PijnvizierPain relief in dental care
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Situations

Pain in the jaw and face

If examination does not identify a clear dental cause.

Prescription options

Widen the differential diagnosis

If pain is unexplained, assess the masticatory muscles and temporomandibular joint as well. Brief attacks of shooting pain may indicate neuropathic pain. If the cause remains unclear, consider appropriate medical referral or referral to an orofacial pain specialist.

Pain relief for acute TMD

For confirmed acute pain from the masticatory muscles or temporomandibular joint, paracetamol can be used briefly alongside measures to rest the jaw. In adults, ibuprofen may be an option if an NSAID is appropriate.

On suspicion of neuropathic pain

If neuropathic pain is suspected, follow a diagnosis-specific care pathway. The guideline advises against opioids in trigeminal neuralgia.

Prescription options

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

Paracetamol aloneShort-term use for confirmed acute masticatory muscle or temporomandibular joint pain

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.

Ibuprofen 400 mg RIAFor confirmed acute TMD, if 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.

Sources for this topic

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