PijnvizierPain relief in dental care
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Situations

Persistent or worsening pain

Reassess if relief is inadequate or the clinical course changes.

Prescription options

Reassess before increasing the dose

Check the diagnosis, how the pain has changed and which medicines the patient has actually taken before changing the regimen. New swelling, fever, difficulty swallowing or bleeding requires a separate assessment.

Pain relief after reassessment

For acute nociceptive pain without complications, where appropriate initial analgesia has not yet been used, paracetamol is a first option. In adults with insufficient relief despite appropriate use, adding ibuprofen may be appropriate if an NSAID is appropriate for both the patient and the confirmed cause.

Next step

For pain after treatment, follow the pathway for After root canal treatment or After extraction. For telephone advice about deferring care, follow Outside opening hours.

Prescription options

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

Paracetamol aloneAfter reassessment of uncomplicated acute pain when suitable initial analgesia is still lacking

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 ibuprofenFor confirmed toothache with inadequate relief from paracetamol, if an NSAID is suitable

For adults weighing over 55 kg without risk factors for hepatotoxicity, if paracetamol alone does not give adequate relief and an NSAID is appropriate. Both medicines can be taken at the same time. Track the dosing interval and daily maximum separately for each.

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. 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 film-coated tablet (Spidifen)

    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
    Spidifen SmPC §4.2: every 4 to 6 hours if necessary.
    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.