3. Utilization pattern of analgesic use

Drug utilization studies are useful quantitative tools for feedback information of analgesic use and for identifying the measures for quality improvement of dental pain therapy. There is an increase in the rate of prescription of analgesics. The most popular analgesic drug group is NSAIDs, followed by acetaminophen, while opioid analgesics are reserved for high intensity dental pain. There is an increase in the prescribing of opioid analgesics or their combination with nonopioid analgesics in nontraumatic dental condition-related visits with more severe pain in the emergency departments [22, 23]. In one recent published study with a large cohort of patients, opioids such as hydrocodone (78%), followed by oxycodone (15.4%), propoxyphene (3.5%) and codeine (1.6%) were reported to be the most frequently prescribed analgesics after surgical extraction of teeth which requires dental care.

However, recently different studies reported a drop by 5.6% in the prescribing of opioids [24, 25]. Taking this into consideration, more should be done to prevent opioid abuse and dentists play an important role in this regard, helping to minimize opioid abuse by careful patient education and appropriate prescribing practice [26]. In mild to moderate acute dental pain, acetaminophen and NSAIDs are the most appropriate choices. COX-2 inhibitors may be considered for patients at risk of gastrointestinal disease or those taking blood thinners such as warfarin. Also, prescribers must be aware to decrease the use of maximum recommended doses and advocate shorter duration of treatment [27]. Ibuprofen was found to dominate over other analgesics [28–31]. This also applies to pediatric dentistry, whereby ibuprofen and paracetamol predominate in prescription rates [32].

However, there are controversial studies, which show that diclofenac or paracetamol may offer improved benefits. Moreover, in patients undergoing third molar surgery, nimesulide followed by diclofenac, ketoprofen and ibuprofen were the most prescribed NSAIDs.

In general, this difference in prescribing may be influenced by different practitioners in different countries, less reported side effects of medications and their effectiveness in different indications [33, 34].
