Pharmacology · patient case question
Which analgesic regimen should be prescribed over the telephone?
Patient case: After-hours telephone call about acute dental pain
Patient: Female, 22 years old
Chief Complaint: Telephones the practice at 11 PM in severe pain from a tooth.
Background: She was diagnosed with caries several weeks ago and scheduled for treatment, but did not attend because of dental anxiety. No drug allergies. No liver or renal disease. Takes no regular medication.
Current Findings: Telephone triage only. She reports throbbing pain that wakes her, lingering after cold, with no facial swelling and no difficulty swallowing at the time of the call.
Show answer and explanation
Correct answer: B. Acetaminophen 325 mg combined with ibuprofen 400 mg
- A. Aspirin is an irreversible antiplatelet agent and is inferior to ibuprofen for dental pain. It also complicates any surgical intervention that follows.
- B. CORRECT. The combination of an NSAID with acetaminophen is the evidence-based first line for acute dental pain. The two act through different mechanisms — peripheral COX inhibition reducing prostaglandin-mediated inflammation, plus central analgesic action — and the combination outperforms either drug alone and matches or exceeds opioid combinations, without the addiction and respiratory depression risk.
- C. Opioids are not first line for acute dental pain. Current CDC and ADA guidance places non-opioid analgesia first, and prescribing an opioid by telephone to a patient who has not been examined compounds the problem.
- D. Ibuprofen alone at 600–800 mg is effective, but adding acetaminophen gives measurably better analgesia at no added risk. When the combination is on offer, it is the better answer.
Note: Analgesia is a holding measure. It never substitutes for removing the cause — pulpectomy, extirpation or extraction. Book her at the earliest possible appointment.