Acute toothacheSwelling and infectionAfter extractionAfter root canal treatment

Acute conditions

• Acute toothachePulpitis and symptomatic apical periodontitis.
• Swelling and infectionAbscess, spread and red flags.
• Pain around a wisdom toothPericoronitis around a partially erupted molar.
• Pain following tooth injuryWith a loose, broken or knocked out tooth.
• Sensitive tooth necksBrief pain triggered by cold, heat or sweet foods.
• Pain in the jaw and faceIf examination does not identify a clear dental cause.
• Painful or bleeding gumsAcute periodontal complaints and local assessment.
• Painful oral mucosaAphthous ulcers, irritation or a persistent ulcer.

After treatment

• After root canal treatmentExpected postoperative pain and reassessment.
• After extractionPain after a simple or surgical extraction.
• Dry socketSevere pain again a few days after extraction.
• Postoperative bleedingActive bleeding after surgery.
• Persistent or worsening painReassess if relief is inadequate or the clinical course changes.
• After a filling or crownSensitivity or pain on biting.
• After placement of an implantEarly pain after treatment or pain around an existing implant.

Special situations

• When taking antithromboticsPain relief after a procedure that causes bleeding.
• Outside opening hoursTelephone assessment and temporary pain relief while awaiting care.
• Pregnancy and breastfeedingChoice of medicine by stage of pregnancy and clinical situation.
• Frailty, kidney or liver impairmentWhen the standard regimen needs to be adapted.
• Pain in childrenPaediatric assessment and dosing by weight.

ParacetamolFirst choice in acute nociceptive pain.

NSAIDs and salicylates

• IbuprofenSystemic NSAID.
• NaproxenSystemic NSAID.
• DiclofenacCheck the contraindications for the specific formulation.
• COX-2 inhibitorsCelecoxib and etoricoxib · specific indications.
• Acetylsalicylic acidSalicylate · bleeding risk and over-the-counter use.

Fixed combinations

• Paracetamol / ibuprofen500/150 mg example for adults.
• Paracetamol / codeineNot recommended in acute endodontic pain.
• Paracetamol / tramadolThe doses cannot be adjusted independently.
• Paracetamol / caffeineCheck for duplicate paracetamol.
• Acetylsalicylic acid / paracetamol / caffeineFor headaches and migraines. Count paracetamol.

Opioids

• TramadolIn case of severe acute pain after re-evaluation.
• Strong opioidsOxycodone and morphine, among others.

Pain in childrenPaediatric assessment and dosing by weight.Paracetamol in childrenDose per administration and daily limit by age, weight and formulation.Dosing aidIbuprofen in childrenIf an NSAID is appropriate, with extra attention to fluid intake.Dosing aid