Non-Opioid Pharmacological Management of Dental Pain

This article discusses the various non-opioid analgesics that are widely put into use in the management of dental pain that include non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. These medications are easy to get and one can readily acquire them without a prescription.

Running Head: NON-OPIOID PHARMACOLOGICAL MANAGEMENT OF DENTAL PAIN 1
Non-Opioid Pharmacological Management of Dental Pain
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NON-OPIOID PHARMACOLOGICAL MANAGEMENT OF DENTAL PAIN 2
Non-Opioid Pharmacological Management of Dental Pain
Non-opioid analgesics are medications that are used relieving pain and reducing
inflammation by limiting the production of inflammatory mediators. Non-opioid pain relievers
include the NSAIDs (non-steroidal anti-inflammatory drugs), selective COX-2 inhibitors and
also acetaminophen. For many years, it has been recorded that these non-opioid analgesics
have been used in the treatment of moderate to severe dental pain. There are various
formulations that contain non-opioid analgesics that are being used to treat dental pain such
as acetaminophen and NSAIDs. These products are widely put into use in dentistry and
have shown to demonstrate a great efficacy in relieving pain than when the individual
ingredient is used separately. The use of non-opioid product has been greatly utilized in
relieving dental pain since the opioid analgesics increases the risk of many adverse and
undesired side effects such as depression of the central nervous system, respiratory system
depression and also the risk of upsetting the gastrointestinal tract and therefore combining
various analgesics that contain non-opioid ingredients provides a suitable alternative in the
management of dental pain. This article will discuss the various non-opioid analgesics that
are widely put into use in the management of dental pain that include non-steroidal anti-
inflammatory drugs (NSAIDs) and acetaminophen. These medications are easy to get and
one can readily acquire them without a prescription but this does not mean that they have an
inferior ability in relieving dental pain (Labianca, Sarzi-Puttini, Zuccaro, Cherubino, Vellucci &
Fornasari, 2012).
Acetaminophen
Acetaminophen is also known as APAP which is an acronym of the chemical
component N-acetyl-p-aminophenol. Acetaminophen in some countries is commonly
referred to as paracetamol. This drug is a non-opioid and has analgesic as well as an
antipyretic activity that can be equated to that of aspirin, but much weaker anti-inflammatory
effects when compared to NSAIDs and aspirin. The exact mechanism of action of
acetaminophen is not well understood but it is believed that it has the same action as aspirin
and NSAIDs that involves the inhibition of prostaglandin production and synthesis. However,
it has been found that acetaminophen is more active in the CNS and may have multiple
mechanisms of action that are not well known. In relieving dental pain, acetaminophen is the
drug of choice especially for patients with contraindications to the use of NSAIDs and aspirin
(Pogatzki-Zahn, Chandrasena & Schug, 2014).
Acetaminophen is not a true anti-inflammatory agent but it has been found to be
much effective in the treatment of dental pain that results from inflammation. There are
various adverse effects associated with the use of acetaminophen in treating dental pain, the
most serious being drug-induced hepatotoxicity as a result of either an acute or chronic
overdose. When used as monotherapy, this drug has proved to be a good and effective
analgesic that reliefs post-operative pain after dental surgery to extract teeth especially the
molars. However, it is important to note that acetaminophen’s analgesic effect is limited
when used in high doses to relieve moderate and severe post-op pain that results from other
dental procedures. As stated above, acetaminophen is considered as a safe analgesic in
dentistry since it produces very few side effects at the usual adult doses. However, it has
been proven that in very high doses, acetaminophen usually interacts with warfarin hence
increasing the tendency of blood to clot and also raises the risk of one having longer
bleeding times after undergoing dental surgery (Moore & Hersh, 2013).

NON-OPIOID PHARMACOLOGICAL MANAGEMENT OF DENTAL PAIN 3
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs are believed to be among the world’s most used relievers of dental pain.
NSAIDs have a very elaborate mechanism of action that involves the inhibition of the
formation of cyclooxygenase-2, an enzyme that is responsible for the production and
synthesis of harmful prostaglandins that produces pain, inflammation, and fever. However,
NSAIDs also inhibit the synthesis and formation of cyclooxygenase-1 which is responsible
for the manufacture of the beneficial prostaglandins that are involved in the production of the
gastrointestinal tract mucous lining, maintaining adequate blood flow to the kidneys and
regulation of platelet activity. The adverse and therapeutic effects of NSAIDs are dose-
related hence the use of lower doses in a combination therapy is considered to be much
advantageous. Research done show that all the NSAIDs have the same ability to relieve
dental pain after dental surgery. For instance, ibuprofen which is one of the commonly used
NSAIDs given in 200mg and 400 mg doses has a great efficacy in relieving dental pain after
dental surgery. However, further studies done on NSAIDs has shown that ibuprofen has a
greater capability to relieve pain in patients having moderate to severe dental pain following
dental surgery and with exact side effects to placebo (Bryce, Bomfim & Bassi, 2014).
Conclusion
From the discussion above, it is evident that there are a couple of non-opioid
products that are pharmacologically used in the management of dental pain. The most
common and effective non-opioid agents that have been discussed include acetaminophen
and NSAIDs. These two agents have been greatly used in dentistry especially after dental
surgery to relieve dental pain and inflammation. Although these substances can be used as
monotherapies, there is a need to combine them so as to increase their efficacy and
minimize side effects when used to relieve dental pain and inflammation.

NON-OPIOID PHARMACOLOGICAL MANAGEMENT OF DENTAL PAIN 4
References
Bryce, G., Bomfim, D. I., & Bassi, G. S. (2014). Pre-and post-operative management of
dental implant placement. Part 1: management of post-operative pain. British dental
journal, 217(3), 123.
Labianca, R., Sarzi-Puttini, P., Zuccaro, S. M., Cherubino, P., Vellucci, R., & Fornasari, D.
(2012). Adverse effects associated with non-opioid and opioid treatment in patients
with chronic pain. Clinical drug investigation, 32(1), 53-63.
Moore, P. A., & Hersh, E. V. (2013). Combining ibuprofen and acetaminophen for acute pain
management after third-molar extractions: translating clinical research to dental
practice. The Journal of the American Dental Association, 144(8), 898-908.
Pogatzki-Zahn, E., Chandrasena, C., & Schug, S. A. (2014). Nonopioid analgesics for
postoperative pain management. Current Opinion in Anesthesiology, 27(5), 513-519.