Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.


All of us in the active practice of dentistry have patients who seemingly have pain which does not respond to conventional pain management. As an oral and maxillofacial surgeon, its management can be even more challenging. This past week I received an anxious telephone call from the mother of a 22 year old patient who was scheduled to have three impacted third molar teeth removed. The call was pertaining to her daughter's difficulty with pain management. Last year, after the removal of her tonsils, she either was in pain or was nauseous from the different narcotic medications prescribed for her. The mom wanted to know what I might do to avoid a similar situation.

Most practitioners rely either on Acetaminophen (Tylenol), N.S.A.D's (Advil, Aleve, Motrin), or more potent analgesics such as Vicodin or Percocet with success; but how do you help your patient who calls, still in pain.

Sometimes, the resolution of your patient's painful situation is the combining of two different analgesic agents with different mechanisms of action. The administration of an opioid given with a peripheral acting analgesic certainly provides greater pain relief, but it (1) restricts the use of central nervous system depressants (2) increases the risk of drug abuse and/or misuse and (3) increases the adverse effects (such as nausea) the patient may experience.

The use of ibuprofen (Advil) plus APAP (Acetaminophen) has now been more fully evaluated and should be considered.

The rational for the administration of combining analgesic drugs is that, in certain situations, the combining of analgesic drugs provides better pain relief than a single agent. There may be additive effects when two different analgesic agents, with different mechanisms of action are combined. Additionally, the genetic differences in patients may explain the efficacy of the combination compared to a single drug.

The additive effects of ibuprofen-APAP (Advil-Tylenol) combination allow the tailoring of the dose to the patient's needs. The combination of these two medications may be the best Rx for mild to severe pains.

Mild NSAID's (200-400mg) Q 4-6 hour's prn pain
Mild to Moderate NSAID's (400-600 mg) Q6 hours for 24 hours
then NSAID's 400mg Q 4-6 hours prn pain.
Moderate to Severe   NSAID's (400-600 mg) with Tylenol (500mg) Q 6 hours for 24 hours, then
NSAID's (400 mg) along with Tylenol Q 6 hour's prn pain.
Severe NSAID's (400-600 mg) with Tylenol (650 mg) with Vicodin 5mg) Q 6 hours for
24-48 hours; then NSAID's (400-600 mg) with Tylenol (500 mg) Q 6 hours prn

A conservative approach to pain management may provide adequate pain relief without adverse effects.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍