Surgical operations to remove wisdom teeth are one of the most commonly performed procedures in oral health, in England alone, 63,000 wisdom teeth are extracted each year in NHS hospitals. Many patients need time off work and their quality of life can be significantly affected. Both ibuprofen and paracetamol are commonly used for the relief of pain following the removal of lower wisdom teeth. In 2010, a new painkiller (marketed as Nuromol) containing paracetamol and ibuprofen in the same tablet, was licensed for use in the UK. This review considers the effectiveness of these painkillers.
What was the research?
A systematic review of the evidence on the effectiveness of paracetamol and ibuprofen, and the combination of both in a single tablet, in the relief of pain following surgical removal of lower wisdom teeth.
Who conducted the research?
The research was conducted by a team led by Edmund Bailey from the University of Manchester, on behalf of the Cochrane Oral Health Group. Helen V Worthington, Arjen van Wijk, Julian M Yates, Paul Coulthard and Zahid Afzal were also on the team.
What evidence was included in the review?
Data was extracted from 7 randomised controlled trials. A total of 2,241 people who had had surgery to remove a lower wisdom tooth participated in the trials. They were randomly assigned to paracetamol or ibuprofen or a combination of both. Painkillers were taken after surgery and different doses of the drug were compared. All the studies included in the review looked only at pain relief and intensity of pain after a single dose of the painkiller after surgery.
What did the evidence say?
Ibuprofen is more effective than paracetamol at all dose levels studied in this review. On limited evidence, the combination of ibuprofen and paracetamol appeared no more effective than the single drugs when measured two hours after surgery, however it was more effective than the drugs taken singly after six hours. Side effects such as nausea, vomiting, headaches and dizziness were comparable among the groups.
How good was the evidence?
All of the results comparing ibuprofen to paracetamol are of high quality, this means that further research is unlikely to change our confidence in the results. However, when comparing combined drugs versus single drugs, the evidence was of moderate quality and further research may be needed on the effectiveness of combination painkillers.
What are the implications for dentists and the general public?
This review proves ibuprofen to be superior to paracetamol when used postoperatively for pain management after removal of lower wisdom teeth. The majority of this evidence compared ibuprofen 400 mg with paracetamol at 1000 mg, these are the most commonly used doses in clinical practice. The combined drugs containing both agents show promising results after six hours, but no significant differences was found from using the drugs singly after two hours.
What should researchers look at in the future?
There is compelling evidence that both paracetamol and ibuprofen are effective and safe for managing postoperative pain for minor surgical procedures such as the removal of wisdom teeth. An area where further research is necessary is determining the efficacy and safety profile for the novel combination drugs that include both paracetamol and ibuprofen as active drugs in the same tablet.
Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004624. DOI: 10.1002/14651858.CD004624.pub2.