What is the recommended treatment for pain due to wisdom teeth?

Management of Pain Due to Wisdom Teeth

For pain due to wisdom teeth, surgical removal is the recommended definitive treatment, with appropriate analgesics for pain management until surgery can be performed.

Pain Management Options

First-Line Analgesics

• Ibuprofen 400 mg is superior to paracetamol (acetaminophen) 1000 mg for pain relief following wisdom tooth removal, with higher rates of achieving at least 50% pain relief at 6 hours 1
• Oral administration is the preferred route for analgesics due to convenience, ease of use, and cost-effectiveness 2
• For mild to moderate pain, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are recommended as first-line therapy 3
• Ibuprofen has both analgesic and anti-inflammatory properties through prostaglandin synthetase inhibition 3

Dosing Recommendations

• Ibuprofen 400 mg every 4-6 hours (not exceeding 2400 mg daily) provides effective pain relief 3, 1
• Paracetamol (acetaminophen) can be used at doses of 500-1000 mg every 4-6 hours (not exceeding 4000 mg daily) if NSAIDs are contraindicated 4
• The combination of ibuprofen and paracetamol shows promising results with superior pain relief compared to either medication alone 1, 5

Severe Pain Management

• For moderate to severe pain, consider combining NSAIDs with paracetamol or adding weak opioids such as codeine 2, 6
• Fixed combinations of NSAIDs with opioids (e.g., ibuprofen with oxycodone) may be necessary for severe pain 2
• When frequent dosing is required, administering analgesics at fixed intervals rather than as needed (prn) may be more effective 2

Surgical Management

• Surgical removal is the definitive treatment for impacted wisdom teeth causing pain 2
• For acute dental abscesses associated with wisdom teeth, surgical drainage is the key intervention, with antibiotics indicated only for specific situations such as systemic involvement or immunocompromised patients 2

Special Considerations

• Pain assessment should be ongoing to ensure adequate management, using appropriate pain scales 2
• Early treatment at appropriate starting doses is important as pain is easier to prevent than treat 2
• Patients with renal impairment should use NSAIDs with caution and at reduced doses 2
• Gastrointestinal side effects should be monitored, though ibuprofen has been shown to cause less gastric irritation than aspirin 3

Algorithm for Pain Management

1. Initial Assessment:

   • Determine pain severity (mild, moderate, or severe)
   • Check for contraindications to NSAIDs (renal disease, GI ulcers, etc.)

2. For Mild to Moderate Pain:

   • Start with ibuprofen 400 mg every 4-6 hours 3, 1
   • If NSAIDs are contraindicated, use paracetamol 1000 mg every 4-6 hours 4

3. For Moderate to Severe Pain:

   • Combine ibuprofen 400 mg with paracetamol 1000 mg 1, 5
   • If inadequate relief, consider adding codeine or other weak opioids 2, 6

4. Arrange for Definitive Treatment:

   • Schedule surgical removal of the wisdom tooth 2
   • Consider antibiotics only if there are signs of systemic infection or in immunocompromised patients 2

Remember that analgesic therapy should be guided by the principle that pain is easier to prevent than treat, so early intervention with appropriate doses is crucial 2.