How to Manage Toothache and Dental Pain
January 10, 2020
We do not want you to be in any pain! However there are situations where pain relief is needed. COVID-19 Alert Level 3 and 4 are examples we would not have anticipated in the past. You might also be travelling in to see us with a sore tooth, or healing an infected or damaged tooth. Here are some guidelines on how best to manage dental pain.
Analgesics (painkiller medications)
Analgesics or ‘painkillers’ include drugs such as paracetamol, NSAID’s (non steroidal anti-inflammatory drugs) and opioids. They are often combined, as in panadeine (paracetamol and codeine) or maxgesic (paracetamol and nurofen). Instructions on how to take analgesics are listed below.
Remember analgesics only block the pain, they do not cure infection or kill bacteria. If you are in pain and are not receiving treatment, it is important to come and see us as soon as possible.
Paracetamol
Paracetamol (Panadol) is very good for managing mild to moderate pain. It can be used for severe pain but is usually combined with other medications. During the first 48-72 hours it is best used at regular intervals, instead of ‘as required’.
Paracetamol is a very safe analgesic. It has few side effects providing you never exceed the recommended daily dose. Be careful when combining with other medications as some pain, cough and cold products also contain paracetamol.
The recommended total daily adult dose is 4g which is 8x 500mg tablets. This is commonly taken as 2x 500mg tablets, 4 times per day (every 6 hours).
NSAIDs: Non-Steroidal Anti-inflammatory Drugs
NSAIDs are excellent for managing mild to moderate pain. When combined with other medications they are very effective against severe pain. They include aspirin, ibuprofen, diclofenac, naproxen and voltaren.
A side effect of NSAIDs is possible indigestion and stomach ulcers. For this reason they should always be taken with food and at the lowest dose for the shortest possible time. They should not be taken for more than 2 weeks without the supervision of your GP.
NSAIDs are safe but should not be used in the following cases:
- Allergy to aspirin or any NSAID
- Aspirin should not be used under the age of 16 years
- During pregnancy or breast feeding
- On blood thinning agents (anticoagulants)
- Suffering from a defect of the blood clotting system (coagulation)
- Active stomach ulcer
Care is needed if you have:
- Asthma
- Kidney impairment
- Heart impairment
- Liver impairment
- You are elderly
Rubbing on topical anti-inflammatory gels such as Voltaren Emugel can reduce joint or muscle pain. However they can also cause the problems listed above. Make sure you wash your hands after use and avoid contacting your eyes.
Mild Opioids (Codeine Phosphate/Dihydrocodeine/Tramadol)
Opioids work well for mild to moderate pain. However they are most effective when used in combination with paracetamol and/or NSAIDs. Opioids are usually used during the early phase of treatment and for shorter periods of time because of their side effects. These include constipation, vomiting, nausea, drowsiness and light headedness. People may also develop a tolerance or addiction to the drugs. To prevent constipation you may need to adjust your diet and drink more fluids.
Tramadol may interact with other medicines (including other opioids, warfarin, antidepressants, and antipsychotics ). It is very important you inform your prescriber of all your medications to avoid this.
If you become dizzy or drowsy do not drive or operate machinery.
How to take analgesics
The trick to getting the best pain relief is to take the drug as a course of medication at regular intervals for a set period of time. This means the blood levels of the drug are kept high and best pain relief is obtained. Most analgesics need to be taken every 4-6 hours
For Mild Pain
Use Paracetamol 500mg tablets.
Take 1-2 tablets every 4-6 hours to a maximum of 8 tablets per day (4g total/24 hours)
OR
Use Ibuprofen (Nurofen/Brufen) 400mg tablets.
Take 1 tablet every 4-6 hours to a maximum of 6 tablets per day (2400mg/24 hours)
For Moderate Pain
In adults, excellent pain relief can be achieved by taking paracetamol and ibuprofen alternately every 2 hours (so each individual drug is only taken at 4 hour intervals). The paracetamol can usually be stopped after 24-48 hours.
Use Paracetamol 500mg tablets.
Take 1-2 tablets every 4-6 hours to a maximum of 8 tablets per day (4g total/24 hours)
PLUS
Use Ibuprofen (Nurofen/Brufen) 400mg tablets.
Take 1 tablet every 4-6 hours to a maximum of 6 tablets per day (2400mg/24 hours)
For Severe Pain
In adults, excellent pain relief from severe pain can be achieved by taking paracetamol and codeine together, and ibuprofen alternately every 2 hours (so each individual drug is only taken at 4 hour intervals). The paracetamol and codeine can usually be stopped after 24-48 hours.
Use Paracetamol 500mg tablets.
Take 1-2 tablets every 4-6 hours to a maximum of 8 tablets per day (4g total/24 hours)
PLUS at the same time
Use Codeine 30mg tablets.
Take 1-2 tablets every 4-6 hours to a maximum of 8 tablets per day (240mg total/24 hours)
PLUS
Use Ibuprofen (Nurofen/Brufen) 400mg tablets.
Take 1 tablet every 4-6 hours to a maximum of 6 tablets per day (2400mg/24 hours)
How else can I manage pain?
- Apply a cold pack to the site of the pain.
- Gently increase activity and exercise, but not in the first 24 hours after a tooth extraction.
- Physiotherapy, osteopathy, chiropractic treatment, massage and acupuncture.
- Distraction and relaxation techniques.
- Alcohol is not recommended.
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