Thursday, September 10, 2015

Medications and Dosages for Mouth or Toothache Pain

Many people when they first have a toothache go to the medication cabinet and will usually decide between Tylenol (Acetominophen) or Advil (Ibuprofen).  Most believe they are interchangeable but because of their different modes of action, the truth is somewhere in between. These medications are both effective but your particular ailment is what will determine which will work better for your ache or pain.

The exact mechanism of how Acetominophen actually works is still a bit of a mystery. It is believed that Acetaminophen is a prostaglandin/COX inhibitor that results in a by-product that reduces fever and activates special serotonin pathways to produce a general feeling of analgesia.

While Acetaminophen shares the fever reducing and analgesic properties of other COX inhibitors such as Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), the one thing it does not exhibit is a significant anti-inflammatory property.

This is where Ibuprofen comes in. Ibuprofen is NSAID that is used to relieve pain, reduce fever and also reduce inflammation. Like Acetaminophen it is also a COX inhibitor that reduces the amount of prostaglandins but it’s mode of action is different.

Prior to 2013 it was suggested that Ibuprofen was the drug of choice with respect to tooth pain. While this is true with respect to mild and mild to moderate tooth pain recent studies have shown the moderate to severe and severe pain are much more effectively treated with the combinatorial therapy of Acetominophen and Ibuprofen together. The chart below depicts a definitive protocol for the administration of these two pain medications to treat toothache pain and/or oral discomfort.
This is our recommendation at our clinic and I have found it is successful in 99.9% of cases. One alternative therapy is Oxycodone but because of the addictive attributes of this opioid it is reserved for severe cases. Ultimately the pain must heal or be treated to address the source of the pain to avoid the need for continuous pain management.

It is important to state that Acetominophen is toxic to the liver at high dosages and Ibuprofen can cause GI bleeds in high dosages which is why one should not exceed the recommended daily maximums and consult with your healthcare professional for specific recommendations.  Also it's important to remember that Advil and Tylenol are just trade names and generic medications can be substituted in their stead.