Analgesics after Tooth Extraction – Types and Dosage

Tooth extraction is a minor Surgical procedure which involves removal of a Tooth from Soft and Hard Tissue (Bone) which tend to cause Post Operative Pain and discomfort, to control such pain Dentists prescribe Analgesics depending on the type of procedure performed. The pain associated with Tooth Extraction ranges from moderate to Severe depending on the type of extraction – Simple Tooth Extraction (mobile teeth, Anterior Tooth extraction), Moderate or regular tooth extraction (Firm tooth) and Surgical Procedure (Third Molar Impaction surgery). Other major surgical procedures such as Fractures, Severe infections like Cysts involving Bone damage lead to severe pain and associated swelling.

The trauma to Soft and Hard tissue leads to release of chemical mediators which cause inflammatory and pain response, the mediators are histamine, serotonin, kinins and prostaglandins. The use of NSAID’s is to reduce the inflammatory response by keeping it under control and promoting rapid healing. This helps in reducing pain, swelling and also limited mouth opening as seen in such cases. NSAID’s tend to have anti-inflammatory, analgesic and antipyretic property which is achieved by inhibiting cyclo-oxygenase (COX) enzymes.

In case of Surgical removal of Impacted 3rd Molar where removal of Bone is done leading to Swelling, the use of Serratiopeptidase (it is a metalloprotease) having anti-inflammatory. Anti-edemic and fibrinolytic action helps in keeping swelling under control.

1. So Let us look at the various Analgesics or Pain Killers used after Tooth Extraction and their dosage.
2. Diclofenac / Acelofenac + Paracetamol – 100/325 mg every 8 hours
3. Acelofenac + Serratiopeptidase + Paracetamol – 100/15/325 mg – every 8 hours (to reduce Swelling after Surgical Removal of Impacted Molar)
4. Diclofenac / Acelofenac – 50 mg -3 times per day (tid)
5. Ibuprofen – 200-400mg every 6-8 hours
6. Ketoprofen – 25-75 mg every 6-8 hours
7. Tramadol + Paracetamol – 37.5/325 mg every 8 hours
8. Paracetamol – 500-1000 mg 3 times per day (tid)
9. Naproxen Sodium – 500 mg, followed by 250 mg every 6-8 hours
10. Flurbiprofen – 50-100 mg every 8 hours
11. Celecoxib – 500-1000 mg 3 times per day (tid)

The above mentioned Analgesics and their combinations are used for most types of dental pain and will give relief in most cases. In case the pain is intense and higher potency medication is needed, these medications are used –

1. Oxycodone/Ibuprofen – 5/400 mg every 6 hours
2. Oxycodone/acetaminophen – 5/500 mg every 6 hours
3. Hydrocodone/acetaminophen – 5/325 mg or 7.5/500 mg every 4-6 hours

So the drugs of choice for Post-Operative pain management are NSAID’s which help in relieving pain, inflammation, swelling, improves mouth opening and overall improving the quality of life post-operatively. These are used In combination with other drugs depending on the procedure and amount of