Pain Relief After Dental Treatment: What to Know About NSAIDs

Choosing the right pain reliever is part of your care

After a tooth extraction, oral surgery or another dental procedure, it is normal to feel some pain or discomfort. To manage it, your dentist may prescribe a pain reliever.

Among the most commonly used are NSAIDs — non-steroidal anti-inflammatory drugs — such as ibuprofen, ketoprofen, naproxen and diclofenac.

They are very effective, but they are not suitable for everyone: the choice must take into account your general health, any treatments you are already receiving, and any stomach, heart, kidney or liver problems.

What are NSAIDs?

NSAIDs relieve pain and reduce inflammation. This makes them particularly useful when dental pain comes with inflammation, for example after an extraction.

The most recent guidelines on the management of acute dental pain confirm that, in adults with no particular contraindications, NSAIDs — alone or combined with paracetamol — are highly effective at controlling pain after dental procedures.

This does not mean, however, that an NSAID is always the best choice.

“Over the counter” does not mean “right for everyone”

Ibuprofen, ketoprofen and other NSAIDs are easy to buy at the pharmacy and are often taken without a prescription for headaches, back pain or other aches.

That is why it is important to tell your dentist about medicines that were not prescribed by a doctor, too.

When we take a patient’s medical history, we don’t just ask “Which medicines do you take?”, but also “What do you usually take when you have a headache, back pain or another kind of pain?”. The answer can make all the difference in choosing a safe treatment after your dental care.

Are NSAIDs safe for the stomach?

Not always.

A common misconception is that an NSAID with an enteric coating or a special formulation is automatically “stomach-friendly”.

In reality, the risk of gastritis, ulcers and gastrointestinal bleeding does not depend only on the medicine’s contact with the stomach lining, but also on how it acts on the body once absorbed.

For this reason, even very common medicines such as ibuprofen and ketoprofen may not be suitable for people who suffer from gastritis, have had an ulcer, or have had gastrointestinal bleeding in the past.

In these cases your dentist will consider an alternative or, if necessary, consult your GP or the specialist who follows you.

What if I have heart problems?

If you have cardiovascular disease, choosing a pain reliever also requires particular care.

Some NSAIDs can increase the risk of cardiovascular events in certain groups of patients. The risk depends on the medicine, the dose, the length of treatment and, above all, the person’s health — and it can be significant even when the medicine is taken for just a few days.

If you have had a heart attack, suffer from heart failure or coronary artery disease, or take heart medication, always tell your dentist before taking an anti-inflammatory.

Take care with aspirin and anticoagulants

Particular caution is needed if you take:

• low-dose aspirin;
• anticoagulants (blood thinners);
• other medicines that affect blood clotting.

Some NSAIDs can increase the risk of bleeding and, in some cases, interfere with the effect of other medicines.

Never stop an anticoagulant or antiplatelet medicine on your own before a dental procedure: that decision belongs to the doctor who manages your treatment, working with your dentist when necessary.

When both stomach and heart need protecting

Some situations are particularly delicate — for example, when a person has both stomach and cardiovascular problems.

There is no one-size-fits-all answer here: your dentist may choose a medicine other than an NSAID, adjust the pain management strategy, or consult your GP or specialist.

This is also why it is not advisable to automatically reach for the pain reliever that worked for you in the past.

The treatment itself helps reduce pain

Pain control does not depend on medication alone.

A procedure carried out with appropriate techniques and as gently as possible helps reduce pain and swelling in the following days. When appropriate, your dentist may also use a longer-acting anaesthetic to make the first hours after treatment more comfortable.

Following the instructions you receive afterwards also matters: applying ice in the first few hours, eating appropriately and keeping up good oral hygiene can all make a difference.

Why not choose a pain reliever yourself?

“I’ve always taken this one and it works for me” is something we hear often.

But things can change from one time to the next: you may have started new medicines, developed stomach or heart problems, or simply be in a different state of health. What’s more, pain after dental treatment can be different from the pain you usually take a pain reliever for.

So it is best not to choose the medicine yourself, or to increase the dose if the pain doesn’t go away.

If the pain is very intense, doesn’t improve over the following days, or gets worse instead of better, contact the practice: persistent pain can be a sign of a complication that your dentist needs to assess.

What to tell your dentist

Before a dental procedure, let your dentist know if you have or take:

• gastritis, an ulcer or previous gastrointestinal bleeding;
• a previous heart attack or other cardiovascular disease;
• kidney or liver problems;
• anticoagulant or antiplatelet therapy;
• aspirin on a regular basis;
• allergies or reactions to pain relievers;
• an NSAID or another pain reliever you are already taking;
• several medicines, or treatment for other conditions.

Please also mention any medicines bought without a prescription.

In summary

NSAIDs are effective medicines and, for people without contraindications, a good option for controlling pain after many dental procedures. But “over the counter” does not mean “right for everyone”.

The choice of pain reliever should take into account the patient’s medical history, the medicines they take and the type of procedure performed.

The simplest advice is also the most important: before taking a pain reliever after dental treatment, ask your dentist which one is best for your situation — and always tell them about every medicine you take, including those bought at the pharmacy without a prescription.

The information in this article is for general guidance only and does not replace the assessment of your dentist or doctor.