Nonopioid analgesics for patients with dental pain

Although new analgesic agents are being introduced at a seemingly increasing frequency, it still appears that the old standards are weathering the storm of competition. For most dental situations, aspirin or acetaminophen is sufficiently efficacious for the management of pain and traumatic swelling. Under unusual circumstances in which the baseline pain is expected to be exceptionally high, ibuprofen may offer additional relief. The choice of which agent to use should be based upon an evaluation of the patient's medical history and the anticipated level of pain. Individuals intolerant to aspirin may be able to tolerate acetaminophen without untoward reactions. However, caution must be observed to assure that cross-intolerance is not present. Utilization of more potent cyclo-oxygenase inhibitors such as ibuprofen markedly increases the probability of cross-intolerance. Other forms of sensitivity to aspirin such as gastrointestinal distress may be averted by choosing any of the alternative agents. Only by trial and error will the clinician be able to pragmatically determine which agent is best suited for the individual patient. Cost is another factor that should be considered. Aspirin and acetaminophen are readily available and are extraordinarily inexpensive. The newer drugs, although perhaps slightly more efficacious, are considerably more costly. Although there may be a tendency for the practitioner to prescribe a drug that will be effective against the extremes, the benefit-to-cost ratio is unsupportive of this approach. Only when severe pain is anticipated or when the patient is unresponsive to the more traditional analgesics, should the more efficacious but much more expensive agents be employed.