It's not uncommon to experience pain or discomfort from oral conditions or following some types of dental treatment. For most people, this is both tolerable and temporary. However, there are some conditions or treatments that may require the use of medication to address pain or discomfort.
Your dentist will recommend an appropriate strategy to help you or a family member manage these situations, but you should be aware of the potential risks of some pain medications. These medications can interact with other drugs and/or lead to dependency or overdose. This is particularly true of opioid medications, which are prescribed by dentists far more frequently than you may realize. This is particularly important to understand if you have a child that is a teenager, or for older adults.
About dental pain
Acute dental pain is often due to underlying conditions like tooth decay, infections, periodontal disease, or dental procedures such as tooth removal, periodontal surgery, or dental implants. It's important to remember that acute pain often subsides quickly following treatment and healing. Pain lasting longer than three months is uncommon, considered chronic, and should be evaluated by a dentist.1
Analgesics (like acetaminophen) and anti-inflammatories (like aspirin and ibuprofen) are the most commonly recommended medications for dental pain. In more severe cases, your dentist may prescribe stronger non-opioid or opioid-based medications, but those are typically only recommended when analgesics cannot effectively manage your pain.
Your dentist should offer a pain management strategy that is specific to you. Their suggestions will be influenced by many things, including a review of your health status. Failing to follow your doctor's recommended pain management strategy may make it more difficult to keep your pain under control. That said, if you feel that you can tolerate discomfort with less or no medication, it is generally safe to do so.
Never self-prescribe additional medications or treatments without consulting your dentist.
Types of pain medications
There are two types of analgesic medications normally recommended or prescribed following dental procedures that are expected to cause temporary pain, inflammation, or bruising. They may be recommended for use either alone or in a combination.
Nonopioid analgesics
Nonopioid analgesics are a class of drugs that include "nonsteroidal anti-inflammatory drugs" (NSAIDs). Examples of NSAIDs include ibuprofen, naproxen, celecoxib, and aspirin. They can be obtained over-the-counter or in prescription dosages.
In general, NSAIDs inhibit an enzyme the body produces as part of the process that causes inflammation, fever, and pain. They help with pain by reducing inflammation at the site where it occurs. NSAIDs do have a "ceiling of effectiveness," meaning that taking more than the recommended dosage will not provide additional pain relief.
Alternatively, acetaminophen acts centrally by blocking the transmission of pain signals within the central nervous system. Acetaminophen is not an NSAID, as it does not reduce inflammation.
Opioid analgesics
Opioids are often prescribed to treat moderate to severe acute dental pain. They include drugs such as oxycodone, hydrocodone, and codeine. They are only legally available by prescription. Opioids do not target inflammation. They only interfere with the perception of pain at the level of the central nervous system. These drugs are usually prescribed in combination with NSAIDs or acetaminophen to relieve temporary pain and reduce inflammation.
When not properly prescribed or used as directed, opioids can present a significant risk of dependence or addiction. This is of particular concern for adolescents, who are often inappropriately or over-prescribed these drugs following procedures such as wisdom tooth removal. You should educate yourself on the risks of opioids, and be sure to talk to your dentist about any questions you have.
Opioids do NOT have "a ceiling of effectiveness," which is the point where additional dosage does not provide additional relief. This can be a key contributor to overuse and addiction.
The American Dental Association (ADA) supports limiting opioid dosages and limiting opioid duration to no more than three days.2 This is consistent with the Centers for Disease Control and Prevention (CDC) guidelines.
As another alternative to opioids, many dentists and oral surgeons are now administering a long-acting local anesthetic called bupivacaine liposome. With this local anesthetic, the injection area typically remains numb for a few days, which extends throughout the typical period of post-treatment pain.
Developing an appropriate pain management strategy
Your dentist will consider a variety of medications and medication combinations when developing a pain management strategy. There is no specific regimen that is guaranteed to produce the right level of pain relief for everyone in every situation. Your dentist will consider all factors, including your health, lifestyle, and medications you take when recommending an appropriate strategy.
Pain control following dental treatment is usually achieved by targeting the source of the pain, which typically is inflammation. Studies have shown that a combination of an NSAID (to target inflammation) and acetaminophen (to block pain signals in the nervous system) is just as effective as regimens that include opioids.3 This approach is also associated with a lower risk of adverse effects, including addiction.
The ADA adopted a statement on opioid use in 2016 that specifically states, "Dentists should consider nonsteroidal anti-inflammatory analgesics (NSAIDs) as the first-line therapy for acute pain management."2
