Objective: To evaluate long-term changes in pain management strategies and assess the outcomes of opioids and non-opioid combination analgesics after dental extractions. Methods: This is a cross-sectional study of patients who received dental extractions and analgesic prescriptions in a large dental urgent care center in two 12-month periods: January 2012 to December 2012 (Year-2012) and March 2021 to February 2022 (Year-2022). Data extracted from electronic records include type of dental extractions, analgesics prescribed, and follow-up visits. The primary outcome was failure rate measured by the proportions of patients who returned to the clinic for management of pain after receiving dental extractions and analgesic prescriptions. Results: A total of 3,357 patients in Year-2012 and 3,785 patients in Year-2022 received analgesic prescriptions in conjunction with dental extractions. Combination analgesics were significantly higher in Year-2022 (62.5%) than in Year-2012 (34.9%) (RR=1.79, 95% CI 1.70-1.89. p<0.0001). Combinations analgesics were almost exclusively opioids and 1,166 patients, or 34.7%, received opioids in Year-2012, compared to none received opioids, 49.4% received ibuprofen/ acetaminophen and 13.1% received gabapentin combinations in Year-2022. After surgical extractions, a majority were prescribed opioids (52.4%), followed by ibuprofen (46.2%) in Year-2012. In contrast, a majority received ibuprofen/acetaminophen (56.2%) or gabapentin combinations (17.3%) in Year-2022. Ibuprofen/acetaminophen had a failure rate (2.2%) lower than gabapentin combinations (4.4%) (RR=0.50, 95%CI 0.31-0.83. p=0.01), or opioid combinations (21.4%) (RR=0.10, 95%CI 0.08-0.14. p<0.0001). Failure rate for gabapentin combinations was lower than opioids (RR=0.21, 95%CI 0.14-0.31. p<0.0001). Conclusions and Relevance: This study showed a paradigm shift from opioids and single medication analgesics to non-opioids and combination analgesics with ibuprofen, acetaminophen and gabapentin as components in prescribing for pain after dental extractions, which presents an opportunity to minimize or eliminate our reliance on opioids for dental pain.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Research Subject Review Board of University of Rochester Medical Center gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All data produced in the present work are contained in the manuscript