A patient experiences moderate pain following extraction of third molars. What is the most appropriate analgesic regimen?

Correct answer: B. Ibuprofen 400 mg + acetaminophen 325 mg every 4–6 hours

• A. INCORRECT. Opioids (hydrocodone) are not first-line analgesics for routine post-extraction pain. Current prescribing guidelines recommend non-opioid analgesics as first-line therapy for moderate dental pain, with opioids reserved for severe pain unresponsive to non-opioids.
• B. CORRECT. The combination of ibuprofen 400 mg + acetaminophen 325 mg (taken together every 4–6 hours) is evidence-based, first-line therapy for moderate post-extraction pain. This multimodal approach combines: (1) NSAID (ibuprofen) — targets prostaglandin-mediated inflammation, and (2) Acetaminophen — acts centrally via endocannabinoid system. Together they provide superior analgesia compared to either drug alone or opioids, without opioid side effects or dependency risk.
• C. INCORRECT. Aspirin inhibits platelet aggregation and increases bleeding risk post-extraction. It is not recommended post-operatively in dental patients, particularly following extractions.
• D. INCORRECT. Codeine alone at 30 mg has limited analgesic efficacy, requires hepatic conversion to morphine (poor metabolizers get no effect), causes constipation and sedation, and is not appropriate as a first-line agent for routine moderate post-extraction pain.