Ibuprofen

Rx Ibuprofen 200mg tablets
Take 1-2 tablets up to three times a day (every 6-8 hours while awake) if required for pain relief. Max dose: 1200mg/day.
Supply 20x tabs

Considerations:

• Up to 90 tabs are funded on the PBS for dentists. However, the patient generally only requires 20x tabs which are readily purchased

  from pharmacies and supermarkets without a prescription.

Paracetamol

Rx Paracetamol 500mg tablets
Take 1-2 tablets every 4-6 hours when required (maximum of 8x tabs /4g per 24 hours)
Supply 20x tabs.

Considerations:

• Preferably take away from food, to enhance onset of action.

• Standard paracetamol tablets are not funded on the PBS for any prescriber. However, the patient only requires 20x tabs which are readily purchased from pharmacies and supermarkets without a prescription.

Diclofenac

Rx Diclofenac 25mg tablets
Take 1-2 tablets up to 3 times daily (every 8 hours) if required for pain relief
Supply 20 tablets. 

Considerations:

• Maybe taken without regard to meals.

• Up to 100x diclofenac tabs are subsidised on the PBS for dentists. However, as the patient only needs 20x tabs no more than that quantity should be prescribed.  Packs of up to 30x 25mg tabs may also be purchased without a prescription as a schedule 3 medicine from the pharmacist.

Ibuprofen + paracetamol (combination tabs)

Rx Ibuprofen 200mg/Paracetamol 500mg tablets (eg. Nuromol)
Take 1-2 tablets up to 4x per day (every 6-8 hours) if required for pain relief, maximum of 6 tablets/day.
Supply 12x tabs. 

Considerations:

• Preferably taken away from food

• Post-operative pain may be best treated as follows:

  Take two tablets to every 6 hours round the clock for the first day, then reduce to 1or 2 tablets every 6-8 hour for 1-2 days. Then change to either ibuprofen or just paracetamol alone up to every 6-8 hours, until pain resolves.

Celecoxib

Rx Celecoxib 100mg capsules
Take 1 capsule up to twice daily (every 12 hours) if required for pain relief
Supply 10 capsules.

Considerations:

• Celecoxib is not funded on the PBS for dentists.  However, 10x capsules can be purchased as a Schedule 3 item from a pharmacist. Provide the patient with a non-PBS prescription for the 10x celecoxib caps to aid communication between the patient and the pharmacist.

Oxycodone IR (immediate release)

Rx Oxycodone 5mg IR tablets
Take 1x tablet up to every 4-6 hours if required for relief of strong pain
Supply 6 (six) tabs. 

Considerations:

• Packs of 10x and 20x are funded on the PBS for dentists. However. the smallest quantity required should be prescribed.

Tramadol IR (Immediate release)

Rx Tramadol 50mg IR caps
Take 1x tablet up to every 4-6 hours if required for relief of strong pain
Supply 6 (six) capsules.

Considerations:

• Packs of 10x and 20x are funded on the PBS for dentists. However. the smallest quantity required should be prescribed.

Paracetamol / codeine

Rx Paracetamol 500mg / Codeine 30mg tablets
Take 2x tablets every 4-6 hours if required for pain relief (Maximum dose = 4g paracetamol per 24 hours)
Supply 10 (ten) tabs.

Considerations:

• Packs of 10x and 20x are funded on the PBS for dentists. However, the smallest quantity required should be prescribed.

• Codeine is no longer considered the opioid of choice for management of acute dental pain. 

  The main reason for this is that codeine is a pro-drug that must be converted to morphine in vivo for its analgesic effect. 

  As there is great inter-individual variability in people’s ability to perform this enzymatic conversion, there is wide variation in its efficacy and tolerability, from completely ineffective in those who cannot convert codeine to morphine,  to toxic opioid side effects in those who readily do convert. These unpredictable outcomes of codeine’s use make it a difficult drug to use safely in clinical practice. The preferred opioid is oxycodone, as it has much more predictable and uniform pharmacokinetics. In addition, many people prescribing codeine are unaware that codeine becomes morphine in vivo, and do not account for this when managing the dose, efficacy and side effects.

PBS = Pharmaceutical Benefits Scheme (as applicable for dental scripts)

Refs:

1)         Oral and Dental Expert Group. Therapeutic Guidelines: Oral and Dental. Version 3. Melbourne: Therapeutic Guidelines Limited; 2019.

2)         Rossi S (ed) Australian Medicines Handbook 2024 (online). Adelaide: Australian Medicines Handbook Pty Ltd; Last updated 2024 July.