What medications are commonly prescribed for dental pain?

Medications Commonly Prescribed for Dental Pain

NSAIDs, specifically ibuprofen, are the first-line medication for acute dental pain, as explicitly recommended by the American Dental Association. 1

First-Line Treatment: NSAIDs

Ibuprofen is the most effective and well-studied NSAID for dental pain:

• Ibuprofen 400-800 mg every 6 hours (maximum 2400 mg/day) provides superior analgesia compared to opioid-containing combinations for moderate to severe dental pain 1, 2
• Naproxen sodium 275-550 mg every 8-12 hours (maximum 1500 mg/day) is an alternative with longer duration of action 1
• NSAIDs are more effective than opioids for surgical dental pain, including wisdom tooth extractions 1, 3

The combination of ibuprofen 600 mg + acetaminophen 1000 mg provides the strongest analgesia:

• This combination is significantly more effective than placebo and shows a trend toward superiority over ibuprofen alone, though not statistically significant 4
• This regimen is particularly useful for severe dental pain 3, 2

Second-Line Treatment: Acetaminophen

When NSAIDs are contraindicated:

• Acetaminophen 650-1000 mg every 6 hours (maximum 4000 mg/day) provides effective analgesia but lacks anti-inflammatory effects 1, 5
• Acetaminophen alone is less effective than NSAIDs for dental pain due to the inflammatory component 2, 5

Third-Line Treatment: Opioid Combinations

Opioids should be reserved for severe pain unresponsive to NSAIDs:

• Acetaminophen 300-500 mg + codeine 30 mg every 4-6 hours 6, 2
• Acetaminophen 325 mg + hydrocodone 5-10 mg every 4-6 hours 2
• Tramadol 50-100 mg every 4-6 hours for dental pain, though less effective than aspirin 650 mg + codeine 60 mg 6

Critical opioid prescribing principles:

• Opioids are NOT more effective than NSAIDs for dental pain and cause significantly more adverse events (nausea, dizziness, sedation) 1
• Early opioid prescribing increases risk of prolonged opioid use and dependency 1
• Limit opioid prescriptions to the shortest reasonable duration (typically 3-5 days maximum) 1

Dosing Strategy

Prescribe analgesics on a fixed schedule rather than "as needed" (PRN):

• Fixed-interval dosing (e.g., every 6 hours around the clock) prevents pain from recurring and is more effective than waiting for pain to return 3, 2
• Pain is easier to prevent than to treat once it becomes severe 3, 2

Critical Contraindications and Cautions

Screen for NSAID contraindications before prescribing:

• Gastrointestinal ulcers or bleeding history 1
• Cardiovascular disease, hypertension, or heart failure 1
• Renal insufficiency or chronic kidney disease 1, 3
• Aspirin allergy or NSAID hypersensitivity 7
• Pregnancy (especially third trimester) 1
• Concurrent anticoagulation or bleeding disorders 7

In older adults and patients with cardiovascular/GI comorbidities, carefully weigh the risks and benefits of NSAID dose and duration. 1

Common Pitfalls to Avoid

• Do not prescribe opioids as first-line therapy for routine dental pain—they are less effective than NSAIDs and carry significant risks 1
• Do not underdose NSAIDs—ibuprofen 200-400 mg is often insufficient; 600-800 mg doses are needed for moderate to severe dental pain 2, 4
• Do not prescribe acetaminophen alone when inflammation is present—it lacks anti-inflammatory properties and is less effective than NSAIDs 2, 5
• Do not use COX-2 selective inhibitors (celecoxib, rofecoxib) as first-line—they are no more effective than conventional NSAIDs, cost more, and carry cardiovascular risks 7