3.1. Prescription and nonprescription analgesics in dental use

The use of analgesics in general practice is regulated by marketing authorization instructions of drug regulatory agencies of the respective states. The number of analgesics in over-thecounter (OTC) drug group is permanently increasing and the consequence of this is the loss of active monitoring from health professionals.

Pain is a common factor for seeking dental advice but may also occur after different interventions. The dentist is responsible to create strategies for the management of different types of pain from the dental, oral, facial, or postoperative procedures. Nonopioid analgesics are available as "over-the-counter" medications and in U.S.A, 16 millions of these drugs are prescribed annually. There are fewer indications for opioids compared to nonopioid analgesics due to their side effects profile; these should be used with caution only in case of severe pain [21].

There are several OTC analgesics and the most used are ibuprofen, acetylsalicylic acid (aspirin), acetaminophen, ketoprofen and, recently, naproxen sodium. The main characteristic used to classify these analgesics within the OTC group is the dosage [35]. NSAIDs, including ibuprofen and naproxen, are used as nonprescription OTC analgesics in doses of 200–400 mg (1200 mg/d) and 440 mg (660 mg/d for maximum of 10 days), respectively. Also, acetaminophen is widely used as an OTC product which is used also in combination with hydrocodone, oxycodone, codeine and propoxyphene. Maximum doses of acetaminophen should not exceed 4000 mg and particular attention is paid to alcohol users, in whom this drug can cause hepatotoxicity [36, 37]. In general, ibuprofen is normally safe and effective for patients who use OTC analgesic, but it has also been shown that in a small percentage of patients who use OTC analgesics maximum doses are exceeded. More sophisticated research analyses are needed in this area to improve our understanding of dosing patterns of nonprescription analgesics. This requires improved patient education about nonprescription analgesic use and prevention of possible adverse events [38, 39]. In OTC NSAID analgesic users, more caution is necessary in the elderly or in patients with rheumatoid arthritis who are already taking NSAIDs, or low dose aspirin, ACEI or diuretics. The shortest duration of treatment is required and the lowest effective doses of NSAIDs are crucial in their efficacy and safety [40]. Due to this, close medical supervision is advisable.

However, recently different studies reported a drop by 5.6% in the prescribing of opioids [24, 25]. Taking this into consideration, more should be done to prevent opioid abuse and dentists play an important role in this regard, helping to minimize opioid abuse by careful patient education and appropriate prescribing practice [26]. In mild to moderate acute dental pain, acetaminophen and NSAIDs are the most appropriate choices. COX-2 inhibitors may be considered for patients at risk of gastrointestinal disease or those taking blood thinners such as warfarin. Also, prescribers must be aware to decrease the use of maximum recommended doses and advocate shorter duration of treatment [27]. Ibuprofen was found to dominate over other analgesics [28–31]. This also applies to pediatric dentistry, whereby

However, there are controversial studies, which show that diclofenac or paracetamol may offer improved benefits. Moreover, in patients undergoing third molar surgery, nimesulide followed

In general, this difference in prescribing may be influenced by different practitioners in different countries, less reported side effects of medications and their effectiveness in different

The use of analgesics in general practice is regulated by marketing authorization instructions of drug regulatory agencies of the respective states. The number of analgesics in over-thecounter (OTC) drug group is permanently increasing and the consequence of this is the loss of

Pain is a common factor for seeking dental advice but may also occur after different interventions. The dentist is responsible to create strategies for the management of different types of pain from the dental, oral, facial, or postoperative procedures. Nonopioid analgesics are available as "over-the-counter" medications and in U.S.A, 16 millions of these drugs are prescribed annually. There are fewer indications for opioids compared to nonopioid analgesics due to their side effects profile; these should be used with caution only in case of severe pain

There are several OTC analgesics and the most used are ibuprofen, acetylsalicylic acid (aspirin), acetaminophen, ketoprofen and, recently, naproxen sodium. The main characteristic used to classify these analgesics within the OTC group is the dosage [35]. NSAIDs, including ibuprofen and naproxen, are used as nonprescription OTC analgesics in doses of 200–400 mg (1200 mg/d) and 440 mg (660 mg/d for maximum of 10 days), respectively. Also, acetaminophen is widely used as an OTC product which is used also in combination with hydrocodone, oxycodone, codeine and propoxyphene. Maximum doses of acetaminophen should not exceed 4000 mg and particular attention is paid to alcohol users, in whom this drug can cause hepatotoxicity [36, 37]. In general, ibuprofen is normally safe and effective for patients who use OTC analgesic, but it has also been shown that in a small percentage of patients who use OTC analgesics maximum doses are exceeded. More sophisticated research analyses are needed in this area to improve our understanding of dosing patterns of nonprescription

ibuprofen and paracetamol predominate in prescription rates [32].

3.1. Prescription and nonprescription analgesics in dental use

active monitoring from health professionals.

116 Pain Relief - From Analgesics to Alternative Therapies

indications [33, 34].

[21].

by diclofenac, ketoprofen and ibuprofen were the most prescribed NSAIDs.
