Before on this site the hazards of opioids prescribed for surgeries like wisdom teeth extraction has been discussed. Instead of taking an opioid like Vicodin which contains hydrocodone or another opioid that contains oxycodone an alternative patients may have if their oral surgeon is willing is to take a combination of ibuprofen and acetaminophen. This combination has been discussed in many articles on the past on this site such as Reducing Opioids in Oral and Maxillofacial Surgery, New Research Being Conducted at Rutgers for Opioid Alternatives Could Lead to Less Potential Drug Abuse for those Having Wisdom Teeth Surgery, and Oral and Maxillofacial Surgeons Current Perspectives on Opioid Prescribing. Patients may have questions about the right dosage level, there side effects, and if they work as well as opioids. According to a white paper by the American Association of Oral and Maxillofacial Surgeons (AAOMS) this combination can rival the analgesic effect of opioids however they causation that the maximum daily dose of acetaminophen and ibuprofen should not exceed 3,000 mg and 3,200 mg respectively.
Acetaminophen is commonly known by the trade name Tylenol. Acetaminophen has the chemical name N-acetyl-p-aminophenol and is known outside the U.S. as paracetamol. It is available over the counter yet it is effective to relieve dental pain and at a 1,000-mg dose has been shown to be more effective than placebo in reducing pain after wisdom teeth removal. Acetaminophen has weak anti-inflammatory effects and is believed to work by inhibiting prostaglandin synthesis. The most serious potential side effects of acetaminophen is drug-induced hepatotoxicity which is due to an overdose. It also has the potential to cause acute liver toxicity, interact negatively with other medications one may be taking, and lead to Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits the formation of cyclooxygenase-1 (COX-1), the enzyme responsible for the production of prostaglandins and also cyclooxygenase-2 (COX-2), the enzyme responsible for the production of prostaglandins. The inhabitation of COX-2 produces the anti-inflammation effects. Several studies have shown ibuprofen at 200-mg and 400-mg doses is more effective than placebo to provide pain relief in patients with moderate to severe postoperative dental pain. One of the more serious potential side effects of ibuprofen is ulcers, bleeding, or holes in the stomach or intestine.
Since acetaminophen and ibuprofen have different mechanisms of action a combination of them can offer a synergistic approach to pain and a superior effect than using just one of the medications alone. However, it is important to note that by taking both this could cause more potential side effects than just taking one medication alone. Even so, a 2019 Cochrane Database of Systematic Reviews titled “Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain (Review)” written by CJ Derry and et al. (2013, Issue 6. Art. No.: CD010210, published in Issue 5, 2019) found that
“Ibuprofen plus paracetamol combinations provided better analgesia than either drug alone (at the same dose), with a smaller chance of needing additional analgesia over about eight hours, and with a smaller chance of experiencing an adverse event.”
In this study the authors looked at some patients taking 200 mg of ibuprofen with 500 mg of paracetamol (acetaminophen) and other patients taking 400 mg of ibuprofen with 1000 mg of paracetamol (acetaminophen). The latter dosage is the same dosage that one oral surgeon in Gurnee, Illinois gives to his patients for wisdom teeth removal (see Reducing Opioids in Oral and Maxillofacial Surgery). A Tylenol extra strength caplet includes 500 mg of acetaminophen and 2 tablets every 6 hours is the maximum dosage, thus 100 mg of acetaminophen would represent the maximum one should take in a 6 hour period for acetaminophen. An Advil caplet includes 200 mg of ibuprofen and taking 2 is only suggested if symptoms do not respond to 1 tablet, thus 400 mg of ibuprofen in a 4 to 6 hour period would represent the maximum one should take. Of course when having wisdom teeth extracted, one should discuss with their doctor what medications they suggest for pain relief and dosage they suggest.
Additional Source:
- Tom Viola, “Combination ibuprofen + acetaminophen effective for dental pain management” DrBicuspid, March 16, 2020.