The efficacy of combination analgesic therapy in relieving dental pain

J Am Dent Assoc. 2002 Jul;133(7):861-71. doi: 10.14219/jada.archive.2002.0300.


Background: An experience of poorly managed pain related to dental treatment can lead patients to avoid or postpone treatment. The development of new pain management strategies equips dental clinicians with additional treatment options that can provide more effective pain relief

Literature reviewed: The author reviewed dental and medical literature dealing with the safety, efficacy and mechanisms of action of common analgesic treatments.

Conclusions: For the treatment of mild to moderate pain, acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs, continue to be the most appropriate options. The use of cyclo-oxygenase2-inhibitor NSAIDs should be strongly considered for use with patients at risk of experiencing gastrointestinal toxicity. The pathophysiology of pain is a complex central and peripheral nervous system process, and the use of combination analgesics that act at multiple pain sites can improve pain relief after a dental procedure. For moderate to moderately severe pain, tramadol or combination medications such as tramadol with acetaminophen or codeine with acetaminophen are appropriate. For severe pain, use of opioids or opioid combinations is advised.

Clinical implications: Providing appropriate treatment after dental surgery requires a careful medical history and an educated anticipation of the level of pain the patient may encounter. New analgesic options are available and should be considered, particularly combination analgesics, which can provide faster onset and prolonged duration of action and can combat pain at multiple sites of action.

Publication types

  • Review

MeSH terms

  • Acetaminophen / administration & dosage
  • Analgesics / administration & dosage*
  • Analgesics, Opioid / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Cyclooxygenase 2
  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors / administration & dosage
  • Decision Trees
  • Drug Combinations
  • Facial Pain / drug therapy*
  • Facial Pain / etiology
  • Facial Pain / physiopathology
  • Humans
  • Isoenzymes / metabolism
  • Membrane Proteins
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / physiopathology
  • Prostaglandin-Endoperoxide Synthases / metabolism
  • Tooth Extraction / adverse effects
  • Tramadol / administration & dosage


  • Analgesics
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors
  • Drug Combinations
  • Isoenzymes
  • Membrane Proteins
  • Acetaminophen
  • Tramadol
  • Cyclooxygenase 2
  • PTGS2 protein, human
  • Prostaglandin-Endoperoxide Synthases