Nonopioids Superior to Opioids on Day 1 After Third Molar Extraction
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FRIDAY, Nov. 14, 2025 -- For patients undergoing impacted mandibular third molar extraction, nonopioid therapy provides superior pain control on day 1 and noninferior control to opioids on days 2 and 3, according to a research letter published online Nov. 6 in JAMA Network Open.
Janine Fredericks-Younger, D.M.D., from the Rutgers School of Dental Medicine in Newark, New Jersey, and colleagues conducted a multisite, noninferiority trial to compare the analgesic effectiveness of a nonopioid combination (ibuprofen 400 mg and acetaminophen 500 mg) with an opioid combination (hydrocodone 5 mg and acetaminophen 300 mg) for postoperative pain management after extraction of an impacted mandibular third molar.
Of the 1,815 participants, 909 received a nonopioid combination and 906 received an opioid. The researchers found that on day 1, nonopioids provided superior pain relief for females and males (mean difference, −0.63 and −0.75, respectively). Nonopioids were noninferior on days 2 and 3 and during the postoperative period, with all confidence intervals within the margin of noninferiority. The nonopioid group had higher patient satisfaction, with 82.8 and 87.8 percent of females and males, respectively, reporting being extremely satisfied in the nonopioid group compared with 76.2 and 81.6 percent, respectively, in the opioid group (odds ratios, 1.51 and 2.20 for females and males, respectively).
"We feel pretty confident in saying that opioids should not be prescribed routinely for dental procedures," Fredericks-Younger said in a statement. "Our nonopioid combination really should be the analgesic choice."
One author disclosed ties to the pharmaceutical industry.
Abstract/Full Text
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