Pain Relief Without the Risks: Non-Opioid Combo Outperforms Opioids After Wisdom Tooth Surgery
A major U.S. clinical trial finds that ibuprofen plus acetaminophen manages post-surgery pain just as well or even better than hydrocodone, without the side effects or addiction risks.
The Opioid Problem in Dentistry
Opioid painkillers are still often prescribed after dental surgeries such as wisdom tooth removal. Yet leftover pills from these prescriptions can become the first step toward addiction—especially among young adults. Dentists are responsible for millions of opioid prescriptions each year, exposing around 5 million opioid-naïve patients annually.
To tackle this issue, researchers across five U.S. universities joined forces to test a safer alternative. Their goal: determine whether a non-opioid combination of ibuprofen (400 mg) and acetaminophen (500 mg) could match—or surpass—the pain-relieving power of the commonly prescribed opioid hydrocodone (5 mg) with acetaminophen (300 mg).
Inside the Landmark Study
The Opioid Analgesic Reduction Study, published in The Journal of the American Dental Association (JADA), was a large, multi-site, double-blind, randomized clinical trial.
Participants: 1,815 adults undergoing lower wisdom tooth (third-molar) extraction
Design: Patients were randomly assigned to either the opioid or non-opioid treatment group
Pain measurement: Participants recorded pain and satisfaction twice daily for several days post-surgery
What the Researchers Found
The results were striking:
Less pain with non-opioids: Patients taking ibuprofen plus acetaminophen experienced significantly less pain during the first two days after surgery than those taking hydrocodone.
Equal performance afterward: Over the entire recovery period, pain levels were similar between groups—proving non-opioids were not inferior to opioids.
Greater satisfaction: 85% of patients in the non-opioid group were satisfied with their pain control, compared to 79% in the opioid group.
Fewer side effects: Non-opioid users reported fewer problems like nausea, dizziness, or drowsiness.
Reduced opioid exposure: Participants taking non-opioids were less likely to seek or receive new opioid prescriptions later.
Importantly, hydrocodone never outperformed the non-opioid option at any time point.
Why This Matters
These findings reinforce the American Dental Association’s recommendation that ibuprofen and acetaminophen should be the first-line treatment for acute dental pain. With the U.S. still facing an opioid crisis responsible for over 80,000 deaths a year, studies like this provide critical evidence that pain can be safely managed without addictive drugs.
Lead author Dr. Cecile A. Feldman of Rutgers University emphasized that the results are “a call to end routine opioid prescribing after dental surgery.”
Takeaway
For most patients recovering from wisdom tooth removal, the best pain relief may already be in the medicine cabinet—a simple mix of over-the-counter ibuprofen and acetaminophen. This approach not only eases pain effectively but also helps prevent unnecessary opioid use and its devastating ripple effects on families and communities.
Reference:
Feldman, C. A., Fredericks-Younger, J., Desjardins, P. J., et al. (2025). Nonopioid vs opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial. Journal of the American Dental Association, 156(2), 110-123.