Nonopioid vs. Opioids for pain control

The Pain Control advantage of Nonopioid vs. Opioids Analgesics is now clearly established in 3rd molar extractions and, for me, by extension, in all dental procedure related pain.

Did You See This Article in The JADA Two Months Ago?

Nonopioid vs opioid analgesics after impacted third-molar extractions. CA Feldman, et al, JADA 2025:156(2):110-123

The Pain Control advantage of Nonopioid vs. Opioids Analgesics is now clearly established in 3rd molar extractions and, for me, by extension, in all dental procedure related pain.

For years I’ve had my DEA license but, in reality, probably only used it to prescribe opioids for pain control once, sometimes twice a year.

I rarely prescribed opioids. And that was especially true if the patient was in their late teens or their early 20s. That is the age when the cells in the human brain are the most vulnerable to opioids, and exposure at that age predisposes them to an increased risk of addiction for the rest of their lives.*

But also, I want to be sure, all of us want to be sure, that the patient has the best medication for pain control. Depending on when you graduated, we were intentionally** misled to believe, (by several pharmaceutical companies) that opioids are the strongest form of pain control medication. Opioids are NOT the strongest medication for dental inflammation-related pain. Essentially, all dental procedures and dental-sourced pain are inflammation-based.

Once again, reconfirmed by the above study, the nonopioids (ibuprofen and acetaminophen) have been clearly documented to be more effective at controlling dental pain than opioids. Plus they have less side effects and better patient acceptance than the opioids. For me that’s the winning trifecta of pain control. Or, if you prefer a basketball analogy, a winning Slam-Dunk for pain control.

Based on this study and others, there is little to no reason to prescribe opioids for pain control in dentistry for patients who are able to take nonsteroidal anti-inflammatory pain medication.

*Opioids can reduce pain, but they work at the central nervous system level. This is why they are more dangerous, especially for adolescents and young adults whose prefrontal cortex is not fully developed, impairing judgment (already an issue for teenagers and especially males in their teens and early 20s). Also, opioids, when taken at a young age, selectively stimulate the nucleus accumbens where we experience euphoria. This increases the long-term risk for addiction. Those who take an opioid before the 12th grade have a 33% increased risk of future opioid misuse, and if opioids are used prior to age 15, it increases the risk of substance use disorder by 550%!

THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE AND ADDICTION ...National Institutes of Health (NIH) (.gov) https://www.ncbi.nlm.nih.gov/books/NBK424849/

2. Prescription Opioids in Adolescence and Future Opioid Misuse. Richard Miech ✉, Lloyd Johnston ,Patrick M O’Malley ,Katherine M Keyes, Kennon Heard PMCID: PMC4834210 NIHMSID: NIHMS719212 PMID: 26504126

**1. Unraveling Purdue Pharmaceutical's role in the opioid crisis

Interconnected influence: Unraveling Purdue Pharmaceutical's role in the global response to the opioid crisis

NOTE: This Breaking Dental Drug News was written in conjunction with Thomas Paumier DDS, a nationally recognized lecturer on pain control and antibiotic use in dentistry

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