Evidence-based clinical practice guidelines for the management of acute dental pain - related commentary

Sep 28, 2026

Uploaded by SANS

A commentary summarizes recommendations from a 2024 evidence-based clinical practice guideline for pharmacological management of acute dental pain tied to tooth extractions and toothache in emergency departments, hospitals, and urgent care settings when definitive dental treatment is not immediately available. A guideline panel evaluated opioid and non-opioid analgesics, local anesthetics (including blocks), corticosteroids, and topical anesthetics using the GRADE approach to support 18 recommendations and six good practice statements.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusion

Introduction

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
Am J Emerg Med. Author manuscript; available in PMC 2025 December 31. | | --- | --- | Published in final edited form as: Am J Emerg Med. 2025 March ; 89: 247–253. doi:10.1016/j.ajem.2024.12.054 . Evidence-based clinical practice guidelines for the management of acute dental pain Victoria G. Green, RDH, MPHa, Deborah E. Polk, PhDb,* , Michael A. Turturro, MDc, Paul A. Moore, DMD, PhDb, Alonso Carrasco-Labra, DDS, PhDd,1 a University of Pittsburgh, Department of Dental Hygiene, School of Dental Medicine, Pittsburgh, PA, USA b University of Pittsburgh, Department of Dental Public Health, School of Dental Medicine, Pittsburgh, PA, USA c University of Pittsburgh, Department of Emergency Medicine, School of Medicine, Pittsburgh, PA, USA dCenter for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA Abstract Objective: In the United States, on average, every 15 s, someone visits a hospital emergency department (ED) for a dental condition. This commentary summarizes the recommendations from a 2024 clinical practice guideline for the pharmacological management of acute dental pain associated with tooth extractions and toothache applicable to ED settings, hospitals, and urgent care clinics where definitive dental treatment is not immediately available. Methods: A guideline panel convened by the American Dental Association, the ADA Science & Research Institute, the University of Pittsburgh School of Dental Medicine, and Penn Dental Medicine examined the effect of opioid and non-opioid analgesics; local anesthetics, including blocks; corticosteroids; and topical anesthetics on acute dental pain. The GRADE approach was used to assess the certainty of the evidence; the GRADE Evidence-to-Decision Framework was used to formulate 18 recommendations and six good practice statements. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). *Corresponding author at: University of Pittsburgh, School of Dental Medicine, 3501 Terrace Street, Suite 6620, Pittsburgh, PA 16260, USA1 DrC., porra-pLtb.edura wa(Dst.Ehe. Polksenio)r. director, Department of Evidence Synthesis and Translation Research, American Dental Association Science and Research Institute, Chicago, IL, when part of the work described in this article was conducted. Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Deborah Polk reports financial support was provided by US Food and Drug Administration. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. CRediT authorship contribution statement Victoria G. Green: Writing – original draft. Deborah E. Polk: Writing – review & editing, Supervision, Project administration, Funding acquisition, Conceptualization. Michael A. Turturro: Writing – review & editing, Formal analysis. Paul A. Moore: Writing – review & editing, Formal analysis. Alonso Carrasco-Labra: Writing – review & editing, Funding acquisition, Conceptualization. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Green et al. Page 2 Results: A beneficial net balance favors the use of non-opioid medications compared with opioid medications. When not contraindicated, nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile compared with opioids. Conclusion: NSAIDs with or without acetaminophen are first-line therapy for managing acute dental pain following tooth extraction(s) and te

FAQs

What clinical settings and scenarios do these recommendations target?

The recommendations apply to EDs, hospitals, and urgent care clinics when definitive dental treatment is not immediately available, including pain related to tooth extractions and toothache.

How were the recommendations developed?

A guideline panel assessed opioid and non-opioid analgesics, local anesthetics, corticosteroids, and topical anesthetics, using the GRADE approach and the GRADE Evidence-to-Decision Framework to generate 18 recommendations and six good practice statements.

What is the recommended first-line therapy for acute dental pain?

NSAIDs with or without acetaminophen are recommended as first-line therapy after tooth extraction(s) and for temporarily managing toothache, while opioids should be reserved for situations where first-line therapy is insufficient or NSAIDs are contraindicated.

Sep 28, 2026

Uploaded by SANS