Following wisdom tooth removal, pain management is important. Painkillers typically play a role post-surgery. Recent research has looked at which is most effective – opioids or non-opioids. This research is helpful, and can advise dentists on the most effective method of treating post-surgery pain.
As many people can attest to, wisdom tooth removal can be challenging. It typically involves pain and normally requires a few days for recovery.
Managing the pain involved in wisdom tooth removal is important. There are many different painkillers available, from over-the-counter medicines to prescription only pills.
Those that are recovering from wisdom tooth removal will often choose between opioids and non-opioids. Many believe that due to the strong nature of opioids, that they are more effective.
However, this may not actually be the case. Now, new research has looked into which is more effective for post-surgical pain – opioids or non-opioids [1].
Wisdom Tooth Removal
Wisdom tooth removal is a very common dental procedure. Most humans have four wisdom teeth – which develop later than the rest of the teeth.
They are the teeth furthest to the back of the mouth, and are commonly referred to as the “third molars.” They usually grow during teenage years [2].
Wisdom teeth often require no treatment at all, and just naturally exist. However, this is not always the case. Sometimes, wisdom teeth do not grow properly.
For example, the tooth might not have enough space to come into the mouth fully, or they may be partly covered by the gums. Problems with wisdom teeth can cause pain, gum disease and tooth decay [2].
While wisdom tooth removal is very straightforward, it can cause pain post-procedure. Therefore, pain management is important to ensure comfort during recovery.
Pain management
Non-opioid painkillers are typically available over the counter. For example, these include Acetaminophen (Tylenol) and Ibuprofen (Advil).
While taking these painkillers daily in the long-term isn’t advisable, they are very effective at treating a range of conditions. These include headaches, colds, sore throats and dental pain.
These painkillers are not addictive, and side effects are rare. However, this is completely different for opioid painkillers.
Opioids are high-strength painkillers. Well-known opioids include Morphine, Hydrocodone and Oxycodone. Unfortunately, they cause a range of side effects, and are addictive [3].
In fact, research shows that the mortality rate of opioid addicts is approximately 6 to 20 times higher than that of the general population – underlining the potential harm [3].
The United States has been battling an opioid epidemic in recent years. In 2017, President Donald Trump declared the epidemic as a public health emergency [4]. Problems have continued in subsequent years.
Due to their potential harm, health organizations have made recommendations against their use in many cases. However, dentists rank among the leading prescribers of opioids.
The Research
The research was carried out by a team from Rutgers School of Dental Medicine. Their findings have been published in the Journal of the American Dental Association [1].
Following wisdom tooth removal, dentists often provide their patients with a prescription for opioids. In fact, 8.9 million opioid prescriptions were written in 2022 by dentists in the United States [1].
For many patients, when being prescribed an opioid for dental pain, this will be their first introduction to these medicines. As discussed earlier, they have a high potential for abuse.
The research involved more than 1,800 patients [1]. These patients all had a wisdom tooth removed, before being split into two groups.
The first group were prescribed a combination of acetaminophen and ibuprofen. Meanwhile, the second group were prescribed the opioid hydrocodone and acetaminophen [1].
The patients were asked to rate various outcomes – including pain levels, sleep quality and general satisfaction – over the week post-surgery [1].
Interestingly, the results overwhelmingly found that non-opioids were more effective in the vast majority of situations [1].
Pain is at its highest in the two days immediately after surgery. The non-opioid group reported less pain during this period [1].
Throughout the week, those in the non-opioid group reported better sleep quality and less interference with daily activities during the week [1].
Moreover, the patients in the opioid group had double the chance of requiring a “rescue” pain medication when compared to the non-opioid group [1].
Overall, those in the non-opioid group experienced less pain, better sleep, and higher satisfaction with treatment. Therefore, the findings produced very clear results.
Author comments
The findings suggest that opioids are not necessary for the post-surgery treatment of wisdom tooth removal. Due to the risks associated with opioid use, this is a very positive conclusion.
By only prescribing non-opioids, this can reduce the risk of addiction to these powerful painkillers. Non-opioids are also typically significantly cheaper.
This is also consistent with the American Dental Association’s recommendation for dentists to avoid opioids as a first-line pain treatment for opioids [5].
Cecile Feldman is the dean of Rutgers School of Dental Medicine, and served as the lead author of the study. She was delighted with the findings, calling it “a landmark study” [5].
Continuing, Feldman said that “the results actually came in even stronger than we thought they would” [5]. Moreover, Feldman exclaimed that the study’s results show “there is no reason to be prescribing opioids” outside of “special situations” [5].
The researchers hope that these findings will result in change occurring in the prescribing practices of dentists. Prescribing non-opioids is safer, and as the research here has showed – is more effective.
Furthermore, the researchers are hoping to carry out further studies into dental pain. For example, they will be looking to see if the same results apply to other dental procedures, like root canal treatments [5].
Thinking points…
1) Are you concerned about your wisdom teeth? Maybe they haven’t grown properly, food is getting stuck near them, or you have pain in the area. If so, you should mention this to your dentist at your next check-up, so that they can take a look at the area. We recommend visiting the dentist at least twice per year. We recommend making an appointment now!
2) Do you know anyone that has an upcoming tooth extraction? If so, you could send this article to them. This article is useful as it can show them that they should opt for a non-opioid pain management schedule. This would help to keep them safe and help them to recover more effectively. Why not send the article now!
What we offer at Savanna Dental
Savanna Dental is a dental clinic based in Calgary, Alberta, Canada. We provide our patients with a range of treatment options and advice, with the aim of improving oral health and boosting overall wellbeing!
We advise our patients to attend our Calgary-based dental clinic twice a year for a dental check-up. If any problems are detected, we have many treatments available. For instance, these include cavity fillings and root canals. To try and prevent problems, it is important to brush your teeth at least twice a day and floss regularly.
Here at Savanna Dental, we also have some cosmetic treatments available! These include dental implants, tooth whitening and Invisalign™! Our patients find that these treatments have a positive impact on their appearance, confidence and self-esteem.
In addition, the fees of our services at our Calgary dental clinic Savanna Dental are set in line with the Alberta Dental Fee Guide.
We would love you to visit our Savanna Dental clinic in Calgary! You can find out more about us by visiting our website https://savannadentalclinic.ca/!
References
[1] Feldman, C. A., Fredericks-Younger, J., Desjardins, P. J., et al. (2025). Nonopioid vs opioid analgesics after impacted third-molar extractions. The Journal of The American Dental Association. (Pre-publication issue). DOI: https://doi.org/10.1016/j.adaj.2024.10.014.
[2] NHS. (2024). Wisdom tooth removal. Available: https://www.nhs.uk/conditions/wisdom-tooth-removal/. Last accessed: 11th January 2025.
[3] Hser, Y-I., Evans, E., Grella, C., Ling, W., & Anglin, D. (2015). Long-Term Course of Opioid Addiction. Harvard Review of Psychiatry. 23 (2): p76-89. DOI: https://www.doi.org/10.1097/HRP.0000000000000052.
[4] Oliphant, J. (2017). Trump declares national emergency on opioid abuse. Available: https://www.reuters.com/article/us-usa-trump-opioid-idUSKBN1AQ2AW. Last accessed: 11th January 2025.
[5] Smith, A. (2025). Non-opioid pain relievers beat opioids after dental surgery, trial shows. Available: https://medicalxpress.com/news/2025-01-opioid-pain-relievers-opioids-dental.html. Last accessed: 11th January 2025.
