Tooth extractions can be painful, but choosing the right medication makes recovery smoother. Here’s what you need to know:
- Best option: Combining ibuprofen (200–400 mg) and paracetamol (500–1,000 mg) is highly effective for managing pain and reducing inflammation.
- For mild pain: Ibuprofen or paracetamol alone can work well.
- Long-lasting relief: Naproxen provides up to 12 hours of relief but has a higher risk of stomach irritation.
- Opioids: Reserved for severe pain when other options fail, but they carry significant risks, especially for older adults.
- Seniors: Paracetamol is often safer due to fewer side effects, while NSAIDs like ibuprofen and naproxen require caution.
For the best results, start medication 2–3 hours after the extraction – before the anaesthetic wears off. Always follow dosage guidelines and consult your dentist or doctor if you’re unsure.
Post-Op Instructions for Tooth Extractions | Pain Relief, Healing Tips & What to Avoid
1. Ibuprofen
Ibuprofen is widely regarded as an effective option for managing pain after a tooth extraction. It works by reducing inflammation, targeting prostaglandins that cause swelling and discomfort following such procedures [5].
“NSAIDs inhibit the prostaglandins responsible for the inflammatory mediators that drive the postoperative pain, swelling and hyperalgesia after procedures such as extractions.” – Leanne Teoh, Dentist [5]
The recommended dosage ranges from 200–400 mg for mild pain and 400–600 mg for more intense discomfort, taken every 4–6 hours. In severe cases, such as after surgical removal of wisdom teeth, combining 400–600 mg of ibuprofen with 500 mg of paracetamol can provide better relief. Always take ibuprofen with food to minimise stomach irritation [6]. Starting the first dose within 2–3 hours of the extraction – before the local anaesthetic wears off – can help manage the peak pain that typically occurs 6–12 hours post-procedure [1]. However, do not exceed 3.2 g per day, and limit its use to 3–5 days [6].
For older adults, ibuprofen requires extra caution. It can exacerbate kidney or heart issues and may increase blood pressure [9]. Additionally, it can interfere with the heart-protective benefits of low-dose aspirin. To preserve aspirin’s effect, take it at least 30 minutes before ibuprofen [6]. Those with a history of stomach ulcers, gastro-oesophageal reflux disease (GORD), or asthma should consult a healthcare professional. In such cases, a COX-2 inhibitor like celecoxib may be a safer short-term alternative [8].
This comprehensive overview of ibuprofen provides a benchmark for comparing it to other medications discussed later.
2. Naproxen
Among the NSAID options, naproxen stands out for its longer-lasting effects. Each dose can provide pain relief for up to 12 hours, which means fewer doses are required compared to ibuprofen, which typically lasts 4–6 hours per dose [6]. For moderate pain, a standard recommendation is 500 mg (or 550 mg of naproxen sodium) every 12 hours, with a maximum daily limit of 1.0 g [6].
Naproxen is known for its strong and prolonged pain relief. A study published in Postgraduate Medicine highlights that a single 440 mg dose of naproxen sodium was more effective than hydrocodone/acetaminophen combinations. Patients using naproxen reported only 2 adverse events, compared to 63 in the group taking the opioid combination [10].
“In moderate-to-severe postsurgical dental pain, a single dose of NapS [naproxen sodium] was at least as effective as HYD+APAP [hydrocodone/acetaminophen] in the early hours, significantly more effective at reducing pain intensity and providing greater pain relief over 12 hours, and was better tolerated.” – Stephen A. Cooper et al., Postgraduate Medicine [10]
That said, naproxen is not without its drawbacks. It poses a higher risk of gastrointestinal issues than ibuprofen, such as stomach irritation, heartburn, and in severe cases, gastric ulcers. Taking it with food can help reduce these risks [3]. As Jeong Taeg Seo from Yonsei University College of Dentistry points out, naproxen is generally recommended when ibuprofen is insufficient for managing pain [6]. Extra caution is advised for older adults due to additional risks.
For seniors, naproxen can affect kidney function and may interact with medications like ACE inhibitors, beta-blockers, and diuretics, requiring careful monitoring. It also diminishes the cardioprotective benefits of low-dose aspirin. If both are necessary, aspirin should be taken at least 30 minutes before naproxen [6]. People with a history of kidney disease, gastric ulcers, or those who are pregnant should avoid using naproxen altogether [3].
3. Acetaminophen
Acetaminophen, known as paracetamol in Australia (e.g., Panadol), is a go-to option for managing mild to moderate pain after a tooth extraction [11]. Unlike ibuprofen or naproxen, it doesn’t focus on reducing inflammation. Instead, it works within the central nervous system to block pain signals, making it effective for pain relief without directly addressing inflammation [6].
The recommended dosage is 1,000 mg every six hours, with a maximum of 3,000–4,000 mg per day. It’s best to start taking it within 2–3 hours after the extraction to minimise the onset of pain [1][6]. Be cautious with other over-the-counter cold or flu medications, as many contain paracetamol, which could lead to accidental overdosing [4].
For older adults, paracetamol is often the preferred choice due to its lower risk of gastrointestinal and cardiovascular side effects compared to NSAIDs [6][11]. As Jeong Taeg Seo from the Department of Oral Biology at Yonsei University notes:
“Acetaminophen is therefore especially suitable for patients who do not tolerate tNSAIDs due to their adverse effects, such as the increased risk of gastrointestinal ulcer disease.” [6]
When dealing with more intense pain, combining paracetamol with ibuprofen can provide stronger relief. A 2025 clinical trial involving 1,815 adults found that pairing 400 mg of ibuprofen with 500 mg of paracetamol was more effective over the first 48 hours post-extraction than a hydrocodone/paracetamol opioid combination. The study also reported higher patient satisfaction rates – 85.3% compared to 78.9% for the opioid option [7].
4. Ibuprofen plus Paracetamol
When combined, ibuprofen helps reduce inflammation at the extraction site, while paracetamol works by blocking pain signals in the central nervous system [12]. This one-two punch makes the combination more effective than using either medication alone.
The American Dental Association (ADA) recommends this pairing as the go-to option for managing acute dental pain [7]. In a 2025 study involving 1,815 adults, those who took 400 mg of ibuprofen along with 500 mg of paracetamol experienced significantly less pain during the first 48 hours after tooth extraction compared to patients using opioid-based pain relief [7]. Another systematic review found that this combination achieved a 1.77 risk ratio for at least 50% pain relief over six hours, compared to a 1.47 risk ratio for ibuprofen on its own [13]. This data highlights how effective the combination is for post-extraction pain, particularly when compared to opioid alternatives.
“The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen.” – The Journal of the American Dental Association [7]
This combination is ideal for moderate to severe pain following a dental extraction. By leveraging the strengths of each medication, the dosing schedule offers a well-rounded and effective solution. A suggested schedule involves taking 1,000 mg of paracetamol every six hours, alternating with 400 mg of ibuprofen every six to eight hours. The first dose should be taken within two to three hours after the procedure [1]. As mentioned earlier, it’s best to take ibuprofen with food to minimise stomach irritation [1].
For older adults, however, this combination requires extra caution. Ibuprofen can increase the risk of gastrointestinal bleeding, kidney strain, and cardiovascular issues, which are more common in older individuals [8]. Adjunct Associate Professor Geraldine Moses explains:
“Individuals with active gastrointestinal disease should avoid nonselective NSAIDs, but COX-2 selective NSAIDs are an option for a very short period (i.e. no more than 5 days).” [8]
Seniors who take low-dose aspirin for heart health should also be aware of ibuprofen’s potential to interfere with aspirin’s cardioprotective effects [6]. If ibuprofen isn’t suitable, paracetamol can be used on its own, though it’s important to note that it doesn’t address inflammation.
5. Opioid-containing Combinations
While NSAID combinations are typically the go-to for managing pain, opioid-based options like paracetamol combined with codeine are reserved for situations where first-line treatments are unsuitable. Codeine helps by interrupting pain signals, but unlike NSAIDs, it doesn’t address the inflammation that often causes post-extraction pain and swelling [5].
Dentist Leanne Teoh highlights this distinction:
“Opioids only interrupt the nociceptive pathway to inhibit pain perception and do not target inflammation.” [5]
Because of this, opioid combinations are rarely the initial recommendation for tooth extraction pain. Research shows that NSAIDs alone – or paired with paracetamol – offer better pain relief and a safer profile compared to opioids [11]. These opioid combinations are typically limited to cases of severe pain when NSAIDs are not an option or when paracetamol alone isn’t effective [11]. If prescribed, the dosage should be kept to the lowest effective amount and only for a short duration, ideally no longer than three days [11].
Codeine also has a genetic factor that influences its effectiveness. For instance, 6–10% of Caucasians and 1–2% of Asians lack a functional CYP2D6 enzyme, making codeine ineffective for them. On the other hand, up to 21% of individuals from Middle Eastern backgrounds may process codeine too quickly, increasing the risk of morphine toxicity [5]. In Australia, concerns over misuse and dependency led to all codeine-containing medicines requiring a prescription as of 1 February 2018 [4].
For older adults, the risks associated with opioids are particularly high. Common side effects include nausea, constipation, drowsiness, and dizziness, but seniors face heightened risks such as confusion, falls, and severe complications like respiratory depression, slowed heart rate, and even loss of consciousness [14]. Those with pre-existing conditions affecting the kidneys, heart, lungs, or nervous system should be especially cautious [14]. As Healthdirect warns:
“Opioids can cause serious side effects, even when you take them exactly as prescribed.” [14]
These risks make opioid-containing combinations a less common choice, particularly for older patients dealing with tooth extraction pain.
Pros and Cons of Each Medication
Medications differ in how they manage pain, their side effects, and their suitability for older adults. The table below breaks down these details to help you weigh the options.
| Medication | Advantages | Disadvantages | Senior Suitability |
|---|---|---|---|
| Ibuprofen | Targets inflammation effectively [2][5] | Can cause gastrointestinal (GI) irritation, kidney strain, and cardiovascular issues; interferes with low-dose aspirin [6] | Use cautiously in seniors, especially those with ulcers, kidney disease, or heart conditions [6] |
| Naproxen | Provides long-lasting relief (up to 12 hours), reducing the need for frequent doses [3] | Higher risk of GI toxicity compared to ibuprofen [6] | May not suit seniors with sensitive stomachs or kidney problems [6] |
| Acetaminophen (Paracetamol) | Gentle on the stomach, no risk of bleeding, and ideal for those unable to take NSAIDs [6][3] | Lacks anti-inflammatory properties; risk of liver damage if the daily limit is exceeded [6] | Often preferred for seniors with GI, cardiovascular, or bleeding concerns [6] |
| Ibuprofen + Acetaminophen | Combines two pain relief pathways for better results; reduces the need for opioids [2][5] | Carries the risks of both drugs; requires strict adherence to dosage limits | Effective for seniors if dosage is carefully monitored |
| Opioid Combinations | Useful for severe pain when other options fail [2] | Does not reduce inflammation; side effects include drowsiness, constipation, and a high risk of dependency [2][5] | Risky for seniors due to confusion, respiratory issues, and increased fall risk [2] |
This table highlights the pros and cons of each option, but there are a few extra points to keep in mind.
- For seniors on low-dose aspirin, take aspirin at least 30 minutes before using an NSAID [6].
- Monitor paracetamol intake carefully: Ensure total daily consumption does not exceed 3–4 g [6].
Studies have shown NSAIDs are more effective than opioids for managing dental pain [5]. A 2025 trial also found people reported higher satisfaction with NSAID combinations compared to opioids [7]. For older adults, the ibuprofen–paracetamol combination offers strong pain relief with fewer risks when used correctly. If NSAIDs are not an option, paracetamol alone remains a dependable choice. This is especially important when preparing for restorative procedures like dental implants.
Conclusion
Managing pain effectively doesn’t always mean reaching for the strongest medication. For most people, combining ibuprofen and paracetamol offers the best first-line approach. This combination tackles inflammation at its source while providing reliable pain relief [2][5]. As dentist Leanne Teoh explains:
“Non-steroidal anti-inflammatory drugs (NSAIDs) are superior to opioids for dental pain and are therefore recommended as first line.” [5]
For older adults, the choice of medication should be tailored to their specific health needs. Those dealing with kidney issues, stomach ulcers, or heart conditions may find paracetamol alone to be a safer option. On the other hand, those without these concerns can benefit greatly from the ibuprofen–paracetamol combination, which remains the most effective non-opioid option for both the general population and seniors. Opioids, such as codeine, should generally be reserved as a last resort due to risks like drowsiness, falls, and unpredictable effects in older individuals.
To stay ahead of post-extraction pain, take your first dose within 2–3 hours of the procedure – before the local anaesthetic wears off. This helps prevent pain from escalating and reduces the likelihood of needing stronger medications [1][2]. This proactive method is widely recommended in Australia.
For tailored advice and support in Australia, the team at Richmond Smiles Dental can assist you in creating a recovery plan that considers your medical history, current medications, and specific pain management needs.
FAQs
Can I take ibuprofen and paracetamol together if I’m on other medicines?
In Australia, it’s common for healthcare professionals to recommend combining or alternating paracetamol and ibuprofen for managing dental pain. These medications work in different ways, providing effective relief when used together. However, if you’re already taking other medications, it’s essential to consult your dentist or GP before starting this approach.
Certain health conditions, such as asthma, bleeding disorders, or gastrointestinal problems, may make ibuprofen an unsuitable choice. To stay safe, always stick to the dosing instructions given by your healthcare professional.
What pain relief is safest after an extraction if I have ulcers, reflux or asthma?
If you deal with ulcers, reflux, or asthma, using standard NSAIDs like ibuprofen might not be the best choice. These medications can lead to stomach irritation or even exacerbate respiratory problems. In such cases, paracetamol is often a safer alternative since it doesn’t carry the same risks.
For those with asthma or NSAID-exacerbated respiratory conditions, a COX-2 selective NSAID, such as celecoxib, could be an option. However, it’s crucial to only consider this under the guidance of a healthcare professional. For personalised advice on managing pain, consult Richmond Smiles Dental.
When should I call my dentist if the pain isn’t improving?
If your discomfort doesn’t ease day by day or worsens after two to three days, it’s time to contact your dentist at Richmond Smiles Dental. Reach out immediately if you experience severe, persistent throbbing pain that doesn’t respond to medication or notice signs of infection. These signs may include swelling, fever, chills, pus, a bad smell or taste, or trouble swallowing. Acting quickly helps ensure you receive the right treatment and avoid further issues.
