Ask 10 dentists how much ibuprofen or acetaminophen they prescribe for pain, and you'll likely get 10 different answers, even with the ADA's own dosing guidance published back in 2015. Tom Viola, RPh, has heard the debate from both sides of the lecture podium for years, and in this episode, he digs into why that consensus still hasn't fully formed.
In this episode of The DrBicuspid.com Podcast, host Kevin Henry talks with Viola before their joint appearance at the Chesapeake Dental Conference in Maryland September 18-20, where both presented. The conversation turns to a newly introduced combination pain reliever, Tylenol with naproxen, which pairs 220 mg of naproxen sodium with 650 mg of acetaminophen per two-tablet dose, capped at four doses daily.
Viola walks through the math and raises a familiar concern: the dosing looks lower than what many dental practitioners already prescribe when combining ibuprofen and acetaminophen separately, echoing similar underdosing questions he's raised about earlier dual-action products like Advil Dual Action.
That leads into a broader discussion of the "how much is too much" question Viola says he fields constantly on the lecture circuit. He references a well-designed 2015 study of 1,800 participants that found 400 mg of ibuprofen combined with 500 mg of acetaminophen outperformed even hydrocodone-acetaminophen combinations, yet Viola notes that plenty of practitioners still prescribe well above that, some regularly reaching 600 mg of ibuprofen or more.
Viola is careful to note he's not in the business of telling prescribers what to prescribe, only providing the pharmacology so practitioners can make informed decisions, including how to navigate patients who self-medicate with over-the-counter versions of the same drugs regardless of what's recommended chairside.
Viola also previews his Chesapeake Dental Conference lecture, "Every Pill You Take, I'll Be Watching You," his long-running course on the medically complex dental patient. He explains the three-question framework at its core: What do you take? Why do you take it? And did you take it today? This approach is designed to help practitioners build a working medication history that often reveals more than what patients volunteer about their medical conditions directly.
The conversation closes with where to find more from Viola, including two new YouTube channels launching this month: Chair Side Confidential, aimed at dental professionals, and Tom's Medicine Cabinet, aimed at patients and the general public.
Learn more from Tom Viola at tomviola.com.
Listen to the full conversation below.
