Can Patients Take Ibuprofen After Wisdom Tooth Extraction?
Yes, ibuprofen is safe and effective for pain relief after wisdom tooth extraction and does not significantly increase bleeding risk. 1
Evidence-Based Recommendation
The American Academy of Otolaryngology-Head and Neck Surgery guidelines (2019) provide strong evidence that NSAIDs, including ibuprofen, can be considered a safe method of analgesia following tooth extraction. 1
Pain Relief Efficacy
Ibuprofen 400 mg is superior to paracetamol 1000 mg for postoperative pain control after wisdom tooth extraction, with a risk ratio of 1.47 for achieving at least 50% pain relief at 6 hours. 2
Patients receiving ibuprofen require rescue medication less frequently than those on paracetamol (risk ratio 1.50 favoring ibuprofen). 2
Ibuprofen provides adequate analgesia without significant side effects in post-extraction patients. 1
Bleeding Risk Assessment
The concern about NSAIDs causing postoperative bleeding has been definitively addressed by high-quality evidence:
A Cochrane review of 1,100 children in 15 studies found that NSAIDs did not significantly increase bleeding risk compared to placebo or other analgesics. 1
A meta-analysis of 1,747 children showed NSAIDs were not associated with increased risk of bleeding, secondary bleeding, readmissions, or need for reoperation due to bleeding. 1
A large study of 6,710 children found that ibuprofen was not a risk factor for post-tonsillectomy bleeding requiring surgical control. 1
Another study of 6,014 children showed no significant difference in bleeding rates between ibuprofen (3.6%) and acetaminophen/codeine (3.4%) groups. 1
Important Distinction from Aspirin
While aspirin increases post-extraction hemorrhage risk, non-aspirin NSAIDs such as ibuprofen and diclofenac do not. 1
This distinction is critical: ibuprofen's mechanism differs from aspirin's irreversible platelet inhibition. 3
Recommended Dosing Protocol
Standard dose: Ibuprofen 400 mg every 6-8 hours as needed for pain 2, 4
- Maximum OTC dose: 1200 mg/day for up to 10 days 4
- Can be combined with paracetamol for enhanced pain relief 2
- The combination of paracetamol 1000 mg plus ibuprofen 400 mg shows superior results (risk ratio 1.77 for pain relief) compared to either drug alone 2
Contraindications and Precautions
Do NOT use ibuprofen in patients with: 1, 5
- Renal insufficiency or active renal hypoperfusion 1, 5
- History of atherothrombosis 1, 5
- Recent coronary stent placement 1, 5
- Concurrent anticoagulant therapy (increases bleeding risk 2.5-fold) 5, 6
Use with caution in: 3
- Patients with preexisting asthma or aspirin sensitivity 3
- Elderly patients or those with poor health status 5
- Patients with history of GI ulceration 3
Additional Benefits
Beyond pain relief, ibuprofen offers:
- Reduced vomiting compared to opioids 1
- No respiratory depression risk (unlike codeine/opioids) 1
- Anti-inflammatory effects that may reduce swelling 4
- Decreased need for opioid rescue medication 1
Common Pitfalls to Avoid
Do not discontinue ibuprofen due to unfounded bleeding concerns - the evidence clearly shows it is safe for dental extractions 1
Do not combine with anticoagulants without careful risk assessment, as this significantly increases bleeding risk 5, 6, 3
Do not use aspirin for post-extraction pain, as it does increase bleeding risk unlike other NSAIDs 1
Ensure adequate local hemostasis at time of extraction (gelatin sponge, suturing) to minimize any bleeding risk 7
Screen for over-the-counter NSAID use during medication reconciliation to avoid excessive dosing 5
Timing of Administration
Ibuprofen can be started immediately postoperatively once adequate hemostasis is achieved 1
Continue for 7-10 days or until pain resolves 4
For patients on low-dose aspirin for cardioprotection, ibuprofen should be taken at least 2 hours after aspirin to avoid interfering with aspirin's antiplatelet effects 3