Evidence Gaps

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) vs paracetamol

Participant‐reported pain relief of 50% or greater · Patients with pain after surgical removal of lower wisdom teeth (third molars) requiring bone removal or with baseline moderate to severe…

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 6… compared with paracetamol (acetaminophen) (single postoperative oral dose; 600 mg… (high certainty).

1 finding from 1 review

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes
6 hours postdosing · Ibuprofen 400 mg vs paracetamol 1000 mg
RR 1.47 [1.28, 1.69]
5 studies · 646 participants
High

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) vs paracetamol

Proportion of patients with >50% maximum pain relief (TOTPAR) over 2 hours · Patients with pain after surgical removal of lower wisdom teeth (third molars) requiring bone removal or with baseline moderate to severe…

Ibuprofen (single postoperative oral dose; 200 mg to 512 mg) leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 2… compared with paracetamol (acetaminophen) (single postoperative oral dose; 600 mg… (high certainty).

1 finding from 1 review

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes
2 hours postdosing · Ibuprofen 400 mg vs paracetamol 1000 mg
RR 1.30 [1.09, 1.55]
5 studies · 645 participants
High

Single preoperative dose of systemic antibiotics (clindamycin 600 mg), total chemo-mechanical debridement and root filling vs Matched placebo, total chemo-mechanical debridement and root filling

Pain at 24 hours · Adults with symptomatic apical periodontitis (no signs of spreading infection or systemic involvement)

1 finding from 1 review

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults 2024 · Cochrane All outcomes
24 hours
The median pain at 24 hours in the control group was 3 (range 0 to 10); the median pain at 24 hours in the intervention group was the same (median 3, range 0 to 8). P = 0.219 (Mann-Whitney U).
1 study · 72 participants
Low

Single preoperative dose of systemic antibiotics (clindamycin 600 mg), total chemo-mechanical debridement and root filling vs Matched placebo, total chemo-mechanical debridement and root filling

Pain at 48 hours · Adults with symptomatic apical periodontitis (no signs of spreading infection or systemic involvement)

1 finding from 1 review

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults 2024 · Cochrane All outcomes
48 hours
Median pain at 48 hours 1 (range 0 to 9) in the antibiotic group versus 2 (range 0 to 10) in the control group. P = 0.242 (Mann-Whitney U).
1 study · 72 participants
GRADE not reported

Single preoperative dose of systemic antibiotics (clindamycin 600 mg), total chemo-mechanical debridement and root filling vs Matched placebo, total chemo-mechanical debridement and root filling

Pain at 72 hours · Adults with symptomatic apical periodontitis (no signs of spreading infection or systemic involvement)

1 finding from 1 review

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults 2024 · Cochrane All outcomes
72 hours
The median pain at 72 hours in the control group was 0 (range 0 to 10); the median pain at 72 hours in the intervention group was the same (median 0, range 0 to 7). P = 0.116 (Mann-Whitney U).
1 study · 72 participants
Low

Single-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)

Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) · People aged 10 years or above requiring root canal treatment; permanent teeth with completely formed apex and without internal resorption

Single-visit root canal treatment showed no clear difference in postoperative pain in the immediate postobturation period (up to 72… compared with multiple-visit root canal treatment (two or more visits) (low certainty).

1 finding from 1 review

Single versus multiple visits for endodontic treatment of permanent teeth 2022 · Cochrane All outcomes
Up to 72 hours postobturation
RR 0.97 [0.81, 1.16]
12 studies · 1329 participants
Low

Combined paracetamol plus ibuprofen in a single tablet (e.g. paracetamol 1000 mg/ibuprofen 400 mg or 500/200 mg) vs Single drugs given separately (paracetamol 1000 mg or ibuprofen 400 mg)

Proportion of patients with >50% maximum pain relief (TOTPAR) over 2 hours · Patients with pain after surgical removal of lower wisdom teeth (third molars) requiring bone removal or with baseline moderate to severe…

Combined paracetamol plus ibuprofen in a single tablet (e.g.… showed no clear difference in proportion of patients with >50% maximum pain relief (TOTPAR) over 2… compared with single drugs given separately (paracetamol 1000 mg or ibuprofen 400… (moderate certainty).

1 finding from 1 review

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes
2 hours postdosing · Paracetamol 1000 mg/ibuprofen 400 mg vs paracetamol 1000 mg or ibuprofen 400 mg
RR 1.29 [0.91, 1.85]
1 study · 170 participants
Moderate

Combined paracetamol plus ibuprofen in a single tablet (e.g. paracetamol 1000 mg/ibuprofen 400 mg or 500/200 mg) vs Single drugs given separately (paracetamol 1000 mg or ibuprofen 400 mg)

Participant‐reported pain relief of 50% or greater · Patients with pain after surgical removal of lower wisdom teeth (third molars) requiring bone removal or with baseline moderate to severe…

Combined paracetamol plus ibuprofen in a single tablet (e.g.… probably leads to higher proportion of patients with >50% maximum pain relief (TOTPAR) over 6… compared with single drugs given separately (paracetamol 1000 mg or ibuprofen 400… (moderate certainty).

1 finding from 1 review

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth 2013 · Cochrane All outcomes
6 hours postdosing · Paracetamol 1000 mg/ibuprofen 400 mg vs paracetamol 1000 mg or ibuprofen 400 mg
RR 1.77 [1.32, 2.39]
1 study · 170 participants
Moderate

Single-visit root canal treatment vs Multiple-visit root canal treatment (two or more visits)

Postoperative pain intensity in the immediate postobturation period (up to 72 hours), continuous (VAS) · People aged 10 years or above requiring root canal treatment; permanent teeth with completely formed apex and without internal resorption

Single-visit root canal treatment showed no clear difference in postoperative pain intensity in the immediate postobturation period… compared with multiple-visit root canal treatment (two or more visits) (low certainty).

1 finding from 1 review

Single versus multiple visits for endodontic treatment of permanent teeth 2022 · Cochrane All outcomes
Up to 72 hours postobturation
MD 0.26 [-4.76, 5.29]
12 studies · 1258 participants
Low

Oral paracetamol vs placebo

At least 50% reduction in pain · Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local…

Paracetamol (single oral dose, any dose or formulation; subgroups up… led to higher achieving at least 50% pain relief at 4 hours (using pain intensity… compared with placebo; GRADE not reported.

3 findings from 1 review

Paracetamol for pain relief after surgical removal of lower wisdom teeth 2007 · Cochrane All outcomes
4 hours
RR 4.87 [2.83, 8.37]
17 studies · 1658 participants
GRADE not reported
Paracetamol for pain relief after surgical removal of lower wisdom teeth 2007 · Cochrane All outcomes
6 hours
RR 3.41 [2.34, 4.97]
13 studies · 1184 participants
GRADE not reported
Paracetamol for pain relief after surgical removal of lower wisdom teeth 2007 · Cochrane All outcomes
4 hours
RR 2.85 [1.89, 4.29]
16 studies · 1498 participants
GRADE not reported

Oral paracetamol vs placebo

Participant‐reported pain relief of 50% or greater · Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local…

Paracetamol (single oral dose, any dose or formulation; subgroups up… led to higher achieving at least 50% pain relief at 6 hours (using pain relief… compared with placebo; GRADE not reported.

1 finding from 1 review

Paracetamol for pain relief after surgical removal of lower wisdom teeth 2007 · Cochrane All outcomes
6 hours
RR 3.32 [1.88, 5.87]
13 studies · 1155 participants
GRADE not reported