Effective pain management is a crucial component of dental practice. When addressing acute pain or managing chronic, or neuropathic pain conditions, dentists must balance efficacy and patient safety. Here we provide an evidence-based overview of pain management strategies for dental professionals, including pharmacologic and non-pharmacologic options.
Understanding Dental Pain
Dental pain can originate from various sources, including inflammation, nerve damage, infection, or procedural trauma. Proper assessment and classification of pain help determine the most appropriate treatment.
Types of Dental Pain
Acute Pain – Short-term pain due to procedures such as extractions, endodontic therapy, or periodontal surgery.
Chronic Orofacial Pain – Persistent pain associated with conditions like temporomandibular disorders (TMJ dental pain).
Neuropathic Pain – Pain resulting from nerve injury or dysfunction, like trigeminal neuralgia, requiring specialized management approaches.
How to Treat Dental Pain
Pharmacologic Pain Management
Pharmacologic therapy is a cornerstone of dental pain management. Dentists must be familiar with the effectiveness, indications, and risks of various analgesics.
1. Non-Opioid Analgesics (First-Line Treatment)
Acetaminophen (Paracetamol) – Effective for mild to moderate pain; often combined with NSAIDs for increased efficacy.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – Such as ibuprofen and naproxen, provide analgesic and anti-inflammatory effects. NSAIDs are recommended as first-line therapy for postoperative dental pain, including pain after dental extraction and pain after dental filling.
Note: Both acetaminophen and most NSAIDs are available as over the counter dental pain relief, but if the patient has trouble paying for medications, consider writing a prescription as they are more likely to be covered under specific benefit plans.
Additionally, both acetaminophen and NSAIDs may be taken in conjunction for short durations. This can help avoid the need for escalation to opioids for dental pain management.
Additional note: Aspirin for dental pain – Can be used as an analgesic, but not regularly used. Do NOT use in patients with bleeding risks, or those who are on other anticoagulants or antithrombotics.
2. Opioid Analgesics (For Severe Pain)
Opioids (e.g., codeine, oxycodone, tramadol) should be prescribed cautiously due to the risk of dependency and side effects.
Used in cases of severe pain, often in combination with acetaminophen.
Limit opioid use to the lowest effective dose for the shortest duration (e.g., 24-48 hours postoperatively prn severe pain).
3. Adjunctive Medications
Topical Anesthetics – Used for pain prevention during and after procedures. Includes topical lidocaine, benzocaine, and tetracaine. Most patients do not enjoy the sensation, and can cause difficulty swallowing if used excessively, so try to use the lowest effective amount.
Injectable Lidocaine, Articaine, Bupivacaine – Provide temporary pain relief during and after procedures. Ensure that maximum doses are not exceeded by using available dose calculators.
Corticosteroids – Used for severe inflammatory conditions. Reduce inflammation and pain in conditions like pulpitis or post-operative recovery.
Anticonvulsants (e.g., gabapentin, pregabalin) – Used for neuropathic pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Antidepressants (e.g., amitriptyline, duloxetine) – Indicated for chronic pain management in some patients. Generally indicated for neuropathic components to pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Muscle Relaxants – Beneficial for TMJ-related pain. Includes cyclobenzaprine (prescription) and methocarbamol (over the counter). Be aware of side effects (particularly fatigue and somnolence) caused by muscle relaxants.
Antibiotics – Necessary for bacterial infections, such as dental abscesses. No direct effect on pain, but pain often resolves naturally after the abscess is cleared.
Nonpharmacologic Pain Management
Non-drug approaches can enhance pain control and reduce reliance on medications.
1. Behavioural and Psychological Approaches
Cognitive Behavioral Therapy (CBT) – Helps patients manage chronic orofacial pain.
Relaxation Techniques – Includes guided imagery and deep breathing exercises.
Cold and Heat Therapy – Cold packs can reduce swelling and numb pain, while heat therapy can relax tense muscles.
2. Physical Therapy and Interventional Techniques
Occlusal Splints – Used for temporomandibular disorders.
Trigger Point Injections – Provide relief for myofascial pain. Contain local anesthetic with or without corticosteroid. Consult a orofacial pain specialist for administration.
Low-Level Laser Therapy (LLLT) – Evidence supports its use for reducing inflammation and pain, including for the management of neuropathic orofacial pain.
3. Patient Education and Self-Care
Encouraging proper oral hygiene to prevent pain-related conditions.
Postoperative care instructions to minimize discomfort and complications, including how to relieve pain from dental implant procedures.
Special Considerations in Dental Pain Management
1. Pain Management in Medically Complex Patients
Patients with Cardiovascular Disease – Avoid NSAIDs in those with high cardiovascular risk as they can increase the risk of hypertension and heart failure, and can even increase short-term risk of stroke.
Patients with Liver Disease – Acetaminophen use should be limited based on the patient's Childs-Pugh score (maximum 2000 mg/day).
Pregnant Patients – Acetaminophen is the preferred analgesic; NSAIDs should be avoided after 20 weeks gestation.
Patients with Chronic Pain – Consider a multimodal approach using non-opioid analgesics, and non-pharmacologic therapies. If opioids are necessary, assess baseline tolerance and collaborate with the patient’s pain specialist.
Patients with Opioid Use Disorder – Avoid initiating opioids whenever possible and prioritize NSAIDs and acetaminophen for pain control. There are many difficult situations that may arise for these patients, and if you believe that opioids are required, coordinate with the patient’s addiction specialist.
2. Pediatric Pain Management
Weight-based dosing for acetaminophen and ibuprofen is required.
Use available pediatric dose calculators to determine safe and effective doses.
Opioid use in children should be highly restricted and closely monitored.
Do NOT use aspirin due to the risk of Reye’s syndrome.
3. Opioid Prescribing Considerations
Dentists should follow national and local guidelines to prevent opioid misuse.
Consider prescription monitoring programs to track opioid dispensing.
Common Dental Pain Scenarios and Management
Pain after dental filling – Usually mild, can be managed with acetaminophen, NSAIDs or topical anesthetics.
Dental crown pain – Can result from improper fit or bite misalignment; adjustments or occlusal splints may be needed.
Pain after dental cleaning – Typically mild and transient; fluoride treatments and desensitizing toothpaste can help, particularly for gum pain after dental cleaning.
Pain from dental implants – Acetaminophen with or without NSAIDs and cold compresses are first-line treatments; severe pain may require further evaluation.
TMJ dental pain – Managed with splints, NSAIDs, physical therapy, and lifestyle modifications. Severe cases of TMJ may require muscle relaxants.
Pain after dental extraction – NSAIDs are typically sufficient; a multimodal approach using NSAIDs, local anesthetics, and careful post-op care can optimize recovery. Persistent pain may indicate dry socket requiring additional treatment.
Dental braces pain relief – NSAIDs, orthodontic wax, and cold compresses can provide relief.
Conclusion
Pain management in dentistry requires a multimodal approach, integrating pharmacologic and non-pharmacologic strategies to optimize patient outcomes while minimizing risks. NSAIDs and acetaminophen remain first-line treatments, with opioids reserved for select cases. Patient education, individualized care, and adherence to prescribing guidelines ensure safe and effective pain control.
For complete prescribing information and dosing guidelines for the above medications, please refer to the DentalRx App.
Using DentalRx, dentists can access up-to-date pain management guidelines, treatment recommendations, and evidence-based prescribing practices, ensuring they provide the best care for their patients. DentalRx simplifies decision-making, helping practitioners stay informed and improve patient safety.
Effective pain management is a crucial component of dental practice. When addressing acute pain or managing chronic, or neuropathic pain conditions, dentists must balance efficacy and patient safety. Here we provide an evidence-based overview of pain management strategies for dental professionals, including pharmacologic and non-pharmacologic options.
Understanding Dental Pain
Dental pain can originate from various sources, including inflammation, nerve damage, infection, or procedural trauma. Proper assessment and classification of pain help determine the most appropriate treatment.
Types of Dental Pain
Acute Pain – Short-term pain due to procedures such as extractions, endodontic therapy, or periodontal surgery.
Chronic Orofacial Pain – Persistent pain associated with conditions like temporomandibular disorders (TMJ dental pain).
Neuropathic Pain – Pain resulting from nerve injury or dysfunction, like trigeminal neuralgia, requiring specialized management approaches.
How to Treat Dental Pain
Pharmacologic Pain Management
Pharmacologic therapy is a cornerstone of dental pain management. Dentists must be familiar with the effectiveness, indications, and risks of various analgesics.
1. Non-Opioid Analgesics (First-Line Treatment)
Acetaminophen (Paracetamol) – Effective for mild to moderate pain; often combined with NSAIDs for increased efficacy.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – Such as ibuprofen and naproxen, provide analgesic and anti-inflammatory effects. NSAIDs are recommended as first-line therapy for postoperative dental pain, including pain after dental extraction and pain after dental filling.
Note: Both acetaminophen and most NSAIDs are available as over the counter dental pain relief, but if the patient has trouble paying for medications, consider writing a prescription as they are more likely to be covered under specific benefit plans.
Additionally, both acetaminophen and NSAIDs may be taken in conjunction for short durations. This can help avoid the need for escalation to opioids for dental pain management.
Additional note: Aspirin for dental pain – Can be used as an analgesic, but not regularly used. Do NOT use in patients with bleeding risks, or those who are on other anticoagulants or antithrombotics.
2. Opioid Analgesics (For Severe Pain)
Opioids (e.g., codeine, oxycodone, tramadol) should be prescribed cautiously due to the risk of dependency and side effects.
Used in cases of severe pain, often in combination with acetaminophen.
Limit opioid use to the lowest effective dose for the shortest duration (e.g., 24-48 hours postoperatively prn severe pain).
3. Adjunctive Medications
Topical Anesthetics – Used for pain prevention during and after procedures. Includes topical lidocaine, benzocaine, and tetracaine. Most patients do not enjoy the sensation, and can cause difficulty swallowing if used excessively, so try to use the lowest effective amount.
Injectable Lidocaine, Articaine, Bupivacaine – Provide temporary pain relief during and after procedures. Ensure that maximum doses are not exceeded by using available dose calculators.
Corticosteroids – Used for severe inflammatory conditions. Reduce inflammation and pain in conditions like pulpitis or post-operative recovery.
Anticonvulsants (e.g., gabapentin, pregabalin) – Used for neuropathic pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Antidepressants (e.g., amitriptyline, duloxetine) – Indicated for chronic pain management in some patients. Generally indicated for neuropathic components to pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Muscle Relaxants – Beneficial for TMJ-related pain. Includes cyclobenzaprine (prescription) and methocarbamol (over the counter). Be aware of side effects (particularly fatigue and somnolence) caused by muscle relaxants.
Antibiotics – Necessary for bacterial infections, such as dental abscesses. No direct effect on pain, but pain often resolves naturally after the abscess is cleared.
Nonpharmacologic Pain Management
Non-drug approaches can enhance pain control and reduce reliance on medications.
1. Behavioural and Psychological Approaches
Cognitive Behavioral Therapy (CBT) – Helps patients manage chronic orofacial pain.
Relaxation Techniques – Includes guided imagery and deep breathing exercises.
Cold and Heat Therapy – Cold packs can reduce swelling and numb pain, while heat therapy can relax tense muscles.
2. Physical Therapy and Interventional Techniques
Occlusal Splints – Used for temporomandibular disorders.
Trigger Point Injections – Provide relief for myofascial pain. Contain local anesthetic with or without corticosteroid. Consult a orofacial pain specialist for administration.
Low-Level Laser Therapy (LLLT) – Evidence supports its use for reducing inflammation and pain, including for the management of neuropathic orofacial pain.
3. Patient Education and Self-Care
Encouraging proper oral hygiene to prevent pain-related conditions.
Postoperative care instructions to minimize discomfort and complications, including how to relieve pain from dental implant procedures.
Special Considerations in Dental Pain Management
1. Pain Management in Medically Complex Patients
Patients with Cardiovascular Disease – Avoid NSAIDs in those with high cardiovascular risk as they can increase the risk of hypertension and heart failure, and can even increase short-term risk of stroke.
Patients with Liver Disease – Acetaminophen use should be limited based on the patient's Childs-Pugh score (maximum 2000 mg/day).
Pregnant Patients – Acetaminophen is the preferred analgesic; NSAIDs should be avoided after 20 weeks gestation.
Patients with Chronic Pain – Consider a multimodal approach using non-opioid analgesics, and non-pharmacologic therapies. If opioids are necessary, assess baseline tolerance and collaborate with the patient’s pain specialist.
Patients with Opioid Use Disorder – Avoid initiating opioids whenever possible and prioritize NSAIDs and acetaminophen for pain control. There are many difficult situations that may arise for these patients, and if you believe that opioids are required, coordinate with the patient’s addiction specialist.
2. Pediatric Pain Management
Weight-based dosing for acetaminophen and ibuprofen is required.
Use available pediatric dose calculators to determine safe and effective doses.
Opioid use in children should be highly restricted and closely monitored.
Do NOT use aspirin due to the risk of Reye’s syndrome.
3. Opioid Prescribing Considerations
Dentists should follow national and local guidelines to prevent opioid misuse.
Consider prescription monitoring programs to track opioid dispensing.
Common Dental Pain Scenarios and Management
Pain after dental filling – Usually mild, can be managed with acetaminophen, NSAIDs or topical anesthetics.
Dental crown pain – Can result from improper fit or bite misalignment; adjustments or occlusal splints may be needed.
Pain after dental cleaning – Typically mild and transient; fluoride treatments and desensitizing toothpaste can help, particularly for gum pain after dental cleaning.
Pain from dental implants – Acetaminophen with or without NSAIDs and cold compresses are first-line treatments; severe pain may require further evaluation.
TMJ dental pain – Managed with splints, NSAIDs, physical therapy, and lifestyle modifications. Severe cases of TMJ may require muscle relaxants.
Pain after dental extraction – NSAIDs are typically sufficient; a multimodal approach using NSAIDs, local anesthetics, and careful post-op care can optimize recovery. Persistent pain may indicate dry socket requiring additional treatment.
Dental braces pain relief – NSAIDs, orthodontic wax, and cold compresses can provide relief.
Conclusion
Pain management in dentistry requires a multimodal approach, integrating pharmacologic and non-pharmacologic strategies to optimize patient outcomes while minimizing risks. NSAIDs and acetaminophen remain first-line treatments, with opioids reserved for select cases. Patient education, individualized care, and adherence to prescribing guidelines ensure safe and effective pain control.
For complete prescribing information and dosing guidelines for the above medications, please refer to the DentalRx App.
Using DentalRx, dentists can access up-to-date pain management guidelines, treatment recommendations, and evidence-based prescribing practices, ensuring they provide the best care for their patients. DentalRx simplifies decision-making, helping practitioners stay informed and improve patient safety.
Effective pain management is a crucial component of dental practice. When addressing acute pain or managing chronic, or neuropathic pain conditions, dentists must balance efficacy and patient safety. Here we provide an evidence-based overview of pain management strategies for dental professionals, including pharmacologic and non-pharmacologic options.
Understanding Dental Pain
Dental pain can originate from various sources, including inflammation, nerve damage, infection, or procedural trauma. Proper assessment and classification of pain help determine the most appropriate treatment.
Types of Dental Pain
Acute Pain – Short-term pain due to procedures such as extractions, endodontic therapy, or periodontal surgery.
Chronic Orofacial Pain – Persistent pain associated with conditions like temporomandibular disorders (TMJ dental pain).
Neuropathic Pain – Pain resulting from nerve injury or dysfunction, like trigeminal neuralgia, requiring specialized management approaches.
How to Treat Dental Pain
Pharmacologic Pain Management
Pharmacologic therapy is a cornerstone of dental pain management. Dentists must be familiar with the effectiveness, indications, and risks of various analgesics.
1. Non-Opioid Analgesics (First-Line Treatment)
Acetaminophen (Paracetamol) – Effective for mild to moderate pain; often combined with NSAIDs for increased efficacy.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – Such as ibuprofen and naproxen, provide analgesic and anti-inflammatory effects. NSAIDs are recommended as first-line therapy for postoperative dental pain, including pain after dental extraction and pain after dental filling.
Note: Both acetaminophen and most NSAIDs are available as over the counter dental pain relief, but if the patient has trouble paying for medications, consider writing a prescription as they are more likely to be covered under specific benefit plans.
Additionally, both acetaminophen and NSAIDs may be taken in conjunction for short durations. This can help avoid the need for escalation to opioids for dental pain management.
Additional note: Aspirin for dental pain – Can be used as an analgesic, but not regularly used. Do NOT use in patients with bleeding risks, or those who are on other anticoagulants or antithrombotics.
2. Opioid Analgesics (For Severe Pain)
Opioids (e.g., codeine, oxycodone, tramadol) should be prescribed cautiously due to the risk of dependency and side effects.
Used in cases of severe pain, often in combination with acetaminophen.
Limit opioid use to the lowest effective dose for the shortest duration (e.g., 24-48 hours postoperatively prn severe pain).
3. Adjunctive Medications
Topical Anesthetics – Used for pain prevention during and after procedures. Includes topical lidocaine, benzocaine, and tetracaine. Most patients do not enjoy the sensation, and can cause difficulty swallowing if used excessively, so try to use the lowest effective amount.
Injectable Lidocaine, Articaine, Bupivacaine – Provide temporary pain relief during and after procedures. Ensure that maximum doses are not exceeded by using available dose calculators.
Corticosteroids – Used for severe inflammatory conditions. Reduce inflammation and pain in conditions like pulpitis or post-operative recovery.
Anticonvulsants (e.g., gabapentin, pregabalin) – Used for neuropathic pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Antidepressants (e.g., amitriptyline, duloxetine) – Indicated for chronic pain management in some patients. Generally indicated for neuropathic components to pain. Consider consultation with an orofacial pain specialist prior to prescribing.
Muscle Relaxants – Beneficial for TMJ-related pain. Includes cyclobenzaprine (prescription) and methocarbamol (over the counter). Be aware of side effects (particularly fatigue and somnolence) caused by muscle relaxants.
Antibiotics – Necessary for bacterial infections, such as dental abscesses. No direct effect on pain, but pain often resolves naturally after the abscess is cleared.
Nonpharmacologic Pain Management
Non-drug approaches can enhance pain control and reduce reliance on medications.
1. Behavioural and Psychological Approaches
Cognitive Behavioral Therapy (CBT) – Helps patients manage chronic orofacial pain.
Relaxation Techniques – Includes guided imagery and deep breathing exercises.
Cold and Heat Therapy – Cold packs can reduce swelling and numb pain, while heat therapy can relax tense muscles.
2. Physical Therapy and Interventional Techniques
Occlusal Splints – Used for temporomandibular disorders.
Trigger Point Injections – Provide relief for myofascial pain. Contain local anesthetic with or without corticosteroid. Consult a orofacial pain specialist for administration.
Low-Level Laser Therapy (LLLT) – Evidence supports its use for reducing inflammation and pain, including for the management of neuropathic orofacial pain.
3. Patient Education and Self-Care
Encouraging proper oral hygiene to prevent pain-related conditions.
Postoperative care instructions to minimize discomfort and complications, including how to relieve pain from dental implant procedures.
Special Considerations in Dental Pain Management
1. Pain Management in Medically Complex Patients
Patients with Cardiovascular Disease – Avoid NSAIDs in those with high cardiovascular risk as they can increase the risk of hypertension and heart failure, and can even increase short-term risk of stroke.
Patients with Liver Disease – Acetaminophen use should be limited based on the patient's Childs-Pugh score (maximum 2000 mg/day).
Pregnant Patients – Acetaminophen is the preferred analgesic; NSAIDs should be avoided after 20 weeks gestation.
Patients with Chronic Pain – Consider a multimodal approach using non-opioid analgesics, and non-pharmacologic therapies. If opioids are necessary, assess baseline tolerance and collaborate with the patient’s pain specialist.
Patients with Opioid Use Disorder – Avoid initiating opioids whenever possible and prioritize NSAIDs and acetaminophen for pain control. There are many difficult situations that may arise for these patients, and if you believe that opioids are required, coordinate with the patient’s addiction specialist.
2. Pediatric Pain Management
Weight-based dosing for acetaminophen and ibuprofen is required.
Use available pediatric dose calculators to determine safe and effective doses.
Opioid use in children should be highly restricted and closely monitored.
Do NOT use aspirin due to the risk of Reye’s syndrome.
3. Opioid Prescribing Considerations
Dentists should follow national and local guidelines to prevent opioid misuse.
Consider prescription monitoring programs to track opioid dispensing.
Common Dental Pain Scenarios and Management
Pain after dental filling – Usually mild, can be managed with acetaminophen, NSAIDs or topical anesthetics.
Dental crown pain – Can result from improper fit or bite misalignment; adjustments or occlusal splints may be needed.
Pain after dental cleaning – Typically mild and transient; fluoride treatments and desensitizing toothpaste can help, particularly for gum pain after dental cleaning.
Pain from dental implants – Acetaminophen with or without NSAIDs and cold compresses are first-line treatments; severe pain may require further evaluation.
TMJ dental pain – Managed with splints, NSAIDs, physical therapy, and lifestyle modifications. Severe cases of TMJ may require muscle relaxants.
Pain after dental extraction – NSAIDs are typically sufficient; a multimodal approach using NSAIDs, local anesthetics, and careful post-op care can optimize recovery. Persistent pain may indicate dry socket requiring additional treatment.
Dental braces pain relief – NSAIDs, orthodontic wax, and cold compresses can provide relief.
Conclusion
Pain management in dentistry requires a multimodal approach, integrating pharmacologic and non-pharmacologic strategies to optimize patient outcomes while minimizing risks. NSAIDs and acetaminophen remain first-line treatments, with opioids reserved for select cases. Patient education, individualized care, and adherence to prescribing guidelines ensure safe and effective pain control.
For complete prescribing information and dosing guidelines for the above medications, please refer to the DentalRx App.
Using DentalRx, dentists can access up-to-date pain management guidelines, treatment recommendations, and evidence-based prescribing practices, ensuring they provide the best care for their patients. DentalRx simplifies decision-making, helping practitioners stay informed and improve patient safety.
