Severe Odontogenic Pain

For the treatment of severe odontogenic pain, a strong, full μ-receptor agonist such as fixed-dose oxycodone w/ibuprofen with “add-on” doses of ibuprofen (and APAP) may be considered (Table 5). Oxycodone w/ibuprofen, 5/400 mg, is more effective than oxycodone w/APAP, 5/650 mg; or hydrocodone w/APAP, 7.5/500 mg.47,48 Fixed-dose oxycodone w/APAP, 5/325 mg, up to a maximum of two tablet per dose and no “add-on” APAP is an alternative, i.e., when NSAIDs are contraindicated.

Table 5. Strong Full μ-receptor Agonists for Severe Odontogenic Pain.

Drug Fixed-dose oral formulations in milligrams “Add-on” options Dosing
Oxycodone w/ibuprofen (Combunox) 5/400 Ibuprofen, 200 mg
+
APAP, 325 to 650 mg
q6h
Ibuprofen, 400 mg
+
APAP, 325 to 650 mg
q8h
Oxycodone w/APAP (generic, Percocet, others) 5/325 N/A q4-6h

Tramadol w/APAP, 75/650 mg, is as effective for the management of postsurgical dental pain as hydrocodone w/APAP, 10/650 mg.49 However, ibuprofen, 200 mg, is more effective than tramadol w/APAP, 112/650 mg.36 Ibuprofen, 400 mg, is more effective for the management of postsurgical dental pain than tapentadol, 200 mg.50 Clearly, neither tramadol nor tapentadol should be considered preferred analgesics for postsurgical odontogenic pain.