Moderate-to-severe Odontogenic Pain

Prescription strength ibuprofen, naproxen, and naproxen sodium are more effective than codeine with APAP, 60/650 mg (Table 3).36 Consequently, full doses of NSAIDs are the drugs of choice for the treatment of moderate-to-severe odontogenic pain.37-43 It is also of note that full doses of NSAIDs administered concurrently with APAP (325 to 650 mg) are more effective for the treatment of odontogenic pain than full dose of a NSAID or APAP (650 mg) alone.44,45,46

Table 3. NSAIDs for Moderate-to-severe Odontogenic Pain.

DrugUsual oral single dose in milligramsDosingMaximum daily dose in milligrams“Add-on” APAP doses in milligrams
Ibuprofen (generic, Motrin)400q4h2,400325 to 650
Naproxen (generic, Naprosyn)250q6h1,000
Naproxen sodium
(generic, Anaprox)

If moderate-to-severe odontogenic pain is not relieved with full doses of ibuprofen with “add-on” doses of APAP, a weak, full μ-receptor agonist such as fixed-dose hydrocodone w/ibuprofen, 5/200 mg, with “add-on” doses of ibuprofen (and APAP) should be considered (Table 4). When NSAIDs are contraindicated alternative options include fixed-doses of hydrocodone w/APAP, 5/325 mg, or codeine w/APAP, 30/325 mg, up to a maximum of two tablets per dose and no “add-on” doses of APAP.

Table 4. Weak, Full μ-receptor Agonists for Moderate-to-severe Odontogenic Pain.

DrugFixed-dose oral formulations in milligrams“Add-on” optionsDosing
Hydrocodone w/ibuprofen (Vicoprofen, Reprexain)5/200Ibuprofen, 400 mg
APAP, 325 to 650 mg
Ibuprofen, 600 mg
APAP, 325 to 650 mg
Hydrocodone w/APAP (generic, Vicodin, others)5/325N/Aq4-6h
Codeine w/APAP (generic, Tylenol w/codeine)30/325N/Aq4-6h