What Is the Best Pain Medicine to Take After Wisdom Teeth Removal or Dry Socket?
Short answer: 400mg Advil (ibuprofen) and 500mg Tylenol (acetaminophen) up to six times a day
Long answer:
Studies are being conducted where pain medication was repackaged in unmarked capsules. The patients who had wisdom teeth removed took the pain medication given without knowing what it was. They rated how much pain relief they got. Medications were scored based on how many people had to take it for one person to get pain relief. A perfect score would be a 1. That means every person that took it got pain relief. A score of two means that if two people took it, one of them would get pain relief.
For example, the placebo medication in the study scored 18. For every 18 people that took a placebo, one would get pain relief. Here are how the medications scored, listed in order from worst to best:
- Codeine alone: 16 (almost as bad as a placebo)
- Codeine with Tylenol: 4.2
- Tylenol alone: 3.8
- Vicodin, Lortab, Norco (hydrocodone/Tylenol): 3.0
- Demerol: 2.9
- Morphine: 2.9
- Percocet (oxycodone/Tylenol): 2.6
- Torodol oral: 2.6
- Ibuprofen alone: 2.4
- Two Alleve (naproxen sodium): 2.3
- Ketorolac IM: 1.8
- 100mg Ketoprofen: 1.6
- Advil (ibuprofen) and Tylenol: 1.6
Medicines with lower scores give better pain relief. For every three people that take hydrocodone, one will get pain relief. That’s not a very high success rate. The Advil/Tylenol combination is two to three times more effective than narcotics like oxycodone and hydrocodone. You can get Advil and Tylenol over-the-counter, while narcotics are by prescription only. Additionally, narcotic use (even if it’s a legal prescription) can be addictive.
Unfortunately, some patients think the more side effects medication has, the better it is. Here are two hypothetical conversations:
Doc: Did the ibuprofen work?
Patient: Not really. I wish you’d given me something stronger.
Doc: Did you have much pain?
Patient: Not really.
vs.
Doc: Did the Percocet work?
Patient: Oh yeah. I threw up and got dizzy and drowsy.
Doc: Did you have much pain?
Patient: Yes. It’s a good thing you gave me some strong medicine to take.
These patients are rating a medication based on their side effects rather than the ability to provide pain relief. Advil and Tylenol have fewer side effects, no addiction risk, and are more easily available. If you’re truly after pain relief, consider pain medications other than narcotics.
What about ketoprofen? It rated as well as the Advil/Tylenol combination. Advil and Tylenol provide pain relief differently. Advil reduces inflammation at the site of the surgery or tissue damage. Tylenol tells the brain not to pay attention to the pain signal. Because they work differently and are processed by different organs, they are a good combination. Ketoprofen reduces inflammation like Advil and has an effect on the brain similar to Tylenol. You get an effect similar to Advil/Tylenol in one medication.
Ketoprofen was available in 12.5mg doses over-the-counter. Now it is available by prescription in 50, 75, and 100mg doses. Consider requesting it from your doctor when pain management is needed.
What Would the Ideal Wisdom Tooth Removal Pain Management Script Look Like? What Is the Best Way to Minimize Pain?1 – Take a dose of Advil and Tylenol before your surgery.
2 – IV steroid at the beginning of the surgery appointment.
3 – Local anesthetic before and after surgery. (Bupivacaine local anesthetic delivered immediately after tooth removal reduces post-op pain for 48-72 hours.)
4 – IV or IM (intramuscular) Ketorolac during surgery.
5 – Take regular doses of Advil and Tylenol for several days after your surgery.
Patients in their late teens and 20s had the highest risk of persistent use if they received opioids around the time of their extraction, a new study finds.
Getting wisdom teeth removed may be a rite of passage for teens and young adults, but the accompanying opioid painkiller prescriptions many of them receive can lay a foundation for long-term opioid use, a new study finds.
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Young people ages 13 to 30 who filled an opioid prescription immediately before or after wisdom teeth extraction were nearly 2.7 times as likely as their peers to still be filling opioid prescriptions weeks or months later.
Those in their late teens and 20s had the highest odds of persistent opioid use compared with those of middle and high school age, a University of Michigan team reports in a research letter published this week in JAMA.
Led by Calista Harbaugh, M.D., a U-M research fellow and surgical resident, the researchers used insurance data to focus on young people who were “opioid naïve” — in other words, those who hadn’t received an opioid prescription in the six months before their wisdom teeth surgery and who didn’t have any other procedures requiring anesthesia in the following year.
“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need them for post-procedure pain,” says Harbaugh, a National Clinician Scholar at U-M's Institute for Healthcare Policy & Innovation.
“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”
Other factors also contributed to a risk of long-term opioid use. Teens and young adults who had a history of chronic pain conditions or mental health issues such as depression and anxiety were more likely than others to go on to persistent opioid use after filling their initial wisdom tooth-related prescription.
More about the study
In all, 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescriptions between 2009 and 2015 went on to persistent opioid use — which is defined as two or more prescriptions filled in the next year written by any provider for any reason.
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Of the 14,256 wisdom tooth patients who didn’t fill an opioid prescription, only 0.5 percent went on to become persistent users.
Though those numbers may seem small, the high number of wisdom teeth procedures each year means a sizable population of young people is at risk, notes Harbaugh, also a research fellow with the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN.
She and her team used data from employer-based insurance plans, available through the Truven MarketScan database purchased for researchers’ use by IHPI. Chad Brummett, M.D., co-director of Michigan OPEN, is senior author of the new research; the team includes U-M School of Dentistry professor Romesh Nalliah, D.D.S., MHCM.
Some uncertainties remain. The data show opioid prescriptions filled, not actual use of opioid pills by patients. Leftover opioids pose a risk of their own, because they can be misused by the individual who received the prescription, or by a member of their household or a visitor.
Researchers also couldn’t tell the reason for the later opioid prescription fills by those who went on to persistent use.
Still, the authors suggest that dentists and oral surgeons should first consider prescribing non-opioid painkillers to their wisdom tooth patients. If pain is acute, they should prescribe fewer pills than the seven-day opioid supply recently recommended by the American Dental Association for any acute dental pain.
“There are no prescribing recommendations specifically for wisdom tooth extraction,” says Harbaugh. “With evidence that nonsteroidal anti-inflammatories may be just as, if not more, effective, a seven-day opioid recommendation may still be too much.”
Brummett adds: “These are some of the first data to show the long-term ill effects of routine opioid prescribing after tooth extractions. When taken together with the previous studies showing that opioids are not helpful in these cases, dentists and oral surgeons should stop routinely prescribing opioids for wisdom tooth extractions and likely other common dental procedures.”
Importance for patients and parents
Getting a prescription for an opioid painkiller around the time of a wisdom tooth procedure comes with many decision points, Harbaugh says.
“Patients must decide whether to fill the prescription and take the medication, and where to store and dispose of the unused pills,” she notes. “All of these decision points need to be discussed with patients. Patients should talk to their dentists about how to control pain without opioids first.
SEE ALSO: Opioids Before Surgery Mean Higher Costs, Problems More Likely Afterward
“If needed, opioids should only be used for breakthrough pain as backup if the pain’s not controlled with other medications.”
The Michigan OPEN team is currently studying the wisdom tooth extraction population further, by speaking with patients and parents about their experience and how many opioid pills they actually took. This will allow them to create evidence-based prescribing guidelines just like the ones they’ve developed for other operations.
The research was funded by the federal Substance Abuse and Mental Health Services Administration, the Michigan Department of Health and Human Services, and University of Michigan Precision Health