Use of opioid analgesics after third molar extraction: a review of scientific literature

Aim: This study aims to perform a literature review that reports on the use of opioid analgesics and their efficacy after extracting third molars, comparing them with other types of drugs. Methods: The search of articles in the PubMed database was carried out from 2006 to 2016, resulting in a total of 131 articles. Of these, 122 articles that did not report the use of opioids that were not from the Dentistry area, or that did not report the use of opioids after the extraction of third molars, were excluded. Literature reviews or non-comparative articles were also excluded. Thus, 9 articles were considered and incorporated into the review. Results: This review identified some clinical trials comparing the use of opioid analgesics with other drug options. From the trials comparing opioid analgesics with other NSAIDs (N = 3), with no drug combinations, NSAIDs proved to be more effective or, in the case of preemptive analgesia, had the same effect. Studies comparing the association of opioid analgesics with NSAIDs (N = 4) have shown that the association is more beneficial than the use of opioids alone. A single study that tested the association between opioids and corticosteroids has shown that this association is more effective than the association between opioids and NSAIDs. One study, which tested the association between opioids and paracetamol with NSAIDs concluded that the efficacy was similar between groups. Conclusion: Opioid analgesics are generally less effective than NSAIDs in controlling pain after the extraction of third molars. Its association with NSAIDs is recommended in some clinical situations. The use of opioids as the first choice seems to be restricted to patients with a contraindication to the use of NSAIDs.(AU)