PijnvizierPain relief in dental care
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Situations

After extraction

Pain after a simple or surgical extraction.

Prescription options

Pain relief after extraction

For adults with pain after a simple or surgical extraction, ibuprofen is a first option according to the ADA if an NSAID is appropriate. If needed, paracetamol can be added. If an NSAID is unsuitable, choose paracetamol alone where appropriate.

The ADA advises against opioids after a simple extraction. For patients taking antithrombotics, follow the KIMO advice above.

In case of abnormal course

Assess worsening pain, persistent bleeding and signs of infection. See Dry socket, Postoperative bleeding or Swelling and infection.

Prescription options

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

Ibuprofen 400 mg RIAFor pain after treatment, 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.

Paracetamol with ibuprofen after a procedureIf paracetamol is needed in addition to ibuprofen

For adults weighing more than 55 kg without risk factors for hepatotoxicity when both medicines are indicated after the dental procedure. Track each medicine's dosing interval and maximum daily dose separately.

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. Count paracetamol from all products.

  • 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

  • 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 aloneIf 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.

Ibuprofen 600 mg · sachet after third molar surgerySingle-dose example after surgical removal of a third molar

Single-dose example for pain after surgical removal of a third molar in a suitable adult. For ordinary toothache, the product information lists 400 mg per dose.

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. Check any ibuprofen already taken and the sodium and sucrose content of this sachet.

  • R/ Brufen Bruis 600 mg, effervescent granules per sachet

    Per dose
    600 mg by mouth (1 sachet). Stir into a glass of water and drink all of the solution.
    Frequency and interval in this example
    Single dose. Reassess if further pain relief is needed.
    Maximum per 24 hours
    600 mg (1 sachet) in this example
    Quantity in this draft
    Maximum 1 sachet

Duration in this example: 1 day. 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.