What are the treatment guidelines for odontalgia (dental pain)?

From the Guidelines

For dental pain treatment, prioritize a biopsychosocial approach and seek professional dental care promptly, as dental pain typically indicates underlying issues like infection, decay, or trauma that require proper diagnosis and treatment. The management of dental pain should consider the patient's overall well-being, including potential co-morbidities such as depression and chronic pain elsewhere 1.

Key Considerations

• Dental pain can be extremely common and may co-exist with other conditions, making a comprehensive diagnosis crucial 1.
• The diagnostic criteria for orofacial pains can be found in the International Association for the Study of Pain (IASP) classification and the International Headache Classification, but a more practical approach may be to divide chronic pain into those with continuous or episodic pain and then unilateral or bilateral 1.
• Facial pain can be secondary to primary cancer or a metastasis from elsewhere, emphasizing the need for a thorough diagnosis 1.

Treatment Approach

• Over-the-counter medications like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) can be used for pain control, with the option to alternate for better relief 1.
• For moderate to severe pain, prescription-strength NSAIDs or a short course of opioids may be necessary, alongside topical anesthetic preparations like viscous lidocaine 2% or cocaine mouthwashes 2%–5% for severe oral discomfort 1.
• Antiseptic oral rinses, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, can help reduce bacterial colonization of the mucosa 1.
• Topical corticosteroids, like betamethasone sodium phosphate or clobetasol propionate 0.05%, can be used to reduce inflammation 1.

Recent Guidelines

• The most recent guideline from 2023 recommends a patient-centered approach, considering the balance of benefits, harms, and burdens of each intervention, with pain relief as the critical outcome 1.
• This guideline, developed using the GRADE approach, emphasizes the importance of individualized treatment plans that reflect typical and expected variations in patient values and preferences 1.

Conclusion is not needed, the above is the answer.

From the Research

Treatment Guidelines for Dental Pain

• The pharmacological management of dental pain involves the use of analgesic agents such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations 2.
• The dental impaction pain model (DIPM) has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain 2.
• Postsurgical dental pain follows a predictable trajectory over the course of one to 3 days and may be moderate to severe but typically resolves in a day or two after the extraction 2.

Recommendations for Managing Acute Dental Pain

• Nonopioid medications, such as NSAIDs alone or in combination with acetaminophen, are recommended as first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache 3, 4.
• Opioids should be reserved for clinical situations when first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs 3, 4.
• Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults 3.

Use of Antibiotics in Dental Pain Management

• There is limited evidence to support the use of antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess 5.
• The use of antibiotics may be associated with both benefits and harms, and further research is needed to determine their effectiveness and safety in dental pain management 5.

Appropriate Analgesic Prescribing

• Acetaminophen and NSAIDs continue to be the most appropriate choices for the treatment of mild to moderate acute dental pain 6.
• The use of selective cyclo-oxygenase (COX)-2 inhibitor NSAIDs may be considered for patients at risk of gastrointestinal sequelae or those taking blood thinners such as warfarin 6.
• Prescribers must be aware of the potential safety concerns associated with analgesic medications, especially in light of new information promoting lower doses, shorter treatment durations, and decreased maximum recommended doses 6.