Choice of analgesic for acute dental pain
When choosing an analgesic regimen for acute nociceptive dental pain, consider the severity of the patient’s pain and patient factors that may influence analgesic choice (see Factors that influence the choice of analgesics for acute dental pain).
- Is the pain mild, moderate or severe? Pain severity determines the most suitable analgesic regimen. When assessing pain severity, consider both patient-reported pain severity and the expected pain severity based on the cause of pain. For more information on assessing pain severity, see here.
- Consider potential adverse effects, and contraindications or precautions to analgesic use. These factors may influence analgesic choice (see Drugs used to treat acute pain in dentistry).
- Can the patient take medications orally? Oral administration is preferred. If this is not possible (ie if the patient has difficulty swallowing or gastrointestinal absorption is likely to be significantly reduced), consider suppositories or injections.
Although nonsteroidal anti-inflammatory drugs (NSAIDs) are preferred for acute nociceptive dental pain because they are anti-inflammatory, their adverse effect profile limits their use in some patients. Before prescribing an NSAID for a patient, determine whether NSAID use is appropriate based on their comorbidities and risk factors. If NSAID use is appropriate, ibuprofen is preferred because of good efficacy with limited toxicity, and widespread experience with its use. However, other NSAIDs have different safety profiles and may be preferred in some patients. See Nonsteroidal anti-inflammatory drug use in dentistry for guidance.
Paracetamol can be combined with an NSAID, or used alone in patients who cannot take NSAIDs.
Opioids can be used for acute nociceptive dental pain in adults, when nonopioid analgesics and nonpharmacological measures (eg dental treatment) have failed to provide adequate pain relief or are unlikely to do so (eg severe pain). Oxycodone is preferred; do not use codeine.
Combining analgesics from different classes can result in enhanced pain management, or synergistic analgesia (eg combining ibuprofen and paracetamol provides greater pain relief than either drug alone).