Relief from dental pain is generally tried with OTC medications before a patient will seek dental care. In addition to aspirin and acetominophen, NSAIDS such as Ibuprofen, naproxen sodium, and ketoprofen are now available over the counter and are recognized as effective analgesics for dental pain. Acetaminophen (Tylenol) is usually administered for pain from headache, colds, flu, muscle aches, toothaches, etc, and has been available since 1949. Acetaminophen when combined with caffeine has been found to be more effective than when used alone. However, when used as an analgesic for dental pain (500 mg) it was found to reach its peak effectiveness within 1 to 2 hours.
Combining acetaminophen with a NSAID produced greater analgesia than either of the 2 alone. Because no combination of these 2 drugs presently exists, the proposed model includes 400mg w/ acetaminophen 650mg every 4 hours. For intense pain, 600 mg of ibuprofen and 1,000 mg of acetaminophen could be given every 6 hours without exceeding the maximum dose for either drug. Risks of self-medicating with acetaminophen over the long term include damage to the liver, especially when combined with excessive alcohol consumption.
Ibuprofen is most often sold under the names of Advil, Motrin IB, and Nuprin. The recommended dosage for these OTC analgesics is 200 mg (1 tab) every 4 to 6 hours, not exceeding 6 tablets in 24 hours. Ibuprofen should not be taken for more than 10 days when used for pain and not more than 3 days when used as a fever reducer. Patients who are allergic to aspirin should not take this drug, and it should not be prescribed during the last 3 months of pregnancy. Ibuprofen in dosages of 50 to 400 mg controls pain of third molar extractions better than aspirin alone, and in a study done in 1990, ibuprofen was better than acetaminophen for dental pain management. Ibuprofen is also faster in pain relief than Celebrex, and relief when using the liqui-gels occurs within the hour.
Naproxen sodium was approved for OTC therapy in 1994 and is sold as Aleve in 200 mg tablets; 200 mg every 8 to 12 hours is equivalent to 200 mg of ibuprofen every 6 hours for pain. In addition, naproxen has been evaluated as a cardioprotective to decrease the incidence of myocardial infarction.
(Source: General Dentistry, March-April 2004)
