Which statement accurately describes first-line analgesic use for dental pain and considerations for NSAIDs in patients with asthma or gastric ulcers?

• A. First-line analgesic is ibuprofen 200–400 mg every 6–8 hours (max 1.2–2.4 g/day); if needed NSAIDs are contraindicated in asthma or gastric ulcers; use paracetamol only.
• B. First-line analgesic is paracetamol (acetaminophen) 500–1000 mg every 4–6 hours (max 4 g/day); if needed and not contraindicated, NSAIDs such as ibuprofen 200–400 mg every 6–8 hours (max 1.2–2.4 g/day); in patients with asthma or gastric ulcers, avoid NSAIDs if possible; use paracetamol or topical measures.
• C. First-line analgesic is aspirin 300 mg; NSAIDs are always safe.
• D. First-line analgesic is codeine; NSAIDs are never used.

Answer: (B)

Paracetamol is the preferred first-line analgesic for dental pain because it provides reliable relief with a broad safety margin for most adults, including those with sensitive airways or stomach issues. The typical adult dose is 500–1000 mg every 4–6 hours, not exceeding 4 g in a 24-hour period. If pain persists and there are no contraindications, an NSAID such as ibuprofen (200–400 mg every 6–8 hours, up to 1.2–2.4 g per day) can be used in addition. However, in people with asthma or gastric ulcers, NSAIDs should be avoided if possible because they can provoke bronchospasm in aspirin-sensitive asthma and can irritate or worsen gastric ulcers by reducing protective prostaglandins. In such cases, rely on paracetamol and consider topical measures or non-drug approaches to manage pain.

The other options aren’t aligned with standard guidance. Using ibuprofen as the first-line analgesic overlooks the safety profile of paracetamol and the need to tailor NSAID use to individual risk factors. Statements that aspirin is always safe or that codeine should be first-line ignore known risks and typical practice for dental pain management.