Use of opioid analgesics after third molar extraction

a review of scientific literature


  • Isadora Soares Wilken Universidade Federal de Minas Gerais
  • Mauro Henrique Nogueira Guimarães de Abreu Universidade Federal de Minas Gerais



Analgesics, opioid, Tooth extraction, Surgery, oral, Anti-Inflammatory Agents


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.


Download data is not yet available.


Santos JAS, Silva LC, Santos TS, Menezes Júnior LR, Oliveira ACA, Brandão JR. Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery. J Craniomaxillofac Surg. 2012;40(8):694-700.

Isiordia-Espinoza MA, Pozos-Guillén AJ, Aragon-Martinez OH. Analgesic efficacy and safety of single-dose tramadol and non-steroidal anti-inflammatory drugs in operations on the third molars: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2014;52(9):775-83.

Souza CMRF, Aranega AM, Leal CR, Martinho J, Costa AR. Controle da dor pós-operatória em cirurgia bucal: revisão de literatura. Rev Odontol Araçatuba. 2005;26(2):56-62.

Swift JQ, Roszkowski MT. The use of opioid drugs in management of chronic orofacial pain. J Oral Maxillofac Surg. 1998;56(9):1081-5.

Courtney MJ, Cabraal D. Tramadol vs diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg. 2001;127(4):385-8.

DeJean KS, Santos IRM, Andrade FV, Souza LMA. Preemptive analgesia in dentistry. UEPG Biol Health Sci. 2008;14(2):23-30.

Gopalraju P, Lalitha RM, Prasad K, Ranganath K. Comparative study of intravenous Tramadol versus Ketorolac for preventing postoperative pain after third molar surgery --a prospective randomized study. J Craniomaxillofac Surg. 2014;42(5):629-33.

Perez-Urizar J, Martínez-Rider R, Torres-Roque I, Garrocho-Rangel A, Pozos-Guillen A. Analgesic efficacy of lysine clonixinate plus tramadol versus tramadol in multiple doses following impacted third molar surgery. Int J Oral Maxillofac Surg. 2014;43(3):348-54.

Costa FAA, Santana TS, Morais HH, Laureano Filho JR, Oliveira EDS, Vasconcellos RJ. Comparative analysis of preemptive analgesic effect of tramadol chlorhydrate and nimesulide following third molar surgery. J Craniomaxillofac Surg. 2012;40(8):e346-9.

Isiordia-Espinoza MA, Sánchez-Prieto M, Tobías-Azúa F, Reyes-García JG, Granados-Soto V. Pre-emptive analgesia with the combination of tramadol plus meloxicam for third molar surgery: a pilot study. Br J Oral Maxillofac Surg. 2012;50(7):673-7.

Isiordia-Espinoza MA, Sánchez-Prieto M, Tobías-Azúa F, Reyes-García JG. Pre-emptive analgesic effectiveness of meloxicam versus tramadol after mandibular third molar surgery: a pilot study. J Oral Maxillofac Surg. 2012;70(1):31-6.

Isiordia-Espinoza MA, Pozos-Guillén AJ, Martínez-Rider R, Herrera-Abarca JE, Pérez-Urizar J. Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery. Med Oral Patol Oral Cir Bucal. 2011;16(6):e776-80.

El-Sharrawy EA, El-Hakim IE, Sameeh E. Attenuation of C-reactive protein increases after exodontia by tramadol and ibuprofen. Anesth Prog. 2006;53(3):78-82.

Desjardins PJ, Black PM, Daniels SE, Bird SR, Petruschke RA, Chang DJ, et al. A double-blind randomized controlled trial of rofecoxib and multidose oxycodone/acetaminophen in dental impaction pain. J Oral Maxillofac Surg. 2007; 65(8):1624-32.

Díaz-González F, Sánchez-Madrid F. NSAIDs: learning new tricks from old drugs. Eur J Immunol. 2015; 45(3):679–86.

Becker DE. Pain Management: Part 1: Managing acute and postoperative dental pain. Anesth Prog. 2010;57(2):67–79.

Medve RA, Wang J, Karim R. Tramadol and acetaminophen tablets for dental pain. Anesth Prog. 2001; 48(3):79–81.

Edwards JE, McQuay HJ, Moore RA. Combination analgesic efficacy: individual patient data meta-analysis of single-dose oral tramadol plus acetaminophen in acute postoperative pain. J Pain Symptom Manage. 2002;23(2):121-30.

Pathan H, Williams J. Basic opioid pharmacology: an update. Br J Pain. 2012;6(1):11-6

nturrisi CE. Clinical pharmacology of opioids for pain. Clin J Pain. 2002;18(4 Suppl):S3-13.

Norman PH, Daley MD, Lindsey RW. Preemptive analgesic effects of ketorolac in ankle fracture surgery. Anesthesiology. 2001;94(4):599-603.

Shah AV, Arun-Kumar KV, Kumar-Rai K, Rajesh-Kumar BP. Comparative evaluation of pre-emptive analgesic efficacy of intramuscularketorolac versus tramadol following third molar surgery. J Maxillofac Oral Surg. 2013;12(2):197-202.

Abramson SB, Weissmann G. The mechanisms of action of nonsteroidal antiinflammatory drugs. Arthritis Rheum. 1989;32(1):1-9.

Dionne RA. Additive analgesic effects of oxycodone and ibuprofen in the oral surgery model. J Oral Maxillofac Surg. 1999;57(6):673-8.

Hochhaus G, Barth J, al-Fayoumi S, Suarez S, Derendorf H, Hochhaus R, et al. Pharmacokinetics and pharmacodynamics of dexamethasone sodium-m-sulfobenzoate (DS) after intravenous and intramuscular administration: a comparison with dexamethasone phosphate (DP). J Clin Pharmacol. 2001;41(4):425-34.

Becker DE. Basic and Clinical Pharmacology of Glucocorticosteroids. Anesth Prog. 2013;60(1):25-31

Golan DE, Tashjian Jr. AH, Armstrong EJ, Armstrong AW. Princípios de farmacologia. 3ª ed. Rio de Janeiro: Guanabara Koogan; 2014.

Agência Nacional de Vigilância Sanitária (Brasil). Portaria n.º 344, de 12 de maio de 1998. Aprova o Regulamento Técnico sobre substâncias e medicamentos sujeitos a controle especial. [acesso em 2017 June 20]. Disponível em:

Kraychete DC, Tesseroli JTS, Garcia JBS. Recomendações para uso de opioides no Brasil: parte I. Rev Dor. 2013;14(4):295-300.



How to Cite

Wilken, I. S., & Abreu, M. H. N. G. de. (2017). Use of opioid analgesics after third molar extraction: a review of scientific literature. Arquivos Em Odontologia, 53.




Most read articles by the same author(s)

<< < 1 2