Customized pharmacological approach to acute and post-operative dental pain control in Iran: guideline review and adaptation

Formulating a tailored clinical practice guideline is imperative for each country, necessitated by the refined considerations of medication availability, accessibility, and affordability. Hence, in this study, we aimed to investigate the clinical practice guidelines regarding acute and postoperative dental pain and customize them in prescribing analgesics for Iranian general dentists. The study employed a two-phase approach; a qualitative customization of dental pain management guidelines and a cross-sectional analytic phase. The qualitative phase involved assembling a panel of specialists and adapting existing guidelines to create customized flowcharts, along with a review of literature regarding relative guidelines. In the cross-sectional analytic phase, two questionnaires (one for each flowchart) were designed to build a consensus-based final guideline for Iranian dentists. Participants provided insights through questionnaires, assessing relevance and clarity. The Scale content validity index (S-CVI) and item content validity index (I-CVI) were assessed, with a threshold of 0.79 considered acceptable. Our search initially identified 763 articles and guidelines. After screening, 36 studies provided recommended strategies for acute dental and post-operative pain management. According to these studies and the available regimens in Iran, pain management was outlined in two flowcharts, A and B, addressing mild, moderate and severe pain levels. The lowest Item-level content validity index (I-CVI) was 0.93 and all items showed acceptable agreement regarding content validity. Scale-level content validity index (S-CVI) values reached 0.99 for flowchart A and B., indicating strong consensus among experts. Also, since all items showed acceptable agreement and were above the threshold value, the S-CVI/UA for the relevance and clarity in both flowcharts A and B were 100% among all experts in our study. Acetaminophen and ibuprofen are the drug of choice for dental pain. For more intense dental and post-operative dental pains a combination of these two drugs or their combination with opioids is recommended. In Iran, the only available opioid is codeine 10–20 mg that is combined with acetaminophen 300–325 mg, which is prescribed for severe dental pains. Naproxen can also be an effective alternative to ibuprofen.