
To compare opioid and non-opioid pain relief, the researchers conducted a randomized trial on patients undergoing surgical removal of impacted wisdom teeth, a common procedure that typically causes moderate to severe pain.
Half the patients received hydrocodone with acetaminophen. The other half got a combination of acetaminophen and ibuprofen. Patients rated their pain levels and other outcomes, such as sleep quality, over the week following surgery.
Results in The Journal of American Dental Association showed the non-opioid combination provided superior pain relief during the peak-pain period in the two days after surgery. Patients taking the non-opioid medications also reported better sleep quality on the first night and less interference with daily activities throughout recovery.
Key Findings: Non-Opioids Are Safer and More Effective
Patients who received the over-the-counter combo were only half as likely as the opioid patients to require additional “rescue” pain medication. They also reported higher overall satisfaction with their pain treatment.
“We feel pretty confident in saying that opioids should not be prescribed routinely and that if dentists prescribe the non-opioid combination, their patients are going to be a lot better off,” Feldman said.
The study’s size and design make it particularly notable. With more than 1,800 participants across five clinical sites, it’s one of the largest studies of its kind. It also aimed to reflect real-world medication use rather than the tightly controlled conditions of many smaller pain studies.
“We were looking at the effectiveness – so how does it work in real life, taking into account what people really care about,” said Feldman, referring to the study’s focus on sleep quality and the ability to return to work.
The findings align with recent recommendations from the American Dental Association to avoid opioids as first-line pain treatment. Feldman said she hopes they will change prescribing practices.
“For a while, we’ve been talking about not needing to prescribe opioids,” Feldman said. “This study’s results are such that there is no reason to be prescribing opioids unless you’ve got those special situations, like medical conditions preventing the use of ibuprofen or acetaminophen.”
Members of the research team said they hope to expand their work to other dental procedures and pain scenarios. Other researchers at the school are testing cannabinoids for managing dental pain.
“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, where we constantly refine our curriculum the light of science.”
Reference: “Nonopioid vs opioid analgesics after impacted third-molar extractions” by Cecile A. Feldman, Janine Fredericks-Younger, Paul J. Desjardins, Hans Malmstrom, Michael Miloro, Gary Warburton, Brent B. Ward, Vincent B. Ziccardi, Patricia Greenberg, Tracy Andrews, Pamela B. Matheson, Rafael Benoliel, Daniel H. Fine and Shou-En Lu, 4 January 2025, The Journal of the American Dental Association.
DOI: 10.1016/j.adaj.2024.10.014
The Opioid Analgesic Reduction Study was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research.
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4 Comments
You people need to stop lying! The dea has terrorized Dr’s for year’s and they’re too afraid to prescribe crucial medication. Did you know the study you based your argument for Tylenol and ibuprofen on had only 12 people in it? A proper double blind study or any type of research that holds medical value need’s at least 1000 people. There have been no studies to date that prove the efficacy of Tylenol and ibuprofen in post surgical care in lieu of not prescribing opiates. This unfounded torture that people are going through over addicts who make poor choices just to avoid an unlikely outcome, is ridiculous. We are treating an under 1% chance for addiction by making people suffer unnecessarily with out appropriate post operative pain management. They will not heal as well. It impacts their lives, jobs bodies, long term complications.
You try getting a dental implant and have someone tell you tylenol and ibuprofen should be fine. I am paying 8 grand for that tooth treat me correctly like you were taught in medical school or I’ll take my money else where. As soon as the numbing wore off I was screaming.
You people have some nerve!
Save the addict ,screw the patient! For fear that what? The one script of 10 pills will do it? Trust me, little Timmy was already doing something long before the dentist came along. Street drugs are a huge jump from taking medication as prescribed.
You people are spreading vile misinformation and people will suffer for it. Please consider the plight of the chronic pain patient who now suffers with no medication, liver and kidney damage from ibuprofen and Tylenol over use- which doesn’t come from opiates. Consider how our country cannot afford more people on disability but we keep forcing more people onto it. Cannabis is not a good replacement for pain medication. I tried for 8 year’s. I ended up quitting. It Isn’t affordable. If my insurance helped me or my state didn’t make costs impossible then maybe. There used to be a low copay and that’s gone. Cannabis has never helped my pain. Sleep maybe. If you dig up those studies, there aren’t many yet. They state it may help nerve pain better than gabapentin. Which is utter trash and dangerous. However, in order to utilize marijuana for pain you need specific product’s that may work for some people and are difficult to make. Formulations are not legal everywhere and costly.
Excellent comments about the state of so called “scientific research” when government funding is looking for certain outcomes.
How do they quantify the pain of a wisdom tooth extraction?
I had a single lower wisdom tooth removed and a few years later the other lower tooth.
Both were very painful and I found out that the nerve was wrapped around the my jaw according to the oral surgeon.
A few more years and I had both upper wisdom teeth removed at one time with comparatively little pain.
Again how did they quantify the expected pain response?
If I had been given the opoid for the lower extractions and was not aware of the nerve being wrapped around my jaw, and the Tylenol and ibuprofen for the upper extractions I certainly would have thought that Tylenol ibuprofen combination was superior!
Odd; that nowhere in this entire article do they show a percentage difference. They say “a marked difference” and use other descriptive words. But at no point do they show any numbers.
I have to agree with all of the other comments. One study is hardly proven science. Everytime I’ve had oral surgery, I’ve made sure that I get a prescription for opiods. That’s my backup plan in the even the OTC drugs don’t work. So far, I’ve never needed them.
The opiod crisis was caused by the pharmacetal industry and complicit doctors. It wasn’t caused by somebody getting a precription for opiods after oral surgery. Because of illegal activity, everybody else is supposed to have their access to pain medications restricted.
I’m not a big fan of Robert Kennedy, but he probably be looking into this.