背景:由美国牙科协会科学与研究所召集的小组,匹兹堡大学,和宾夕法尼亚大学进行了系统评价和荟萃分析,并制定了循证建议,用于简单和手术拔牙后急性牙痛的药物管理和临时管理(即,无法立即获得最终的牙科治疗)与青少年牙髓和根尖疾病有关的牙痛,成年人,和老年人。
方法:小组进行了4次系统评价,以确定阿片类和非阿片类镇痛药的效果,局部麻醉药,皮质类固醇,和局部麻醉药治疗急性牙痛。面板使用了“建议分级”,评估,开发和评估方法,以评估证据的确定性和建议的等级,评估,制定和评估决策证据框架,以制定建议。
结果:专家组使用现有的最佳证据制定了建议和良好实践声明。与阿片类药物相比,使用非阿片类药物存在有利的净平衡。特别是,与阿片类药物相比,非甾体类抗炎药单独使用或联合使用对乙酰氨基酚可能能更好地缓解疼痛,安全性更好.
结论:非阿片类药物是治疗拔牙后急性牙痛和临时治疗牙痛的一线疗法。当一线治疗不足以减轻疼痛或存在非甾体类抗炎药禁忌症时,应保留阿片类药物的使用。临床医生应避免常规使用阿片类药物的处方,并且在向青少年和年轻人处方阿片类药物时应格外谨慎。
A panel convened by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania conducted systematic reviews and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management (ie, definitive dental treatment not immediately available) of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults.
The panel conducted 4 systematic reviews to determine the effect of opioid and nonopioid analgesics, local anesthetics, corticosteroids, and topical anesthetics on acute dental pain. The panel used the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations, Assessment, Development and Evaluation Evidence-to-Decision Framework to formulate recommendations.
The panel formulated recommendations and good practice statements using the best available evidence. There is a beneficial net balance favoring the use of nonopioid medications compared with opioid medications. In particular, nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile than opioids.
Nonopioid medications are first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache. The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs. 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.