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  • Pain relief guidelines

    Pain relief guidelines

Recommended pain relief for dental pain in adults

Mild to moderate pain

1000mg paracetamol four times daily

Or 400mg ibuprofen three times daily

Moderate to severe pain

400–600mg ibuprofen three to four times daily*

And 1000mg paracetamol four times daily

*For severe or acute conditions, ibuprofen can be prescribed to a maximum of 2.4g daily (600mg, four times a day).
If you wish to purchase the product over the counter, then the maximum dose is 1.2g daily (400mg, three times a day). For severe or acute pain, paracetamol and ibuprofen may be combined, doses of each may be taken together or alternately. To minimise confusion, it is recommended that doses of ibuprofen and paracetamol are taken together.

Recommended guidelines for combining paracetamol and ibuprofen for moderate to severe pain

Breakfast

1000mg paracetamol 400–600mg ibuprofen

Lunch

1000mg paracetamol 400–600mg ibuprofen

Dinner

1000mg paracetamol 400–600mg ibuprofen

Before bed

1000mg paracetamol 400–600mg ibuprofen

Or the alternative is to stagger the doses of paracetamol and ibuprofen over 24 hours. If this regimen is used, ensure that ibuprofen is taken with food.

  • Ibuprofen should be taken with food
  • Do not exceed recommended maximum doses:
    • 4000mg paracetamol in a 24-hour period
    • 2400mg ibuprofen in a 24-hour period.

Patients should let their dentist know what they are already taking or normally take for pain before prescribing, including any prescribed or over the counter remedies.

Avoid ibuprofen if:

  • You have a hypersensitivity to aspirin or any other non-steroidal anti-inflammatory drug (NSAID), including if you have experienced attacks of asthma, angioedema, urticaria or rhinitis precipitated by aspirin or another NSAID
  • You have active peptic ulcer disease or a history of NSAID-associated ulcer disease
  • You are in the third trimester of pregnancy
  • You have severe heart failure
  • You are taking any other NSAID painkillers

 

Use ibuprofen with caution if:

  • You have a history of asthma or other allergic disease, bowel problems, ulcerative colitis, Crohn’s disease or connective tissue disorders
  • You have severe renal, cardiac or hepatic impairment
  • You are elderly
  • You have uncontrolled hypertension
  • You have coagulation defects or inherited bleeding disorders
  • You are in the first 6 months of pregnancy
  • You are breastfeeding
  • You are taking the following medicines: anticoagulants, antihypertensives, methotrexate, selective serotonin reuptake inhibitor (SSRIs), lithium, antiplatelet agents

Avoid paracetamol if:

  • You have a hypersensitivity to paracetamol or any of its formulations

Use paracetamol with caution if:

  • You have severe hepatic or renal impairment

It is important to always let your dentist know if there are any changes to your medical history.

 

Recommended pain relief for dental pain in children

Regimens for combining paracetamol and ibuprofen as for adults, but using doses in table below:

Paracetamol doses for children

Age 6 months–1 year

120mg every 4–6 hours, maximum 4 times per day

Age 2–3 years

180mg every 4–6 hours, maximum 4 times per day

Age 4–5 years

240mg every 4–6 hours, maximum 4 times per day

Age 6–7 years

240–250mg every 4–6 hours, maximum 4 times per day

Age 8–9 years

360–375mg every 4–6 hours, maximum 4 times per day

Age 10–11 years

480–500mg every 4–6 hours, maximum 4 times per day

Age 12–15 years

480–750mg every 4–6 hours, maximum 4 times per day

Age 16–17 years

0.5–1g every 4–6 hours, maximum 4 times per day


Ibuprofen doses for children

Age 6 months–11 months

50mg 3 times a day, maximum daily dose in 3–4 divided doses; max 30mg/kg per day

Age 1–3 years

100mg 3 times a day, maximum daily dose in 3–4 divided doses; max 30mg/kg per day

Age 4–6 years

150mg 3 times a day, maximum daily dose in 3–4 divided doses; max 30mg/kg per day

Age 7–9 years

200mg 3 times a day, maximum daily dose in 3–4 divided doses; max 30mg/kg per day up to max 2.4g per day

Age 10–11 years

300mg 3 times a day, maximum daily dose in 3–4 divided doses; max 30mg/kg per day up to max 2.4g per day

Age 12–17 years

Initially 300–400mg 3–4 times a day (up to 600mg 4 times a day); maintenance 200–400mg 3 times a day


For more information

If further information is required, seek advice from your dentist, a pharmacist, a medical practitioner or the North West Medicines Information Centre/National Dental Medicines Information Service (NWMIC).

The NWMIC enquiry service is available Monday to Friday 08.30 to 17.00 by phone on 0151 794 8113 or email at nwmedinfo@nhs.net

Visit www.evidence.nhs.uk for UKMi and NHS Medicines Information resources.

If you or your child exceed the recommended dose or experience any abnormal reactions, seek immediate advice from a pharmacist, a medical practitioner or attend A&E in the case of an emergency.

This is to be used as guide only; always read the patient information leaflet and understand combining medication fully before taking. Do not hesitate to query any dosages with your dentist, pharmacist or the NWMIC (above).

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