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Opioids Not First Line Dental Pain — MFDS Part 1 MCQ

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EasyPharmacologyOpioids Not First Line Dental PainMFDS Part 1

An otherwise healthy adult has acute inflammatory pain following an uncomplicated dental extraction. There are no contraindications to ibuprofen or paracetamol. Why should an opioid generally not be selected as first-line analgesia?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Ibuprofen, alone or with paracetamol, usually has a better efficacy–safety balance; opioids add dependence and respiratory-depression risks

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

A is correct. Acute pain after dental extraction is predominantly inflammatory, so ibuprofen is usually effective when it is not contraindicated; combining it with paracetamol can provide additional analgesia. Evidence from dental-extraction studies shows a better overall efficacy–safety balance for NSAIDs, with or without paracetamol, than for most opioid regimens. Opioids can provide analgesia, but introduce risks including sedation, constipation, dependence and respiratory depression, so they are not routine first-line treatment. They do not require concurrent antimicrobials, and UK dentists are not absolutely prohibited from prescribing an appropriate opioid. Opioids do not predictably cause dry socket through impaired clotting and do not antagonise amide local anaesthetics. Definitive treatment of the dental cause remains essential.

Reference: Miroshnychenko A et al. Acute Postoperative Pain Due to Dental Extraction in the Adult Population: A Systematic Review and Network Meta-analysis. Journal of Dental Research, 2023. https://pubmed.ncbi.nlm.nih.gov/36631957/ (consistent with SDCEP Management of Acute Dental Problems, Analgesia: https://www.acutedentalproblems.sdcep.org.uk/supporting-tools/analgesia/)