dr. peter copp    certified specialist

My Recommendations for you to manage pain

In general the best way to alleviate dental pain is to have the problem treated as soon as practical. Until that can be done, taking medication for pain can be very effective especially if you use the recommended medicines in layers so to speak. Similarly pain after dental treatment often starts mild on day one after your treatment and often escalates and reaching a peak by day three. Using ice packs if we’ve recommended that and staying ahead of the pain by taking medication when you feel enough pain you wish relief from it, usually results in less medication being taken ultimately.

If you judge your pain to be mild-moderate in intensity and is not distressing you limiting your ability to swallow, chew, eat or sleep start by using:

FOR ADULTS OF AVERAGE SIZE AND NO KNOWN PROBLEMS TAKING THESE MEDICATIONS SUCH AS ALLERGY OR GASTRO-INTESTINAL BLEEDING:

Acetaminophen (such as Tylenol) in a dose of 500-1000 mg every 4 hours to a maximum dose of 4000 mg (4 grams). The most common size pills of  acetaminophen are 325mg and 500mg (extra-strength).

The dose for children is 65 mg per kilogram of body weight per day divided into 4 to 6 doses.

If you judge your pain to be Moderate to Severe

ADD a Non-Steroidal Anti-Inflammatory Drug (NSAID) such as IBUPROFEN (common trade names are Advil and Motrin) if you have taken them before without difficulty and/or are not allergic to aspirin and and no history of stomach or gastric (stomach) ulcers or bleeding nor severe asthma . The dose of IBUPROFEN is 400 mg every 4 hours ON TOP of the acetaminophen for greatest benefit.

I often prescribe flurbiprofen as an NSAID because many find it very effective for dental pain AND inflammation. The dose of flurbiprofen is 50 - 100 mg every 4 hours.

If you cannot take aspirin or NSAID such as ibuprofen for the reason stated above I will usually prescribe an opioid medication to ADD to the full dose of acetaminophen. Take the prescribed opioid for pain that breaks-through the full dose of acetaminophen only as needed every 4-6 hours.

IF YOU FEEL YOUR PAIN I SEVERE

Increase your dose of ibuprofen to 600 mg every 4-6 hours but remain within the maximum daily dose.

For SEVERE pain that breaks through ADD the prescribed opioid every 4-6 hours but maintain the base of acetaminophen and NSAID.

Often, I prescribe an NSAID mouth rinse call Tantum. It is to be used as directed to sooth discomfort that is less localized and more spread-out inside your mouth.

USE OF ANALGESICS FOR CHILDREN 

Acetaminophen is usually considered the drug of choice for pediatric patients. It should be administered in a dose of 10-15 mg/kg q4-6h, up to a maximum
of 65 mg/kg per day. Ibuprofen can also be used in a dose of 10 mg/kg, q6-8h. 

ASA is contraindicated for pediatric patients, because it can potentially induce Reye’s syndrome. 

12 Guidelines | November 2015 

Health Canada has recommended that codeine only be used in patients aged 12 and over. This is due to the potential of the rare complication of ultra-rapid metabolism of codeine leading to morphine overdose. 

    •    Youth and prescription painkillers: What parents need to know http://knowledgex.camh.net/amhspecialists/ resources_families/Documents/Youthand Misuse%20E.pdf