If you’ve ever dealt with severe dental pain you know how important it is to be able to use a painkiller to help deal with the pain until you see your dentist. I’m going to go over all the different types of painkillers that are typically used for dental pain and which ones are best in certain situations. Broadly, we can break up painkillers into two categories: Opiates and Non-opiates. The non-opiate painkillers are all over the counter while opiate painkillers are all by prescription only.
Aspirin – Aspirin was one of the first painkillers discovered. It is in a class of drugs known as salicylates. One of the side effects of aspirin is that it increases bleeding which is generally not great in dentistry when you need a tooth taken out or other surgery. You don’t get great pain control with aspirin compared to other options. Aspirin can also cause a very serious condition known as Reyes Syndrome is taken by a child. I don’t recommend aspirin for dental pain.
Tylenol / Acetaminophen – Tylenol is an analgesic that is good for mild pain. Tylenol works by blocking pain messages from your brain. Unlike Ibuprofen, it doesn’t reduce inflammation in any meaningful way. A common dosage for Tylenol for is 400-500 mg however you can take up to 1000 mg every 6 hours. Too much Tylenol can cause severe liver damage so you don’t want to take high doses for more than a couple of days. If you have liver disease, consult with your doctor before taking. Tylenol is often combined with opiate medications (see the next section) for better pain control.
Ibuprofen / Motrin / Advil – If you are able to take Ibuprofen, it is the recommended over the counter medication for dental pain. It works very well for mild to moderate pain. Ibuprofen is in a group of medications known as non-steroidal anti-inflammatory drugs (NSAIDS). Another common NSAID is naproxen sodium which works in a similar manner. The most common dosage of Ibuprofen is 400 mg but you can take up to 800 mg every 6 hours. Ibuprofen tends to upset your stomach and can cause kidney damage at high dosages. If you have problems with your GI system or kidneys, ask your doctor if you should be taking Ibuprofen.
Combination – When better pain control is needed with over the counter medications, you can take Ibuprofen and Tylenol at the same time. They work in separate ways and will not cause an overdose when taken together.
Opiate Painkillers (also known as Narcotics)
Opiate painkillers are usually used when someone is expected to have moderate to severe pain. In most dental cases this means after a tooth extraction, dental surgery, or a toothache in which you need a root canal.
Hydrocodone / Acetaminophen – The most commonly prescribed opiate medication for dental pain is a combination of hydrocodone and acetaminophen. Dosages of the hydrocodone usually range from 2.5 mg to 10 mg and the dosage of acetaminophen is 325 mg. This combination goes by several different names including Vicodin, Lortab, or Norco.
Oxycodone / Acetominophen – For more severe pain a combination of oxycodone and acetaminophen is used. Oxycodone is a slightly stronger opiate than hydrocodone. Dosages usually range from 2.5 mg to 10 mg with a 325 mg dosage of acetaminophen. As with any medication that is in combination with Tylenol, don’t take more than 1000 mg every 6 hours or you risk liver damage.
Demerol (Meperidine) – This is prescribed for people who have a true allergy to codeine / morphine based opiates. It is in a separate class of opiates known as phenylpiperidines. It isn’t quite as effective as hydrocone or oxycodone. The most common dosage is 50 mg.
Some cautions about using opiate painkillers. Side effects of opiates include constipation, nausea, stomach upset, and itchiness. Taking them on a full stomach can alleviate some of these side effects. Opiate painkillers should also never be taken at the same time as alcohol or benzodiazepines. These can interact strongly leading to a variety of complications up to and including death. Most accidental overdose deaths are a result of taking multiple drugs (including alcohol) at the same time. Opiate medications also carry a very real risk of addiction if you have a personality susceptible to this. If you have any inkling that you might be at risk, please be mindful of the risk and take precautions. Opiate painkillers should only be taken when absolutely needed and discarded afterwards. It is good to put someone else (responsible) in charge of discarding them when you don’t need them anymore.