Analgesic regimens for mild to moderate acute dental pain in adults
For factors that affect the choice of analgesic regimen, see here.
Nonopioid analgesics (NSAIDs and paracetamol) should be taken regularly, rather than as required, to achieve continuous pain relief.
If adjunctive analgesia is required for mild to moderate acute nociceptive dental pain (see Indications for analgesics for acute dental pain), use:
ibuprofen 400 mg orally, 6- to 8-hourly for the shortest duration possible and no more than 5 days without review dental pain, mild to moderate (adults) ibuprofen
PLUS
paracetamol 1000 mg orally, 4- to 6-hourly (to a maximum of 4 g in 24 hours) for the shortest duration possible. dental pain, mild to moderate (adults) paracetamol
Avoid fixed-dose combination products because they do not allow the daily dose of each drug to be maximised. As the tissue heals, stop ibuprofen and use paracetamol as a single drug.
If a COX-2–selective NSAID is preferred based on the patient’s risk factors (see Nonsteroidal anti-inflammatory drug use in dentistry), use:
celecoxib 100 mg orally, twice daily for the shortest duration possible and no more than 5 days without review dental pain, mild to moderate (adults) celecoxib
PLUS
paracetamol 1000 mg orally, 4- to 6-hourly (to a maximum of 4 g in 24 hours) for the shortest duration possible. paracetamol
As the tissue heals, stop celecoxib and use paracetamol as a single drug.
If NSAIDs are contraindicated (see Patients who should not be prescribed an NSAID by a dentist), use:
paracetamol 1000 mg orally, 4- to 6-hourly (to a maximum of 4 g in 24 hours) for the shortest duration possible. paracetamol
If analgesics are used after a surgical procedure that causes postoperative pain, inform the patient of the usual course of pain (eg pain is worst 48 to 72 hours after surgery, then improves). Advise the patient to return to the dentist for review if pain persists.