Relative efficacy of oral analgesics after third molar extraction.
OBJECTIVE
To compare the relative efficacy of analgesics after third molar extraction from systematic reviews of randomised, double blind studies.


METHODS
Dental trials from systematic reviews of randomised, double-blind studies of analgesics in acute pain.


METHODS
Number of patients with moderate or severe pain achieving at least half pain relief over 4 to 6 hours after a single oral dose of analgesic.


METHODS
Independently by two reviewers.


RESULTS
Use of dichotomous information from active and placebo treatments, first to calculate the statistical significance using relative risk, and then to evaluate the clinical relevance using number needed to treat (NNT). Non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase-2 (COX-2) inhibitors had the lowest (best) NNTs for the outcome of at least half pain relief over 4-6 hours compared with placebo. With the best performing analgesics, 50-70 patients out of 100 had good pain relief compared with about 10 out of 100 with placebo. Only paracetamol 600/650 mg plus codeine 60 mg was associated with any significant increase in any patient experiencing an adverse event.


CONCLUSIONS
NSAIDs and COX-2 inhibitors have the lowest (best) NNTs. They may also have fewer adverse effects after third molar surgery, though conclusive evidence is lacking. At least 80% of analgesic prescribing by UK dentists is in line with the best available evidence on efficacy and safety.
Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, Oxford OX3 7LJ, UK.
J
J
Barden
J E
JE
Edwards
H J
HJ
McQuay
P J
PJ
Wiffen
R A
RA
Moore
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000284:Administration, Oral; D000700:Analgesics / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D004311:Double-Blind Method; D004338:Drug Combinations; D006801:Humans; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic; D014081:Tooth Extraction / Q000009:adverse effects* / Q000706:statistics & numerical data
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D004338:Drug Combinations; D000082:Acetaminophen; D003061:Codeine