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Known allergy to NSAID, Patients with a history of Patients with treated and
history of peptic ulcer disease uncontrolled hypertension
angioedema and chronic
renal failure Most of these patients will Long-term use of NSAIDS
NSAIDs should not be used be taking a proton may increase blood
in these patient pump inhibitor (PPI) and this pressure and the impact of
groups and the dentist will protect this efect varies
should contact the from the gastric irritation from person to person.16
patient’s GP to discuss associated with For treatments of
alternative analgesic NSAIDs. In these cases, the up to two weeks in a patient
options. Renal failure can be dentist can use the with properly
made quickly NSAID regimes treated hypertension and no
worse by the use of NSAID recommended for moderate renal disease,
medicines.12 and severe pain, but if the the recommendations for
Common groups to have treatment course the use of NSAIDs
renal failure include for severe dental pain is in moderate and severe
patients with diabetes prolonged beyond dental pain apply.
mellitus (type 1 and2) and two weeks, then the dentist If treatment is to continue
patients with longstanding should liaise with afer two weeks,
poor hypertension control. If the GP to ensure no other the dentist should discuss
in any doubt, the gastric precautions management with
patient should have an are needed. the GP and the NSAID
estimated glomerular If a patient is not taking a should continue as
fltration rate (eGFR) blood PPI and has a long as blood pressure
test requested history of at least one monitoring and renal
from the GP – a value of episode of proven peptic function monitoring is
>60 is safe for NSAID ulcer disease (usually by carried out regularly.
use. Below this level, the previous endoscopy), The combination of NSAIDs,
GP should be asked has another risk factor for angiotensin-
for advice as to the best gastric bleeding converting enzyme (ACE)
analgesia regime such as an anticoagulant inhibitors and
and is likely to be diuretics can signifcantly
taking the NSAID for more increase the risk
than two weeks, of kidney damage in some
the dentist should discuss patients.3
the need for a PPI If blood
(omeprazole or pressure starts to rise or
lansoprazole) with the GP renal functiondeteriorates,
before prescribing, an alternative analgesic
especially if the patient is regime
already taking aspirin.15 should be considered.
Box 1 gives risk groupfor GI Patients with uncontrolled
bleeding; patients should be hypertension
considered (>140/90) should not be
high risk if they have a prescribed high-
history of previous ulcer dose ibuprofen (2,400
disease or more than two mg/day) or diclofenac
risk factors and at without consulting the
moderate risk if they have patient’s GP.3
one or two risk
factors
Severe asthma
This includes patients who
have hadprednisolone use
in last six months or any
hospital admission for
asthma. Do not use any
NSAID drugs in these
patients. Contact the
patient’s GP for an
alternative analgesic
regime.