A patient with toothache who is also taking calcium carbonate, alendronic acid weekly, atorvastatin, folic acid, ramipril and a beta-agonist inhaler requests OTC analgesics. What is the most appropriate action?

• A. Refer to the dentist
• B. Sell OTC analgesic
• C. Advise NSAIDs as needed
• D. Use home remedies only

Answer: (C)

The key idea is balancing effective pain relief with safety in the context of multiple medicines. For toothache, NSAIDs are often the first-line OTC option because they reduce both pain and the inflammatory component of dental pain. In this patient, there is a weekly alendronic acid (bisphosphonate) and ramipril (ACE inhibitor), but short-term NSAID use can still be appropriate if there are no red flags such as a history of peptic ulcer, GI bleeding, significant kidney disease, or an NSAID allergy. The safest approach is to advise using NSAIDs as needed, at the lowest effective dose for the shortest duration, and to take them with food to minimize GI irritation. Provide warning signs to stop and seek care if symptoms worsen, if there’s GI upset, reduced urine output, or any signs of an allergic reaction. If there is any doubt about kidney function or if the patient has risk factors for NSAID-related complications, consider acetaminophen (paracetamol) as an alternative and refer for dental assessment if the toothache persists. The emphasis is on offering effective symptomatic relief now while monitoring for safety and arranging dental evaluation for definitive care.