Department of Diagnostic & Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Office of the Dean, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Expert Rev Clin Pharmacol. 2023 May;16(5):435-451. doi: 10.1080/17512433.2023.2206118. Epub 2023 Apr 26.
Extraction of impacted molar teeth is a common procedure performed by oral surgeons and general dentists, with postoperative pain being a significant adverse event post-surgery. If mismanaged, pain can lead to complications that impact oral and systemic health. The current scourge of the opioid epidemic has ushered in a new era of provider-directed analgesic (PDA) therapy in dentistry.
This article provides an in-depth review on the major pharmacological and therapeutic properties of established and alternative analgesics used to manage dental pain.
Substantial evidence-based literature shows a combination of a non-steroidal anti-inflammatory drug (NSAID; e.g. ibuprofen) and acetaminophen provides superior pain relief than single-agent or combination opioid regimens. However, there are clinical scenarios (e.g. severe pain) where a short-course opioid prescription is appropriate in select patients, for which a 2-3-day treatment duration is typically sufficient. Alternative agents (e.g. caffeine, gabapentin, phytotherapies), typically in combination with established agents, can mitigate postoperative dental pain. Some evidence suggests preemptive therapies (e.g. corticosteroids, NSAIDs) reduce amounts of postsurgical analgesic consumption and might lessen opioid prescription burden. In summary, this comprehensive review provides an opportune update on the evolving landscape of pharmacotherapy for acute postsurgical dental pain, informing best practices for PDA in the dental setting.
拔除阻生磨牙是口腔外科医生和普通牙医经常进行的一项操作，术后疼痛是手术后的一个重大不良事件。如果处理不当，疼痛可能会导致影响口腔和全身健康的并发症。目前，阿片类药物流行的泛滥带来了牙科领域中医生主导的镇痛（PDA）治疗的新时代。
本文深入综述了用于治疗牙科疼痛的已确立和替代镇痛剂的主要药理学和治疗特性。
大量基于证据的文献表明，非甾体抗炎药（NSAID；例如布洛芬）和对乙酰氨基酚的联合使用比单一药物或联合阿片类药物方案能提供更好的疼痛缓解效果。然而，在某些临床情况下（例如严重疼痛），对于某些特定患者，短期阿片类药物处方是合适的，通常治疗持续时间为 2-3 天。替代药物（例如咖啡因、加巴喷丁、植物疗法）通常与已确立的药物联合使用，可以减轻术后牙科疼痛。一些证据表明，预防性治疗（例如皮质类固醇、NSAID）可以减少术后镇痛药物的使用量，并可能减轻阿片类药物处方的负担。总之，这篇全面的综述提供了对急性术后牙科疼痛药物治疗不断发展的景观的及时更新，为牙科 PDA 的最佳实践提供了信息。
