Dr. Markus Tröltzsch (Göttingen) provides a presentation about the use of analgesics associated with orofacial indications. The use of painkillers like willow bark, also known as nature’s aspirin, dates back more than 2000 years. Also, Laudanum, an extract of raw opium, has been used for a long time. Today, the use of analgesics is an integral part of everyday life in dentistry.
Dr. Markus Tröltzsch explains the pharmacological fundamentals of analgesics and defines their indications and limitations. He mentions their active ingredients and illustrates their therapeutic range based on sample cases. In general, the effective concentration of all medicines taken orally is greatly reduced due to first pass metabolism. With the intravenous application, this mechanism can be bypassed and thus the medicine can act faster and more efficiently. Important for the effect of an analgesic is its dosage.
The therapeutic width of a medicine is determined by the relationship of its therapeutic to its toxic dose. If pain reduction is achieved by applying a relatively low dose, and the toxic level of an analgesic is reached late, the drug has a large therapeutic width. This is always desirable, but especially important in patients with low compliance. As analgesics, NSAIDs have a wide application in everyday dentistry. However, Aspirin is usually not used due to bleeding problems, and must never be applied for pain relief in pregnant women and children because of the risk of Reye Syndrome.
Acetaminophen/Paracetamol is effective with light to moderate pain. A maximum dose of 2mg to 4mg a day is recommended. Due to its hepatotoxicity, it must not be taken by patients with hepatic issues. Usually, for odontogenic treatments the non-opioid analgesics Ibuprofen and Metamizole are administered. Ibuprofen is nowadays the standard painkiller, applied for light to moderate pain. The maximum dose is 2400mg per day.
For Metamizole, which is recommended for stronger pain, the maximum dose is 4000mg per day. However, it is contraindicated during pregnancy. These drugs show very few side effects and are effective for the reduction or elimination of weak and moderate (Ibuprofen) and stronger pain (Metamizole). They are given in combination with a proton-pump inhibitor (Omeprazol/Pantoprazole) to protect the gastric mucosa. If stronger pain relief is needed, opioid pain killers may be used.
In general the application of analgesics should happen with an appropriate dosage, regularly and in combination with rest and cooling. It should also be extendable in case of potential spikes in pain.