Most postoperative dental pain is acute and typically accompanied by tissue injury and/or inflammation. The drugs of choice for postoperative dental pain are acetaminophen and nonsteroidal anti-inflammatory drugs, which act by inhibiting cyclooxygenase enzymes that are responsible for the formation of prostaglandins that promote pain and inflammation.
Year of United States Food & Drug (FDA) Approval of Common Opioid Analgesic Medications.
*Morphine and codeine were common in medical use before FDA was established. The dates given represent when morphine and codeine were first isolated.
Because opioid-based medications (Table 1) are not anti-inflammatory agents, medications such as hydrocodone, oxycodone, or codeine/tramadol are not considered the drugs of choice for treating most postoperative dental pain. Rather, these opioid analgesics should be reserved for when severe dental pain is anticipated. Whenever possible, clinicians should utilize OTC medications in a tiered approach based on the patient’s anticipated level of pain (Table 2) to provide effective nonopioid analgesic regimens.