Rutgers study finds over-the-counter pain meds work as well as opioids for both men and women after tooth extraction
Over-the-counter pain medications are just as effective — and in some cases better — than opioids after wisdom tooth extraction for both men and women, according to a Rutgers Health-led study published in JAMA Network Open.
The new analysis builds on a landmark study involving more than 1,800 patients that found a combination of ibuprofen and acetaminophen provided greater pain relief and satisfaction than hydrocodone with acetaminophen following oral surgery. The follow-up subgroup analysis confirmed those benefits apply equally to both sexes.
“We wanted to determine whether the pain medication’s effects were consistent in males and females separately,” said Janine Fredericks-Younger, an associate professor at Rutgers School of Dental Medicine and lead author of the analysis. “And what we found is that in both subgroups (males and females), the non-opioid was superior for that first day and night, and then no worse than the opioid for the rest of the post-op period.”
Funded by an $11 million grant from the National Institutes of Health, the trial compared patients who received 400 milligrams of ibuprofen (Advil, Motrin) combined with 500 milligrams of acetaminophen (Tylenol) against those who received 5 milligrams of hydrocodone with acetaminophen.
Researchers emphasized the significance of studying gender-specific outcomes, as women often report higher pain levels after surgery.
“There’s obviously different biological mechanisms, different hormones involved,” said Cecile Feldman, dean of Rutgers School of Dental Medicine and senior author of both studies. “But results confirm that the analgesic effect for both groups is the same.”
Patients from five universities tracked their pain, sleep, daily activity, and satisfaction for nine days. On every measure, the over-the-counter combination matched or outperformed the opioid. Participants who took non-opioid medications reported better sleep and less interference with daily life, while those prescribed opioids were twice as likely to call back requesting additional medication.
“The results actually came in even stronger than we thought they would,” Feldman said. “We expected to find the non-opioid to be non-inferior, so that at least it was no worse than opioids. We were surprised to see that it was actually superior.”
Dental procedures are a common entry point for opioid exposure — dentists wrote more than 8.9 million opioid prescriptions in 2022.
“There are studies out there to show that when young people get introduced to opioids, as many have via wisdom tooth extraction, there’s an increased likelihood that they’ll eventually use them again, and then it can lead to addiction,” Fredericks-Younger said.
The research focused on the extraction of impacted wisdom teeth, a standard model for testing pain medications due to the moderate-to-severe pain it causes for about 48 hours. Feldman said the findings likely apply to other dental procedures but called for further studies across other types of surgeries.
Despite growing evidence, many dentists still prescribe opioids “just in case.” The next phase of Rutgers research will examine why those patterns persist.
“How can we now, with the evidence and the knowledge that we have, eliminate these prescriptions from being written?” Fredericks-Younger said.
The study’s findings align with American Dental Association recommendations to avoid opioids as first-line pain treatment.
“We feel pretty confident in saying that opioids should not be prescribed routinely for dental procedures,” Feldman said. “Our non-opioid combination really should be the analgesic choice.”
