Suzetrigine (Journavx) for Acute Dental Pain: First Clinical Case Series of a Selective Naᵥ1.8 Inhibitor in Endodontics.

INTRODUCTION

Emergency dental pain remains a significant clinical challenge, with many patients experiencing moderate-to-severe pain that is inadequately controlled by non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. This is compounded by high rates of anesthetic failure in dental practices for cases with symptomatic irreversible pulpitis. Inflammation-driven upregulation of Naᵥ1.8 sodium channels contributes to persistent nociceptive signaling and local anesthetic failure. Suzetrigine (Journavx), a first-in-class selective Naᵥ1.8 inhibitor approved for acute moderate to severe pain, offers a mechanism-based approach by targeting the peripheral sodium channel driving inflammatory dental pain.

METHODS

This case series describes four patients treated at endodontic specialty practices who received suzetrigine for distinct acute pain scenarios: (1) augmentation of local anesthesia in a patient with symptomatic irreversible pulpitis and prior anesthetic failure, (2) management of preoperative emergency dental pain in a patient with symptomatic irreversible pulpitis refractory to conventional analgesics, (3) control of post-treatment inflammatory flare-up pain inadequately managed by NSAIDs and corticosteroids, and (4) management of post-surgical pain in a medically complex patient with Ehlers-Danlos syndrome for whom NSAIDs and corticosteroids were contraindicated. Suzetrigine was prescribed as a 100 mg oral loading dose, followed by 50 mg every 12 hours as needed.

RESULTS

Across all four cases, suzetrigine provided clinically meaningful reductions in pain intensity. In case 1, a single preoperative loading dose facilitated profound pulpal anesthesia and successful completion of nonsurgical root canal treatment on 2 teeth that had previously been refractory to multi-agent local anesthetic protocols. In case 2, suzetrigine consistently reduced pain from 6-8/10 to ≤2/10, effectively bridging the patient to definitive treatment over 6 days without opioid use. In case 3, suzetrigine in combination with ibuprofen and acetaminophen achieved complete symptom resolution of flare-up pain that had been inadequately controlled by high-dose ibuprofen, a corticosteroid dose pack, and antibiotics. In case 4, a single loading dose provided significant pain relief in a patient with contraindications to NSAIDs and corticosteroids. No adverse effects attributable to suzetrigine were reported in any case.

CONCLUSIONS

This case series provides the first clinical evidence for the use of suzetrigine in the management of acute dental pain thereby highlighting the role of Naᵥ1.8 in both preoperative and postoperative dental pain. Further investigation through randomized controlled trials to establish optimal dosing, combination strategies, and efficacy relative to conventional analgesic regimens is warranted.