Why no Ibuprofen after tooth extraction?

When shouldn’t you take Ibuprofen after a tooth extraction?

When searching for information about managing pain after a tooth extraction, you may find articles or websites that advise against taking the common over-the-counter (nonprescription) medication Ibuprofen. 

Dentists commonly recommend that –

• Patients take painkillers before a tooth extraction as a pre-emptive pain management strategy.
• Patients take painkillers after a tooth extraction to relieve post-surgical pain.

And Ibuprofen (available under the brand names Motrin and Advil) is often the painkiller recommended or prescribed.

For many people, taking over-the-counter Ibuprofen for pain management after a tooth extraction is perfectly fine.  

However, no drug is perfect, and the unregulated use of Ibuprofen can be potentially dangerous for people with certain medical conditions. For these people, the use of Ibuprofen as a pain reliever should be limited or even totally restricted.

Aren’t Over-the-Counter Medications Harmless?

There is a common misconception that over-the-counter drugs are harmless compared to prescription drugs.  Unfortunately, that is not the case.  The truth is that over-the-counter drugs are only safe as long as you use them according to the instructions on the packaging and with the consent of your medical doctor.  

Many medications can become quite unsafe when taken at higher doses than the instructions permit or in the presence of certain medical conditions, of which your medical doctor should keep you informed. 

Someone who is attempting to fight severe pain may take double or triple the recommended dosage, placing him at risk of experiencing adverse effects or overdosage.  Specific to dentistry, people often take too much Ibuprofen or Acetaminophen to manage a toothache so they can avoid going to the dentist for treatment. Unfortunately, this not only does not safely address the pain; it also does not address the underlying cause of the pain, and the person remains at risk for the dangerous spread of infection.  For severe toothache pain, you must see a dentist as soon as possible.

Overdosage of Ibuprofen is not uncommon, and it results in calls to Poison Control and emergency room visits.  Overdoses of Ibuprofen can be accidental, purposeful in an attempt to relieve pain, or suicidal in nature.  If you or a loved one is experiencing a potential ibuprofen overdose, it is vital that you tell your healthcare provider exactly how much you took and why.  You also need to divulge any other medications you took and share any medical conditions you know you have.

These side effects can be reduced by careful attention to the dose and duration of therapy, concomitant risk factors, and the combined use of more specific drugs to reduce disease activity.

• Exactly as prescribed or as on the label
• At the lowest dose possible
• For the shortest period of time.

How Does Ibuprofen Work?

Ibuprofen prevents the formation of chemicals in the body called prostaglandins.  These chemical compounds are important in the inflammatory response, which causes swelling, redness, heat, and pain at the site of injury.  A tooth extraction is technically an “injury”, so it is natural that your body responds to it with inflammation.  Ibuprofen reduces the body’s inflammatory response by blocking the formation of prostaglandins.

Ibuprofen also has a dulling effect on pain-sensing nerve fibers by blocking prostaglandins (which sensitize or heighten those same nerve fibers).  Thus, this medication has both an anti-inflammatory and analgesic effect, making it a wonderful drug for pain management after any type of surgery.

Ibuprofen can also lower fevers by working on temperature regulators in the brain.

What Adverse Effects does Ibuprofen Cause?

So far, it sounds like blocking prostaglandins is a good thing!  They cause pain and inflammation, both of which we want to stop after a dental procedure.  Prostaglandins also serve some important purposes, for which we need them to maintain a healthy body.  When we block them for long periods of time or have a high dose of the blocker (Ibuprofen), adverse effects are likely to occur.

Prostaglandins preserve the integrity of the soft tissue lining the GI tract.  Without them, the innermost layer because weak and easily ulcerated.  GI upset is a common side effect of too much ibuprofen, and chronic use of Ibuprofen may lead to bleeding ulcers.  

Prostaglandins also maintain good blood flow to the kidneys.  This is vital for the health of the kidneys, which filter the blood.  Blocking prostaglandins can reduce blood flow to the kidneys, leading to poor filtration.

Another chemical mediator blocked by Ibuprofen is thromboxane, which is vital to normal blood clotting.  When we block thromboxane, it can lead to increased bleeding and longer clotting times.

Ibuprofen has been shown in many studies to increase blood pressure and aggravate asthma, as well.

Who Should Use Caution and Consult a Doctor Before Taking Ibuprofen?

Because of the wide range of adverse effects of ibuprofen, there are many categories of people who could consider a different pain reliever than ibuprofen.  When there is a question, always consult your medical doctor first!

Ibuprofen And Cardiovascular Risk

Research has shown a link between consistent use of high doses of ibuprofen and heart failure.  Recent information showed that taking a high dosage of ibuprofen increases the risk of heart failure, especially in those patients already predisposed to it.  

This means if you have a family history of heart failure or other heart diseases, you should take the lowest effective dose possible to manage any pain.  If your doctor has already diagnosed you with heart failure, avoid ibuprofen and discuss your other pain management options with your treating doctor.  

Fatal heart failure is rare, but possible after high doses of ibuprofen, and the risk increases with more frequent dosing.  The risk is relatively low if you take a low dose only occasionally.  The risk is high for those who take the medication every day and frequently take doses of 600 to 800 milligrams.

Ibuprofen And Gastrointestinal Conditions

Gastrointestinal disorders are one of the serious side effects caused by nonsteroidal anti-inflammatory drugs like Ibuprofen.

When a tooth is extracted, high levels of the compound prostaglandins appear in the tissue at the site of the extraction. Prostaglandins play an important role in the inflammation process, and when it is produced in the affected area, it causes reactions like swelling, redness, and pain.

Although inflammation is one of the natural stages of tooth extraction healing, it can cause patients discomfort and pain. Ibuprofen works to combat this type of tooth extraction pain by effectively blocking the production of Prostaglandins.

However, as well as being pivotal in the production of inflammation and pain, Prostaglandins are also involved in a number of healing and protective activities in certain areas of the body, especially the stomach. In a healthy stomach, the moist inner lining will contain a high concentration of Prostaglandins.

As ibuprofen blocks Prostaglandins synthesis in order to relieve tooth extraction pain, it also weakens the natural defense systems of the gastric mucosa ( lining of the stomach ), making it more susceptible to injury.

Taking Ibuprofen frequently and at high doses increases the risk for dyspepsia (upset stomach) and ulcers.  With the chronic use of ibuprofen, these ulcers can become severely painful and bleed.  The bleeding may be serious enough to lead to anemia.

If you have a history of ulcers or a sensitive stomach, you should avoid any high dosage of ibuprofen.  Many people experience mild stomach upset when they take ibuprofen for several days in a row, and this side effect is reversible.  After you stop taking the medication, your stomach lining regrows and returns to normal health.

Research has also shown that females are at greater risk of experiencing gastrointestinal problems related to NAISD drugs like Ibuprofen.

If you have concerns about taking any medication that could upset your stomach, talk to your doctor about an alternative to NSAIDs for pain management after a tooth extraction.

Ibuprofen And Kidney Risk

Ibuprofen blocks the chemical essential to healthy kidney function through good blood flow.  With chronic ibuprofen usage, kidney function decreases.  For anyone with kidneys that are already impaired or damaged, ibuprofen should be strictly avoided.

Our kidneys are delicate organs and essential to normal bodily function.  When they become impaired by disease or injury, we must protect whatever amount of function they still have.  Because of the risk for further impairment by ibuprofen, it is simply not worth any pain management you could gain.  

The kidneys are the major organ responsible for the excretion of nonsteroidal anti-inflammatory drugs. This makes them particularly vulnerable to the side effects caused by Ibuprofen painkillers.

Research analysis has suggested that there are a number of risk factors that can be used to predict renal damage caused by Ibuprofen –

• Patient’s age (equal to or greater than 65 years of age).
• Gender (males are more likely to reach kidney failure sooner than females).
• Patients with existing kidney impairment.
• Patients with coronary artery disease.
• Patients with high blood pressure.
• Patients who have been prescribed diuretic medicines.

Your doctor can work with you to determine a pain management regiment that is safe for your kidneys.

Ibuprofen And Allergy Risk

Allergies to ibuprofen are rare, but just like any drug, it can cause a severe anaphylactic reaction, and even death, in a patient who is allergic to it.  If you have ever experienced a skin rash, instant GI upset or nausea and vomiting, and/or difficulty breathing after taking ibuprofen, you should avoid taking it until you consult with your medical doctor.

You may require allergy testing to confirm or rule out a true allergy.  It is best to treat the medication as a dangerous allergen until you know for sure.  An acute allergic reaction can lead to hospitalizations, or in the worst cases, death.

Ibuprofen And Asthma

Some people who suffer from asthma experience aggravation of breathing problems after taking ibuprofen.  This aggravation does worsen with higher doses.  The medication could provoke a serious asthma attack.

If you have asthma, it is important to use caution when taking ibuprofen and avoid anything higher than the doses recommended on the packaging.  Talk to your pulmonologist about your specific risk for asthmatic episodes from taking ibuprofen, and discuss pain management options.

Ibuprofen And High Blood Pressure

In many research studies, ibuprofen has been shown to increase blood pressure both in subjects with normal blood pressure (normotensive) and those with high blood pressure (hypertensive).  For healthy patients with normal blood pressure readings, this is of little concern.  For those who already suffer from hypertension, talk to your doctor before taking ibuprofen, especially at prescription-strength doses.

It is important for anyone who takes medication to manage blood pressure to know whether that medication is working.  Many people take prescriptions to lower their high blood pressure without knowing if they are actually lowering it.  Follow up with your medical doctor to see if your medicine has hypertension under control.  If it is not, avoid ibuprofen.

Ibuprofen And The Elderly

The natural aging process is not the same for everyone across the population and the quality of health varies dramatically based on factors like socioeconomic status, genetics, and lifestyle. Defining the patient population in terms of age can be confusing and problematic, but in general, when we talk about the “elderly” we are referring to the age range of 65 years of age and older.

The use of Ibuprofen after a tooth extraction is more risk-prone and complicated for an elderly patient. As we age our vital organs become less resilient and don’t work as efficiently as they used to. And as a result, our ability to absorb, metabolize and excrete drugs can become impaired. Elderly patients who take NSAID painkillers like Ibuprofen are at higher risk of experiencing adverse drug reactions (ADRs). 

NSAID use causes an estimated 41,000 hospitalizations and 3300 deaths each year among older adults.

All of the adverse effects associated with ibuprofen are statistically more likely to occur in elderly patients.  Research has shown that the persistent use of NSAID drugs like Ibuprofen increases the risk of kidney failure, peptic ulcers, stroke, and heart attacks.

Elderly tooth extraction patients who have multiple health conditions should consult a medical doctor before combining their prescription medicines with over-the-counter Ibuprofen.   The doctor may advise you to use a lower dosage of the medication or avoid it completely.

Ibuprofen And Pregnancy

Ibuprofen is not considered safe for women who are pregnant. The compound Prostaglandins is known to play an important role in human ovulation and implantation. Using NSAID painkillers like Ibuprofen during pregnancy can reduce Prostaglandins in reproductive tissue and increase the risk of miscarriage.

It has also been proposed that inhibiting Prostaglandins production with painkillers like Ibuprofen can disrupt normal blood pressure during pregnancy and negatively affect fetus circulation. Most obstetricians consider the risk high enough and recommend that Ibuprofen should be avoided completely during pregnancy.

Alternatives To Ibuprofen For Pain Management After A Tooth Extraction?

If you fall into one of the above categories, meaning you should avoid ibuprofen, you may find pain management more challenging after a tooth extraction.  The best course of action is to discuss this with both your dentist and your primary care physician before the extraction procedure.