What is the best pain medication for dental pain?

Best Pain Medication for Dental Pain

NSAIDs, particularly ibuprofen, are the first-line treatment for dental pain due to their superior analgesic and anti-inflammatory effects compared to other analgesics. 1

First-Line Treatment: NSAIDs

Ibuprofen

• Recommended dose: 400mg every 4-6 hours (not exceeding 3200mg/day) 1, 2
• Provides both analgesic and anti-inflammatory effects
• Consistently more effective than aspirin 650mg, acetaminophen 600mg, and both aspirin and acetaminophen when combined with codeine 60mg 3
• Has faster onset of action with greater peak and overall analgesic effect than acetaminophen 4, 5
• Mode of action related to prostaglandin synthetase inhibition 2

Other NSAIDs

If ibuprofen is contraindicated, consider other NSAIDs such as:

• Naproxen (250-500mg)
• Diclofenac
• Ketoprofen (25-75mg)

Second-Line Treatment: Acetaminophen (Paracetamol)

• Dose: 500-1000mg every 4-6 hours (not exceeding 4000mg/day) 6
• Less effective than ibuprofen for dental pain 4, 5
• Consider when NSAIDs are contraindicated
• Acetaminophen appears to reach an analgesic ceiling effect at 1000mg 7

Combination Therapy

For moderate to severe dental pain:

• Combining NSAIDs with acetaminophen can provide enhanced analgesia through different mechanisms of action
• Adding codeine 60mg to acetaminophen 1000mg offers additional analgesic advantages 7, but should only be considered after maximizing non-opioid options 6

Cautions and Contraindications

NSAID Precautions

• Use with caution in patients with:
  • History of GI bleeding or ulcers
  • Severe renal impairment
  • Heart failure
  • Third trimester of pregnancy
  • Allergy to aspirin or NSAIDs 1
  • Cardiovascular disease 6

Opioid Considerations

• Opioids should only be considered when:
  • Non-opioid options have been maximized
  • Pain is severe enough to warrant opioid therapy
  • Benefits are anticipated to outweigh risks 6
• If prescribed, limit to the shortest duration possible (typically ≤3 days) 1
• Prescribe as "as needed" rather than on a scheduled basis 6

Special Populations

Pregnant and Postpartum Patients

For postpartum dental pain:

• First-line: Acetaminophen or NSAIDs
• If needed, add low-dose, low-potency, short-acting opioids for the shortest reasonable course 6

Important Clinical Considerations

1. Definitive Treatment: Analgesics should be used as an adjunct to definitive dental treatment, not as a substitute 1

2. Timing: For predictable pain (e.g., after dental procedures), administer analgesics before pain becomes severe

3. Monitoring: Watch for adverse effects, particularly GI issues with NSAIDs

4. Common Pitfall: Underdosing NSAIDs - the optimal analgesic dose of ibuprofen for dental pain is 400mg, not the OTC recommendation of 200mg 3, 5

5. Duration: Use for the shortest duration necessary to control pain while addressing the underlying dental condition

By following this evidence-based approach to dental pain management, clinicians can effectively control pain while minimizing risks associated with analgesic medications.