What pain meds do dentist give after tooth extraction?

Anesthesia Options for Oral Surgery

Dentistry has advanced to the point where pain is almost a thing of the past. Powerful, pain-relieving medications known as anesthetics not only help a patient avoid discomfort during a procedure but postoperatively as well.

We understand many patients feel anxiety prior to their oral surgery procedure—and this is completely normal! The entire surgical staff at our office wants to ensure that you feel as comfortable as possible for your procedure, which is why we offer many options for sedation when you undergo any oral surgical procedure at Greater Modesto Dental Implant & Oral Surgery Center. Often, the methods used depend on the preference of the patient and the nature of the surgical procedure.

Types of medications include

Analgesics – Analgesics are also called pain relievers and include common non-narcotic medications such as ibuprofen and Tylenol ® . Analgesics are usually used for mild cases of discomfort and are typically prescribed following such procedures as a root canal or tooth extraction.

Local anesthesia – Anesthetics can be topically applied, injected, or swallowed. Dentists often apply topical anesthetics with a cotton swab to an area of the mouth where a procedure such as a restoration will be performed. This numbs the affected area. Topical anesthetics are used in many dental procedures such as tooth restoration. Topical anesthetics are also used to prepare an area for injection of an anesthetic. Novocaine ® and lidocaine are the most common type of injectable anesthetics. Such medications block the nerves from transmitting signals and are used for more major types of procedures such as fillings and root canals.

Sedation and general anesthesia – Sedatives are medications designed to help a patient relax. This can be a powerful tool in avoiding pain. Sedatives are sometimes used in combination with other types of pain relievers. Nitrous oxide, or laughing gas, is a type of sedative. Conscious sedation involves administering a sedative while the patient is alert and awake. Deep sedation or general anesthesia involves administering a medication that places a patient in a state of monitored and controlled unconsciousness. Common sedatives include:

Intravenous (IV) sedation – Usually in the form of a tranquilizing agent; patients given IV sedation are often awake, but very relaxed and may not remember anything about their procedure.
Inhalation sedation – a form of sedation in which medication (such as nitrous oxide, sevoflurane) is administered through a special mask.

Exparel ® for Post-Surgical Pain Management

Over-prescription and misuse of narcotic prescription pain medications (such as hydrocodone, oxycodone, morphine, and codeine) have led to an opioid abuse crisis in our country—with accidental opioid-related deaths continuing to rise. Oral surgeons are on the forefront of the fight against opioid addiction and overdose with the introduction of Exparel, a clinically proven medication that offers oral surgery patients a powerful, non-opioid choice for controlling their post-operative discomfort. It is used in addition to your chosen method of anesthesia to control pain after your surgery is over and your anesthesia has worn off. We are proud to offer Exparel to our Greater Modesto Dental Implant & Oral Surgery Center patients.

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If you choose Exparel as part of your surgical treatment plan, your oral surgeon will administer Exparel locally to your surgical site while you are under anesthesia during your oral surgery. This single dose of sustained-release medication will already be controlling your post-operative discomfort when your anesthesia wears off and will continue to work for several days into your recovery. Exparel often eliminates the need for prescription narcotic pain medications during your recovery time. It’s that effective!

Exparel allows our patients to enjoy the following benefits:

Postpone or eliminate the need to fill pain prescriptions to manage your post-surgical pain.
No risk of opioid dependence and withdrawal. Exparel is not a narcotic medication is therefore completely opioid-free.
You will not experience a gap in pain-control after your surgery. Exparel is already working to manage your pain when your anesthesia wears off!

It is our priority to determine how surgery can comfortably and safely be performed for you. When you meet with Dr. Barber or Dr. Springer for your consultation appointment, you can discuss Exparel in detail and decide if adding this medication to your treatment plan is the best choice for you.

Exparel

We like to keep our patients informed of advancements in medical science that can affect them in positive ways. Exparel is one of those instances. This pain-relief solution is becoming a preferred method of post-operative pain management with oral surgeons and patients alike. For more information about Exparel and its benefits, your oral surgeon will be happy to discuss this medication with you during your consultation appointment.

If you have any questions or concerns prior to your surgical procedure at Greater Modesto Dental Implant & Oral Surgery Center, please don’t hesitate to contact us at 209-527-5050. It is our primary goal to make sure you are comfortable with your procedure and want to ensure you experience optimal results from your treatment.

Ibuprofen versus paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth

This review, carried out by the Cochrane Oral Health Group, seeks to compare the effectiveness of two commonly used painkillers, paracetamol and ibuprofen and the combination of both in a single tablet in the relief of pain following surgical removal of lower wisdom teeth.

Worldwide the number of surgical operations to remove wisdom teeth is immense, in England alone approximately 63,000 are removed in National Health Service (NHS) hospitals each year. Many patients need time off work and their quality of life is significantly affected. However, despite these consequences, people are often most concerned about pain following the operation which can be severe. It is suggested that the most intense pain is felt three to five hours after surgery. The pain experienced after oral surgery is widely used as a model to measure the effectiveness of painkillers in general.

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Both paracetamol and ibuprofen are commonly used for the relief of pain following the surgical removal of lower wisdom teeth. In 2010, a new painkiller (marketed as Nuromol) containing paracetamol and ibuprofen in the same tablet was licensed for use in the United Kingdom.

All the drugs studied in this review had minimal side effects noted when used correctly for short-term pain relief.

Study characteristics

The evidence on which this review is based was current as of 20 May 2013. Seven studies with a total of 2241 participants all involving a direct comparison of ibuprofen to paracetamol or the combination of both were included in this review. All participants had surgery to remove a lower wisdom tooth or teeth that required bone removal or at least caused moderate to severe pain. Painkillers were taken after surgery and different doses of the drugs were compared.

The majority of the studies took place in the USA with one in Puerto Rico. Four of the trials took place in clinical research facilities, two in university dental hospitals and one in a private oral surgery clinic. The age of participants differed slightly between studies but was broadly similar, ranging from 15 to 65 years old. All studies included male and female participants.

All the studies included in this review looked only at pain relief and intensity information after a single dose of the painkiller after surgery. It is known that pain does continue after this and the drugs evaluated in this review are normally taken every six to eight hours (maximum of four times per day).

Key results

Ibuprofen is more effective than paracetamol at all doses studied in this review. On limited evidence, the combination of ibuprofen and paracetamol appeared to be no more effective than the single drugs when measured two hours after surgery. However, again on limited evidence, it was found to be more effective than the drugs taken singly when measured at six hours after surgery. Participants taking the combined drug also had a smaller chance of requiring rescue medication.

The information available regarding adverse events from the studies (including nausea, vomiting, headaches and dizziness) indicated that they were comparable between the treatment groups. However, review authors could not formally analyse the data as it was not possible to work out how many adverse events there were in total.

Quality of the evidence

All of the results (outcomes) comparing ibuprofen to paracetamol are of high quality. This means that further research is very unlikely to change our confidence in the estimates of the effect.

When comparing combined versus single drugs, the body of evidence for the proportion of patients with > 50% maximum pain relief (TOTPAR) over two and six hours, was assessed as of moderate quality due to imprecise estimates based on single studies. This means that further research is likely to have an important impact on our confidence in the estimate of the effect. The body of evidence for the use of rescue medication was assessed as being of high quality.

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Authors’ conclusions:

There is high quality evidence that ibuprofen is superior to paracetamol at doses of 200 mg to 512 mg and 600 mg to 1000 mg respectively based on pain relief and use of rescue medication data collected at six hours postoperatively. The majority of this evidence (five out of six trials) compared ibuprofen 400 mg with paracetamol 1000 mg, these are the most frequently prescribed doses in clinical practice. The novel combination drug is showing encouraging results based on the outcomes from two trials when compared to the single drugs.

Read the full abstract.
Background:

Both paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United Kingdom, this drug has shown promising results to date and we have chosen to also compare the combined drug with the single drugs using this model. In this review we investigated the optimal doses of both paracetamol and ibuprofen via comparison of both and via comparison with the novel combined drug. We have taken into account the side effect profile of the study drugs. This review will help oral surgeons to decide on which analgesic to prescribe following wisdom tooth removal.

Objectives:

To compare the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth, at different doses and administered postoperatively.

Search strategy:

We searched the Cochrane Oral Health Group’sTrials Register (to 20 May 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4); MEDLINE via OVID (1946 to 20 May 2013); EMBASE via OVID (1980 to 20 May 2013) and the metaRegister of Controlled Trials (to 20 May 2013). We checked the bibliographies of relevant clinical trials and review articles for further studies. We wrote to authors of the identified randomised controlled trials (RCTs), and searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied to the searches of the electronic databases.

Selection criteria:

Only randomised controlled double-blinded clinical trials were included. Cross-over studies were included provided there was a wash out period of at least 14 days. There had to be a direct comparison in the trial of two or more of the trial drugs at any dosage. All trials used the third molar pain model.

Data collection and analysis:

All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief (based on total pain relief (TOTPAR) and summed pain intensity difference (SPID) data) was calculated for all three drugs at both two and six hours postdosing and meta-analysed for comparison. The proportion of participants using rescue medication over both six and eight hours was also collated and compared. The number of patients experiencing adverse events or the total number of adverse events reported or both were analysed for comparison.

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Main results:

Seven studies were included, they were all parallel-group studies, two studies were assessed as at low risk of bias and three at high risk of bias; two were considered to have unclear bias in their methodology. A total of 2241 participants were enrolled in these trials.

Ibuprofen was found to be a superior analgesic to paracetamol at several doses with high quality evidence suggesting that ibuprofen 400 mg is superior to 1000 mg paracetamol based on pain relief (estimated from TOTPAR data) and the use of rescue medication meta-analyses. The risk ratio for at least 50% pain relief (based on TOTPAR) at six hours was 1.47 (95% confidence interval (CI) 1.28 to 1.69; five trials) favouring 400 mg ibuprofen over 1000 mg paracetamol, and the risk ratio for not using rescue medication (also favouring ibuprofen) was 1.50 (95% CI 1.25 to 1.79; four trials).

The combined drug showed promising results, with a risk ratio for at least 50% of the maximum pain relief over six hours of 1.77 (95% CI 1.32 to 2.39) (paracetamol 1000 mg and ibuprofen 400 mg) (one trial; moderate quality evidence), and risk ratio not using rescue medication 1.60 (95% CI 1.36 to 1.88) (two trials; moderate quality evidence).

The information available regarding adverse events from the studies (including nausea, vomiting, headaches and dizziness) indicated that they were comparable between the treatment groups. However, we could not formally analyse the data as it was not possible to work out how many adverse events there were in total.

Relief From Dry Socket Pain After Wisdom Teeth Removal

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It is normal to have some pain after wisdom teeth removal. Dry sockets are the result of unusual healing that causes more pain–and for longer a longer period of time–compared to normal healing. What is the best medicine to take to help with healing pain?

Short answer: 400mg Advil (ibuprofen) and 500mg Tylenol (acetaminophen) up to six times a day

Studies are being conducted where pain medication was repackaged in unmarked capsules. The patients who had wisdom teeth removed took the pain medication given without knowing what it was. They rated how much pain relief they got. Medications were scored based on how many people had to take it for one person to get pain relief. A perfect score would be a 1. That means every person that took it got pain relief. A score of two means that if two people took it, one of them would get pain relief.

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For example, the placebo medication in the study scored 18. For every 18 people that took a placebo, one would get pain relief. Here are how the medications scored, listed in order from worst to best:

Codeine alone: 16 (almost as bad as a placebo)
Codeine with Tylenol: 4.2
Tylenol alone: 3.8
Vicodin, Lortab, Norco (hydrocodone/Tylenol): 3.0
Demerol: 2.9
Morphine: 2.9
Percocet (oxycodone/Tylenol): 2.6
Torodol oral: 2.6
Ibuprofen alone: 2.4
Two Alleve (naproxen sodium): 2.3
Ketorolac IM: 1.8
100mg Ketoprofen: 1.6
Advil (ibuprofen) and Tylenol: 1.6

Medicines with lower scores give better pain relief. For every three people that take hydrocodone, one will get pain relief. That’s not a very high success rate. The Advil/Tylenol combination is two to three times more effective than narcotics like oxycodone and hydrocodone. You can get Advil and Tylenol over-the-counter, while narcotics are by prescription only. Additionally, narcotic use (even if it’s a legal prescription) can be addictive.

Unfortunately, some patients think the more side effects medication has, the better it is. Here are two hypothetical conversations:

Doc: Did the ibuprofen work?
Patient: Not really. I wish you’d given me something stronger.
Doc: Did you have much pain?
Patient: Not really.

Doc: Did the Percocet work?
Patient: Oh yeah. I threw up and got dizzy and drowsy.
Doc: Did you have much pain?
Patient: Yes. It’s a good thing you gave me some strong medicine to take.

These patients are rating a medication based on their side effects rather than the ability to provide pain relief. Advil and Tylenol have fewer side effects, no addiction risk, and are more easily available. If you’re truly after pain relief, consider pain medications other than narcotics.

What about ketoprofen? It rated as well as the Advil/Tylenol combination. Advil and Tylenol provide pain relief differently. Advil reduces inflammation at the site of the surgery or tissue damage. Tylenol tells the brain not to pay attention to the pain signal. Because they work differently and are processed by different organs, they are a good combination. Ketoprofen reduces inflammation like Advil and has an effect on the brain similar to Tylenol. You get an effect similar to Advil/Tylenol in one medication.

Ketoprofen was available in 12.5mg doses over-the-counter. Now it is available by prescription in 50, 75, and 100mg doses. Consider requesting it from your doctor when pain management is needed.