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Wisdom teeth removal and Dry socket pain relief

What is the best pain medicine to take after wisdom teeth removal or dry socket?

It is normal to have some pain after wisdom teeth removal.  Dry socket is unusual healing that causes more pain for longer compared to normal healing.  What is the best medicine to take to help with healing pain?

Which pain medicine is best after wisdom teeth removal?

Short answer: 400mg Advil and 500mg Tylenol up to six times a day

Long answer:

Studies are being conducted where pain medication was repackaged in unmarked capsules.  The patients who had wisdom teeth removed took the pain medication given without knowing what it was.  They rated how much pain relief they got.  Medications were scored based on how many people had to take it for one person to get pain relief.  A perfect score would be a 1.  That means every person that took it got pain relief.  A score of two means that if two people took it, one of them would get pain relief.

For example, the placebo medication in the study scored 18.  For every 18 people that took a placebo, one would get pain relief.  Here are how the medications scored, listed in order from worst to best:

codeine alone: 16 (almost as bad as a placebo)

codeine with Tylenol, like Tylenol #3: 4.2

Tylenol alone: 3.8

Vicodin, Lortab, Norco (hydrocodone/Tylenol): 3.0

Demerol: 2.9

Morphine: 2.9

Percocet (oxycodone/Tylenol): 2.6

Torodol oral: 2.6

Ibuprofen alone: 2.4

Two Alleve (naproxen sodium): 2.3

Ketorolac IM: 1.8

100mg Ketoprofen: 1.6

Advil (ibuprofen) and Tylenol: 1.6

Medicines with lower scores give better pain relief.  For every three people that take hydrocodone, one will get pain relief.  That’s not a very high success rate.  The Advil/Tylenol combination is two to three times more effective than narcotics like oxycodone and hydrocodone.  You can get Advil and Tylenol over-the-counter, while narcotics are by prescription only.

Unfortunately, some patients think the more side effects a medication has, the better it is.  Here are two hypothetical conversations:

Doc: Did the ibuprofen work?
Patient: Not really.  I wish you’d given me something stronger.
Doc: Did you have much pain?
Patient: Not really.

vs.

Doc: Did the Percocet work?
Patient: Oh yeah.  I threw up and got dizzy and drowsy.
Doc: Did you have much pain?
Patient: Yes.  It’s a good thing you gave me some strong medicine to take.

These patients are rating a medication based on its side effects rather than it’s ability to provide pain relief.  Advil and Tylenol have fewer side effects, no addiction risk, and are more easily available.  If you’re truly after pain relief, consider pain medications other than narcotics.

What about ketoprofen?  It rated as well as the Advil/Tylenol combination.  Advil and Tylenol provide pain relief differently.  Advil reduces inflammation at the site of the surgery or tissue damage.  Tylenol tells the brain not to pay attention to the pain signal.  Because they work differently, they are a good combination.  Ketoprofen reduces inflammation like Advil and has an effect on the brain similar to Tylenol.  You get an effect similar to Advil/Tylenol in one medication.

Ketoprofen was available in 12.5mg doses over-the-counter.  Now it is available by prescription in 50, 75, and 100mg doses.  Consider requesting it from your doctor when pain management is needed.

What would the ideal wisdom tooth removal look like?  What is the best way to minimize pain?

1 – Take a dose of Advil and Tylenol before your surgery.

2 – IV steroid at beginning of surgery appointment.

3 – Local anesthetic before and after surgery. (Bupivacaine local anesthetic delivered immediately after tooth removal reduces post-op pain for 48-72 hours.)

4 – IV or IM (intramuscular) Ketorolac during surgery.

5 – Take regular doses of Advil and Tylenol for several days after your surgery.