What Type of Pain Medication Should My Dental Implant Patient Use for Comfort?
This is a great question as patients are always apprehensive as to how they will feel during and after a dental implant or other surgical procedure. Questions such as taking time off of work, restricting activities and pain in general are foremost on their mind. Many years ago, I learned from an instructor in my training that ibuprofen is the best. However, he told me that people do not take it properly. Most patients under medicate themselves. He told me that the full effect of the drug will take place after the patient has taken 2g of the drug. This is equivalent to 10 OTC tablets. I started the patient on the drug the day before the procedure. I followed this protocol preoperatively for years although I never saw research on this. I found that post op was amazing for the patient. Literally they had no issues.
A number of years later a study involving periodontal surgery with the use of pre-op ibuprofen caused an increase in bleeding at the time of surgery and its pre-op use was not recommended. I looked at my cases and decided to break my all or nothing rule. Not only do I follow this in my daily practice, I also suggest this protocol in my dental implant training lecture: If the case involved only a small area, for example less than 3 teeth, I continued my protocol. If it involved a much larger area, especially in edendtulous case, I curtailed my recommendation back to the day of surgery.
Just recently a study appeared by Anita Aminoshariae, DDS, MS, an associate professor in the Case Western Reserve University School of Dental Medicine’s Department of Endodontics. She echoed my thoughts and clinical experience on the most effective analgesic for dental discomfort. She said that “the best available data suggests that the use of non-steroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.”
In cases where patients need a little more, I suggest altering 1000mg of acetaminophen with the ibuprofen every 2 hours. This protocol was one that I actually learned from a pediatrician. Her research further showed that this combination was far better than opioids which many patients demand and many doctors go to when pressured. Although every drug involves a benefit-risk thought process, the risk and side effects of opioids is typically far worse than NSAID and acetaminophen.
I keep my patients on post op meds for at least one day and prn after that. This has worked extremely well and with this we have put one of the biggest patient fears to rest.