Background & Aims
Dental pain is the most common type of pain in human (1-3). Pain of dental pulp origin is the most common reason for a visit to hospital emergency rooms (4-6). Emergency treatments of such patient often involve invasive procedures (such as tooth extractions) likely resulting in additional acute pain (7, 8). Management of acute dental pain after dental surgeries remain challenging amid an ongoing opioid crisis (9, 10). We have recently eliminated opioids for acute pain after dental surgeries. We prescribed acetaminophen, ibuprofen or their combination for most of the patients, while some patients received a combination of gabapentin with either acetaminophen or ibuprofen when indicated (11). However, pain control outcomes and patient satisfaction in these patients were not known. The primary objective was to investigate patient-reported pain control outcomes and patient satisfaction among those received tooth extractions and non-opioid analgesics in a dental emergency center.
Methods
We conducted phone interviews with patients who received tooth extractions and prescription analgesics for acute dental pain within a 6-month period at our dental emergency center. Patients were queried about their pain intensity during the first week post-extraction, the amount of pain medication they consumed, whether they contacted or revisited the clinic due to pain, and their overall satisfaction with the treatment. Demographic and treatment-specific data, including patients’ age, gender, baseline pain levels, the nature of dental procedures (surgical versus routine tooth extractions), and the type of pain medications prescribed, were extracted from the dental electronic record system. We used bivariate analyses (ANOVA and Chi-square) and logistic regression to compare pain outcomes and patient satisfaction after the treatments and to investigate factors associated with the patient-reported pain outcomes in these patients.
Results
Among the 634 patients (mean age of 39 years, 50.3% females) interviewed, 221 (34.9%) underwent surgical and 413 received routine extractions; and 138 (21.9%) received acetaminophen, 55 (8.7%) ibuprofen, 361 (56.9%) acetaminophen and ibuprofen, 80 (12.6%) gabapentin with either acetaminophen or ibuprofen post-extraction. Baseline pain levels were uniformly high (mean 7.8, SD 2.1 on a 10-point scale), with no differences among patients receiving different medications. There were no significant differences in pain intensity, overall satisfaction, number of pain pills consumed, or patients contacting or returning to the clinic due to pain within the first week post-extraction across medication groups. While 124 (19.4%) patients reported no pain at all, 62 (9.8%) reported pain exceeding moderate levels, and only 51 (8.0%) consumed more than 12 pain pills post-extraction. Logistic regression revealed no association between pain intensity post-extraction and gender, baseline pain levels, or type of pain medication, but showed significant associations with age and type of extraction. Younger patients and those undergoing surgical extractions reported higher pain levels. Patients expressed high overall satisfaction (Median = 9 on a 10 point scale, IQR=2) with treatments.
Conclusions
A non-opioid analgesic approach incorporating acetaminophen, ibuprofen, or their combinations for the majority of patients, alongside combinations of gabapentin with either acetaminophen or ibuprofen for a specific subset of patients, proved effective in managing pain following both surgical and routine tooth extractions. Patients expressed high satisfaction with the non-opioid analgesics following tooth extractions. Nearly 20% reported experiencing no pain at all, while 92% of patients consumed no more than 12 pain pills within the first week after the procedure, indicating that a 3-day prescription of non-opioid analgesics sufficed for most patients. Younger individuals undergoing surgical extractions might benefit from the ibuprofen and acetaminophen combination medications, as they reported experiencing more pain during the initial week.
References
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Presenting Author
Yanfang Ren
Poster Authors
Yanfang Ren
DDS, PhD, MPH
Eastman Institute for oral Health, University of Rochester
Lead Author
Megha Sheth
BDS
Eastman Institute for Oral Health, University of Rochester Medical Center
Lead Author
Linda Rasubala
DDS
Eastman Institute for Oral Health, University of Rochester Medical Center
Lead Author
Eli Eliav
Eastman Institute for Oral Health, University of Rochester Medical Center
Lead Author
Changyong Feng
PhD
Department of Statistics and Computational Biology, University of Rochester Medical Center
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain