PijnvizierPain relief in dental care
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Situations

Dry socket

Severe pain again a few days after extraction.

Prescription options

Inspect the extraction wound

Severe pain that develops or returns a few days after extraction may indicate alveolitis. Assess the wound urgently and look for signs of another complication, such as spreading swelling or fever.

Local aftercare

Consider local irrigation with normal saline. See also After extraction.

Pain relief in addition to wound care

Check which analgesics the patient has already taken. For temporary relief in adults, ibuprofen can be used if there is no active bleeding and an NSAID is appropriate. Otherwise, if needed, choose paracetamol where appropriate.

Prescription options

Drafts for adults. Check the indication, contraindications and current medicines before prescribing.

Ibuprofen 400 mg RIAAlongside wound care, if there is no active bleeding and an NSAID is suitable

Short-term example for adults with pain after a dental procedure or acute muscle or joint pain, when an NSAID is suitable.

Checks before prescribing

KIMO advises against NSAID use after a dental procedure that causes bleeding in patients taking antithrombotics, even if antithrombotic therapy has been temporarily interrupted. Discuss over-the-counter NSAIDs as well. See When taking antithrombotics. Check gastrointestinal, renal and cardiovascular risk factors, pregnancy, hypersensitivity and interactions. Do not combine two NSAIDs. See Frailty, kidney or liver impairment. Do not use Ibuprofen RIA in patients with active bleeding, a bleeding diathesis or receiving anticoagulant treatment. Full contraindications in the SmPC.

  • R/ Ibuprofen 400 mg RIA film-coated tablet

    Per dose
    400 mg by mouth (1 tablet)
    Frequency and interval in this example
    If necessary up to 3 times a day, approximately 8 hours between intakes
    Ibuprofen RIA SmPC §4.2: repeat every 4 to 6 hours, up to 3 tablets of 400 mg daily.
    Maximum per 24 hours
    1,200 mg (3 tablets)
    Quantity in this draft
    Maximum 6 tablets

Duration in this example: 2 days. Stop earlier if the medicine is no longer needed. Reassess if pain relief is inadequate or pain worsens.

Paracetamol aloneAlongside wound care if an NSAID is unsuitable

First option for acute nociceptive pain. This example applies to adults weighing more than 55 kg without risk factors for hepatotoxicity.

Checks before prescribing

Include all paracetamol from over-the-counter and combination products. Adjust the dose if there are risk factors.

  • R/ Paracetamol 500 mg tablet

    Per dose
    1,000 mg by mouth (2 tablets)
    Frequency and interval in this example
    If necessary up to 3 times a day, approximately 8 hours between intakes
    Maximum per 24 hours
    3,000 mg (6 tablets)
    Quantity in this draft
    Maximum 12 tablets

Duration in this example: 2 days. Stop earlier if the medicine is no longer needed. Reassess if pain relief is inadequate or pain worsens.

Sources for this topic

Reference for dentists on acute dental pain and pain after treatment.