Pain Relief After Wisdom Teeth Removal

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Over the counter painkillers worked well for mild to moderate pain after tooth extraction

August 20, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) After a person has their wisdom teeth pulled, pain management is the next step. Prescription painkillers alone may not be as effective as an over-the-counter combo.

In a recent review, dental health researchers looked at trials that tested different painkiller options for people after having had their wisdom teeth removed.

The results of the study showed that a combination of ibuprofen and acetaminophen relieved pain better than any single medication alone.

Even for severe pain, using these over-the-counter painkillers along with a small dose of an opioid painkiller worked better than the prescription painkiller alone.

"Talk to your dentist about safe OTC painkiller doses."

Paul A. Moore, DMD, PhD, MPH, Chair of the Department of Dental Anesthesiology at the University of Pittsburgh, led this investigation into effective pain management after people had their wisdom teeth removed. 

According to the study's authors, dentists typically prescribe over-the-counter (OTC) painkillers in addition to opioids like hydrocodone (found in combination with acetaminophen in the brand Vicodin) to treat pain after tooth extraction.

Opioid painkillers have the potential for misuse among patients. To control pain, a combination of OTC painkillers, or OTC painkillers and a small dose of an opioid painkiller, may be able to provide acceptable, if not better, pain management than opioids alone.

Previous research has found that the combination of an opioid painkiller and an OTC painkiller managed pain after having wisdom teeth pulled better than the opioid alone.

For this study, the researchers looked through 178 studies and clinical trials for information on prescription and OTC painkillers to treat pain after tooth removal.

The trials tested different doses and combinations of aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), acetaminophen (Tylenol), oxycodone, codeine and celecoxib (Celebrex).

Along with pain relief, ibuprofen has anti-inflammatory properties, and acetaminophen has fever-reducing properties.

Oxycodone and codeine are both prescription opioids. Naproxen and celecoxib both belong in the nonsteroidal anti-inflammatory drug (NSAID) category.

The researchers found that 400 milligrams of ibuprofen combined with 1,000 milligrams of acetaminophen provided better pain relief than 200 milligrams of ibuprofen and 500 milligrams of acetaminophen, 1,000 milligrams of acetaminophen alone or 400 milligrams of ibuprofen alone.

With several of the painkillers, certain risks may exist. The FDA warns against taking more than 4,000 milligrams of acetaminophen per day because of the risk for liver damage. The makers of Tylenol warn against taking more than 3,000 milligrams of acetaminophen per day.

Interactions with blood thinners may be a concern with ibuprofen or NSAIDs. Long-term use and/or high doses of ibuprofen or acetaminophen have been known to cause stomach trouble.

The researchers noted that people taking aspirin to protect against a heart attack might need to delay taking NSAIDs for 30 to 60 minutes after taking aspirin. NSAIDs may interfere with the heart-protective effects of aspirin.

Based on their findings, the researchers recommended the following:

  • For mild pain, 200-400 milligrams of OTC ibuprofen
  • For mild to moderate pain, 400-600 milligrams of ibuprofen
  • For moderate to severe pain, 400-600 milligrams of ibuprofen and 500 milligrams of acetaminophen
  • For severe pain, 400-600 milligrams of prescription ibuprofen, 650 milligrams of acetaminophen and 10 milligrams of hydrocodone

The study authors concluded that OTC painkillers effectively managed pain for patients after wisdom tooth extraction without increased risks of side effects. 

"This study provides a valuable strategy for patients to control their postoperative discomfort as effectively as narcotic pain medications can, but without the side effects," Mark Bornfeld, DDS, an actively practicing dentist and partner at DentalTwins in Brooklyn, NY, told dailyRx in an email. 

"Patients should take care to conform to the recommended dosages, and to consult with their dentists in situations when self-care does not provide sufficient pain control," Dr. Bornfeld, who was not involved with this study continued. 

This study was published in August in The Journal of the American Dental Association.

Dr. Hersh reported grant funding from Wyeth Consumer Healthcare to study ibuprofen formulations from 1999 to 2003. No other financial disclosures were made.