{"doi":"10.1016/j.adaj.2024.10.014","title":"Nonopioid vs opioid analgesics after impacted third-molar extractions","abstract":"BACKGROUND: Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted. METHODS: To determine whether combination nonopioid analgesics are at least as good as opioid analgesics, a multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial was conducted, which examined patient-centered outcomes after impacted mandibular third-molar extraction surgery. Participants were randomized to receive 5 mg of hydrocodone with 300 mg of acetaminophen (opioid) or 400 mg of ibuprofen and 500 mg of acetaminophen (nonopioid). After an initial dose, analgesic was taken every 4 through 6 hours as needed for pain. RESULTS: In this randomized multisite clinical trial (n = 1,815 adults), those not taking opioids experienced significantly less pain (numeric rating scale ranging from 0 [no pain] through 10 [worst pain imaginable]) for first day and night (mean difference, -0.70; 95% CI, -0.94 to -0.45; P < .001) and second day and night (mean difference, -0.28; 95% CI, -0.52 to -0.04; P = .015), and experienced no more pain than participants taking opioids over the entire postoperative period (mean difference, -0.20; 98.75% CI, -0.45 to 0.05; P = .172). Participants not taking opioids had higher overall satisfaction at the postoperative visit (85.3% extremely satisfied or satisfied vs 78.9%; 95% CI, 1.21 to 1.98; P = .006). CONCLUSIONS: The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen. At no time did hydrocodone outperform the nonopioid. PRACTICAL IMPLICATIONS: Routine opioid prescribing after dental surgery is not supported. The results of this study confirmed the American Dental Association's recommendations that ibuprofen and acetaminophen in combination should be the first-line therapy for acute pain management. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04452344.","journal":"The Journal of the American Dental Association","year":2025,"id":515791,"datarank":0.4394938264490522,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.06675782898085209,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.06675782898085209,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":9,"citers_with_citation_signal":3,"citers_with_endowment":3,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9591,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04452344"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":832389,"name":"Janine Fredericks-Younger","orcid":"0000-0003-4500-5932","position":1,"is_corresponding":false},{"id":832390,"name":"Paul J. Desjardins","orcid":"0000-0002-5870-6546","position":2,"is_corresponding":false},{"id":351207,"name":"Hans Malmström","orcid":"0000-0003-2450-7650","position":3,"is_corresponding":false},{"id":832391,"name":"Michael Miloro","orcid":"0000-0002-0030-7411","position":4,"is_corresponding":false},{"id":832792,"name":"Gary Warburton","orcid":null,"position":5,"is_corresponding":false},{"id":714678,"name":"Brent B. Ward","orcid":null,"position":6,"is_corresponding":false},{"id":832793,"name":"Vincent B. Ziccardi","orcid":null,"position":7,"is_corresponding":false},{"id":247081,"name":"Patricia Greenberg","orcid":"0000-0001-6652-5019","position":8,"is_corresponding":false},{"id":247082,"name":"Tracy Andrews","orcid":"0000-0002-2926-390X","position":9,"is_corresponding":false},{"id":1128153,"name":"Pamela B. Matheson","orcid":null,"position":10,"is_corresponding":false},{"id":1380692,"name":"Rafael Benoliel","orcid":"0000-0002-2252-9066","position":11,"is_corresponding":false},{"id":467512,"name":"Daniel H. Fine","orcid":"0000-0001-6242-6451","position":12,"is_corresponding":false},{"id":284822,"name":"Shou‐En Lu","orcid":"0000-0002-0916-1842","position":13,"is_corresponding":false},{"id":832388,"name":"Cecile A. Feldman","orcid":"0000-0001-8004-4473","position":0,"is_corresponding":true}],"reference_count":76,"raw_metadata":null,"created_at":"2026-07-19T02:48:44.647022Z","pmid":"39755971","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}