For tooth pain prevention – Please do this!

Dental pain is primarily an inflammatory process and thus use of anti-inflammatory medication is the ideal treatment. Tooth pain prevention after a dental visit is something we can help with as long as we follow a medication regimen of anti-inflammatory drugs.

The ideal pain regimen that is MORE effective than narcotic prescriptions like Tylenol #3.

Every 8 hours take

1. 2 Extra Strength Tylenol 500mg
2. 3 Advil 200mg

If pain starts back up in-between doses then take 2 more ibuprofen tablets for a total of 400mg ibuprofen.

Moore 2013 JADA article and Merry 2010 about the effectiveness of combing ibuprofen and acetaminophen. Donaldson Gen Dent 2023 talks about the 2-4-24 strategy of 600mg ibuprofen and 650mg acetaminophen 4 times a day.

Total dosages are 2 extra strength Tylenol, which are 500mg acetaminophen, for a total of 1000mg acetaminophen and 3 Advil, which are 200mg ibuprofen, for a total of 600mg ibuprofen.

The rest of this page is more about prevention than it is about dealing with pain that currently exists. So if you are in pain ignore the rest and follow the above regimen.

The rest of this page is prevention of pain from starting.

Tooth pain prevention of a normal to moderate dental procedure

This is just a reminder of what I want you to take for pain prevention and to either keep the nerve from dying or to calm down the tissue around the tooth.  I am recommending this to you to keep the inflammation down on a tooth that has just gone through a somewhat traumatic procedure.  That is typically either a deep filling that was close to the nerve, a tooth that received a crown that had a large crack and/or deep decay, or a tooth that just had a root canal.

Please follow my 3x3x3 RULE for tooth pain prevention!!

3 ibuprofen pills   ——   3 times a day  ——-     for 3 days

That is 3 Advil (ibuprofen is generic and is fine) 200mg tablets.

That is a total of 600mg, three times a day.  That totals 1800mg ibuprofen during your waking hours.
The maximum dose for full grown adult is 3200mg ibuprofen for a 24 hour period.

Take ibuprofen with food or milk to lessen stomach upset.

If you take an anti-inflammatory for another condition you do not need to follow this rule as you are already taking all the anti-inflammatory you need.

Individuals that are pregnant, have kidney problems, have stomach/ulcer problems or intestinal bleeding issues, are at serious risk of stroke, heart attack, or CVT shouldn’t take ibuprofen.

Don’t take if you recently had or are expecting to have any heart surgeries.

Don’t take if you are allergic to ibuprofen, obviously!!!

This link has more information than you would likely ever want to know.  Here is dosing amounts for children.

What other drugs will affect ibuprofen?

Since you are only taking ibuprofen for three days this may not matter. However, here is a list of medicines that will either work a little better or work a little worse with ibuprofen.

• Antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft). Taking
  any of these medicines with an NSAID may cause you to bruise or bleed easily.
• aspirin or other NSAIDs such as naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others
• heart or blood pressure medicine such as benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and others
• lithium (Eskalith, Lithobid)
• diuretics (water pills) such as furosemide (Lasix)
• methotrexate (Rheumatrex, Trexall, Otrexup (PF), Xatmep) chemo/immunosuppressive
• steroids (prednisone and others)
• a blood thinner such as warfarin (Coumadin, Jantoven).

This list is not a complete list and other drugs may interact with ibuprofen.

Tooth pain prevention of a moderate to invasive dental procedure

For the more invasive procedure I prefer more than just ibuprofen. These would include multiple extractions and bone removal or large  incisions. I like the 1-2-4-24 regimen, which stands for 1 single dose of dexamethasone, then two drugs in 4 doses for 24 hours. That is one 4mg dose of dexamethasone pre or immediately postoperatively, followed by 600mg ibuprofen and 1000mg acetaminophen every 6 hours. The 1-2-4-24 regimen is in this Goodchild article. Some others do very similar but make easier by just doing 3 ibuprofen and 2 regular strength acetaminophen, which is 650 mg instead of 1000mg.

Medrol pain prevention

Medrol did not make a difference in pain levels for root canal treatment according to Fuller JOE 2018

NSAID information

There are 7 subclasses of NSAID. Goodchild and Donaldson have a great article in Gen Dent from Nov/Dec 2019

Health problems that limit NSAID usage

NSAID allergy

Suspected psuedoallergic reactions Type I-IV

• Acetaminophen
• Salsalate up to 1000mg bid
• Choline Magnesium trisalicylate up to 1000mg bid
• Celecoxib up to 200mg bid

True allergy

• Acetaminophen
• Glucocorticoids
• Opioids

Renal or GI issues

• Acetaminophen
• Tramadol
• Opioids

Pregnant

• Acetaminophen
• Codeine
• Glucocorticoids

Breastfeeding

All is fine except aspirin.