Therapeutic Considerations

Satisfactory relief of odontogenic pain can be attained through an approach that incorporates primary dental care in conjunction with intraoperative local anesthesia and the administration of a postoperative analgesic regimen based on a disease-modifying agent. Therefore, unless otherwise contraindicated, NSAIDs are first-line drugs for the treatment of all odontogenic pain. It is of note that response to an analgesic can vary widely; i.e., some individuals respond better to one analgesic than to another.

Consider the efficacy of NSAIDs vis-à-vis other available options when prescribing analgesics. Since direct head-to-head trials of the various analgesics are not always available, an alternative is to consider the numbers needed to treat (NNT), i.e., the number of patients who need to receive the active drug for one to achieve at least 50% pain relief over 4 to 6 hours compared with a placebo in randomized, double-blind, single-dose studies in patients with moderate-to-severe pain (Table 1).36

Table 1. The Oxford League Table for Analgesic Efficary.36

Analgesic Dosages in milligrams Number of people in comparison % with ≥ 50% pain relief NNT Lower confidence level Upper confidence level
Ibuprofen 800 76 100 1.6 1.3 2.2
Ibuprofen 600-800 165 86 1.7 1.4 2.3
Ibuprofen 600 203 79 2.4 2.0 3.1
Ibuprofen 400 5,456 55 2.5 2.4 2.7
APAP w/oxycodone 650/10 315 66 2.6 2.0 3.5
APAP w/tramadol 650/75 679 43 2.6 2.3 2.3
Naproxen sodium 400-440 197 51 2.7 2.1 4.0
Naproxen 500-550 784 52 2.7 2.1 3.3
Ibuprofen 200 3,248 48 2.7 2.5 2.9
Morphine (IM) 10 946 50 2.9 2.6 3.6
Naproxen sodium 200-220 202 45 3.4 2.4 5.8
APAP w/codeine 650/60 1,123 42 4.2 3.4 5.3
ASA 600-650 5,061 38 4.4 4.0 4.9
APAP 600-650 1,886 38 4.6 3.9 5.5
Codeine 60 1,305 15 16.7 11.0 48.0
Placebo - >10,000 18 N/A N/A N/A

Analgesics should be administered on schedule. The “by-the-clock” administration of analgesics is much more effective than waiting for pain to return before giving the next dose and may actually reduce the total dosage required for the management of a painful episode. The optimal dose of an analgesic that will provide adequate pain relief must be established by titration. The dosage interval is predicated on the drug’s elimination half-life.