From the Research
For a patient with a severe toothache (7/10 pain) and an ibuprofen allergy, acetaminophen (Tylenol) is recommended as the first-line medication, typically at a dose of 650-1000 mg every 6 hours, not exceeding 4000 mg per day. This recommendation is based on the study by 1, which suggests that acetaminophen is a safe choice for relieving pain associated with orthodontic tooth movement, with no significant effect on prostaglandin synthesis.
The patient's allergy to ibuprofen necessitates avoiding all NSAIDs, including aspirin, naproxen, and celecoxib. Instead, acetaminophen can be used as a primary analgesic, and if the pain is not adequately controlled, a non-NSAID analgesic such as tramadol 50-100 mg every 6 hours can be considered.
Some key points to consider in managing this patient's pain include:
- Avoiding NSAIDs due to the patient's allergy
- Using acetaminophen as the first-line medication
- Considering tramadol as an adjunct if necessary
- Applying a cold compress to the affected area for temporary relief
- Using clove oil for its natural analgesic properties
It is essential to note that these measures are temporary, and the patient should seek dental care as soon as possible to address the underlying cause of the toothache, which may be an infection, abscess, or severe decay requiring professional treatment 2. Without addressing the root cause, pain will likely persist or worsen regardless of pain management strategies.