Oral surgical procedures, whether dental, endodontic or periodontic are routinely done to help patients receive the care they need. One of the most common procedures for patients between 16-24 years old is wisdom tooth removal. For this and other oral treatments, pain management will be used to keep the patient comfortable while minimizing long-term side effects.

The Problem With Opioids

Opioid analgesics like Vicodin®, Percocet®, and Oxycontin® are the most frequently abused prescription drugs and have more side effects such as drowsiness, nausea, vomiting, dizziness and constipation than over-the-counter (OTC) pain relievers.

When it comes to pain management, we take into account the risk of opioid abuse which has skyrocketed in recent years, particularly in younger people. Their brains are still developing and more sensitive to the effects of opioid use, increasing the potential for addiction and abuse. Studies have found that young people who used opioid prescriptions after a wisdom tooth extraction were at greater risk of using opioids three-months-to-one year later.

Fortunately, contrary to popular belief, opioid pain relievers aren’t necessarily better for pain management than OTC pain relievers. Instead, it is a matter of matching the medication that relieves your specific kind of pain.

When a patient undergoes oral surgery, most will experience pain and swelling for about three to four days afterward. With wisdom teeth removal, however, this can last up to a week. The pain level and duration depend more on where the teeth are located, how deeply the tooth was embedded in the bone and how hard it was to extract them.

Pain Management Options

For most dental patients, post-surgical pain is managed with anti-inflammatory, non-opioid OTC medications such as ibuprofen along with acetaminophen. For those with deeply impacted wisdom teeth or needing jaw reconstruction, an opioid medication might be needed, but you should only be given enough to cover the first several days after the surgery.

Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin IB) and naproxen (such as Aleve). These lessen inflammation, so they are highly effective for pain. And while acetaminophen (Tylenol) doesn’t impact inflammation, it does work to lower your perception of pain. Combining an NSAID with acetaminophen is more effective against moderate-to-severe pain than opioids in patients having wisdom teeth removed and with fewer side effects.

Local dental anesthesias, such as lidocaine and mepivacaine, are safe for long-acting anesthesia, which is effective for dental, endodontic and periodontal surgeries. For third molar extractions, bupivacaine used with prednisolone (a steroid) can safely and effectively reduce pain and swelling.

Post-surgical pain management is begun immediately after a procedure to keep pain levels from building up. Long-lasting anesthetic use, coupled with a steroid to reduce swelling, can help immensely. You can then use cool packs post-surgery, and take NSAIDs before the anesthetic wears off. It is then followed by treating the pain level and adjusting the medication accordingly. Tylenol No.3 contains codeine, and it is a good choice to manage pain levels and can be called into your pharmacist rather than requiring a physical prescription like opioids.

We make sure our patients are as comfortable as possible before, during and after surgical treatment. If you have any questions for our team, please feel free to reach out and give us a call today!