PijnvizierPain relief in dental care
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Situations

After root canal treatment

Expected postoperative pain and reassessment.

Prescription options

Post-treatment pain relief

For mild, expected pain after treatment, paracetamol may be sufficient. If substantial postoperative pain is expected, the NVvE prefers paracetamol with an NSAID. In adults, consider paracetamol with ibuprofen if ibuprofen is appropriate. If an NSAID is contraindicated, choose paracetamol alone if suitable.

Reassessment

Unexpected or increasing pain requires reassessment of the cause. After extraction, follow the pathway for After extraction.

Prescription options

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

Paracetamol aloneFor mild postoperative pain or when 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.

Paracetamol with ibuprofen after a procedureWhen substantial postoperative pain is expected and an NSAID is suitable

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.

Sources for this topic

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