BackgroundBoth paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United Kingdom. This drug has shown promising results to date and we have chosen to also compare the combined drug with the single drugs using this model. In this review we investigate the optimal doses of both paracetamol and ibuprofen via comparison of both and via comparison with the novel combined drug. We have taken into account the side effect profile of the study drugs. This review will help Oral Surgeons to decide on which analgesic(s) to prescribe following wisdom tooth removal.ObjectivesTo compare the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth, at different doses and administered postoperatively.Data collection and analysisThe proportion of patients with at least 50% pain relief (based on TOTPAR and SPID data) was calculated for all three drugs at both two and six hours post dosing and meta-analysed for comparison. The number of participants using rescue medication over both 6 and 8 hours was also collated and compared. The number of patients experiencing adverse events, and/or the total number of adverse events reported were analysed for comparison.Main resultsSeven studies were included; they were all parallel group studies, two studies were assessed as at low risk of bias and two at high, three were considered to have unclear bias in their methodology. All trials used the third molar model for trialing the analgesics. A total of 2241 participants were enrolled in these trials. Ibuprofen was found to be a superior analgesic to paracetamol at several doses with high quality evidence suggesting that ibuprofen 400mg is superior to 1000mg paracetamol based on pain relief (estimated from TOTPAR and SPID data) and the use of rescue medication meta-analyses at both 2 and 6 hours post dosing. The risk ratio for greater than 50% pain relief (based on TOTPAR) at 6 hours is 1.47 (95% confidence interval 1.28-1.69) favouring 400mg ibuprofen over 1000mg paracetamol. The combined drug showed promising results from only two studies, with the analysis of participants using rescue medication at 8 hours giving a risk ratio of 1.67 (95% confidence interval 1.48 to 1.90) favouring the combined drug over the single drugs. There were no differences noted in the frequency of adverse events associated with any of the drugs; however, there was insufficient data to conduct a meta-analysis as it was unclear as to whether the events were being counted by number of procedures or number of participants.Authors' conclusionsThere is high quality evidence that ibuprofen is superior to paracetamol at doses of 200mg to 512mg and 600mg to 1000mg respectively based on pain relief, pain intensity difference and use of rescue medication data collected six hours postoperatively. The novel combination drug is showing encouraging results based on the outcomes from two trials when compared to the single drugs.