Does a  Preoperative Dose of Ibuprofen Reduce the Pain Associated with Wisdom Tooth Removal?

 Should I take a dose of ibuprofen prior to my wisdom tooth treatment?  There have been many studies through the years showing that taking an NSAID, such as ibuprofen, prior to extraction of wisdom teeth reduces post-treatment pain and swelling.  (J Oral Maxillofac Surg 77:1990-1997, 2019).  I believe this is true for most dental procedures performed under local anesthesia, and I would advise that therapeutic measure.

In our practice, nearly all of our third molar (wisdom tooth) extraction cases are performed under IV anesthesia (the patient is asleep for the treatment) and, as part of that treatment, we often use an intravenous steroid, which is a more potent drug, to reduce inflammation, swelling, and pain.  Patients receiving IV anesthesia are asked to fast (no food or liquids) for six to eight hours prior to treatment, so they would not take in a medication like this.  I do feel that a preemptive dose the night before treatment is fine, but I do not feel that it makes a difference in outcomes.  In fact, over the years we have tried a number of different pretreatment and intraoperative regimens such as oral rinses, IV NSAIDs, and oral steroids.  My results with these are anecdotal, but have been consistent with what has been shown in the literature.  These do not make significant difference.  Truth-be-told:  I do prescribe additional oral steroid, mouth rinses, and/or prescription NSAIDs, for certain specific cases where I feel that the extent of surgery warrants, but for the routine case I do not feel they make any difference.

The final point that has been shown over and over is that the skill of the operator, reduced surgical time, careful techniques, early age of the patient, minimal access, and proper debridement and cleaning of the surgical site are the big factors that give better outcomes when removing third molar teeth.