Patients who present with profound dental pain often do not require prescribed analgesics if they are treated promptly by a dentist. In the vast majority of presentations, the dental treatment will manage the patients' pain. Nevertheless, although the prescription of an analgesic for ongoing pain management is often not required, professional advice about the most appropriate and effective over-the-counter medicine to use is a professional courtesy we should offer to our patients.
The considerable inter-individual variation in the effectiveness of codeine, combined with its rare but potentially serious adverse events, suggests that codeine for dental pain should be avoided. Patients with ongoing pain who are able to use a non-steroidal anti-inflammatory drug, such as ibuprofen, are likely to have more predictable control of their pain. The pain management strategies outlined in Therapeutic Guidelines: Oral and dental1 provide clear advice to help patients manage their pain or their expected pain, following dental treatment.
The warning 'take caution with codeine' should resound in the dental setting, particularly with patients who specifically request opioid drugs as an alternative to adequate dental treatment.