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

AnalgesicDosages in milligramsNumber of people in comparison% with ≥ 50% pain reliefNNTLower confidence levelUpper confidence level
APAP w/oxycodone650/10315662.62.03.5
APAP w/tramadol650/75679432.62.32.3
Naproxen sodium400-440197512.72.14.0
Morphine (IM)10946502.92.63.6
Naproxen sodium200-220202453.42.45.8
APAP w/codeine650/601,123424.23.45.3

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.