To think dental pain isn't taken seriously?

[MrsLouisTomlinson]

I'm up literally pacing the floors with pain from an infected root canal. I have been to the emergency dentists twice (currently away from home) and now have a second course of antibiotics after the first did nothing. I've been in pain since Friday. It has really ramped up the last 24 hours. I am taking ibuprofen and paracetamol with dihydracodeine in. Neither time would the dentist prescribe me any analgesia as over the counter should cover it. It isn't, I'm crying and pacing and am at my wits end. I don't want to bother A&E and can't face being told I'm in the wrong place or misusing the system and can't/won't be helped. The emergency dentist is costing me 20 quid a pop plus prescriptions so I'm reluctant to go back there, especially given the fact they told me last night they wouldn't prescribe analgesia. Why are they so reluctant? Is there anywhere I can go? Walk in?

[Gobbolinothewitchscat]

GPs shouldn't be prescribing analgesia (or anything really) for tooth pain. But that was post extraction, at least.

However, this is a totally different situation where there is an infection that needs dealt with - either by extraction or antibiotics. The pain relief just masks the pain which could be dangerous. It's like dosing someone with sepsis up on morphine. Yes - they'll feel better but it won't deal with Feb sepsis. Please always go back to the dentist and get it treated.

The difficulty for dentists is that infections take a grip very rapidly but they are not permitted to prescribe antibiotics on a "might need" basis. So DH often sees people who don't meet the criteria at the specific time of the appointment but it's likely they will do the next day. Nevertheless he can't prescribe antibiotics until they come back the next day. He works one day a week at an emergency access clinic and often sees patients who didn't get antibiotics the day before from their regular dentists but need then when they see him.

That said, antibiotics are not the answer to treating a lot of infections and often an extraction etc is needed.

All this from DH who has got back from work!

[Darlink]

I'm a dentist and I care very much about dental pain.

There Is so much misunderstanding around pain and infection in teeth, and very wrong advice is sometimes given on forums like these.

Do you have swelling or a fever ? If neither there is NO indication for antibiotics.

I am properly confused as to how this has been managed.


Do you mean the tooth has had a root filling placed some time in the past ? And the root filling is still in place ?

Is it an upper premolar? One of the two teeth behind the canine ?
Is it sore to press the tooth ?

[statetrooperstacey]

Oral gel it's the only thing that works for me on top of paracetamol and ibuprofen obviously . It's horrible, many sympathies.

[Heatherjayne1972]

It's because if you have antibiotics for a tooth issue they should kick in and ease the pain within 24 hours and so they don't offer anything else. in my 25 years dental experience I've never seen them offer anything stronger than otc painkillers as it's considered not necessary

[zen1]

There is an emergency walk-in here www.guysandstthomas.nhs.uk/resources/patient-information/dental/welcome-to-the-acute-dental-care-clinic.pdf, but you have to get there early to be sure to be seen.

I am similarly suffering OP. Have been for 2 months. I have a dying / infected wisdom tooth that no dentist will touch due to root system. I've been referred for extraction by they move at a snail's pace. Antibiotics only go so far in helping with the pain.

[Marynary]

It is bad that they are just prescribing antibiotics rather than doing any dental treatment. I thought that unless the infection has spread and you have swelling or fever, antibiotics aren't necessary at all if they give extract the tooth so the infection can drain.

[MrsLouisTomlinson]

Darlink yes to all of the questions you have asked, it's an upper tooth, behind the pointy one, it had a root canal done in September. I was x-rayed on Saturday (sorry think I may have said Friday elsewhere) at my own dental Surgery which showed a small area of what the dentist thought was potentially infection. At the time the gym above the tooth was tender to touch and moderate throbbing was felt inside the tooth as it were. It is exactly the kind of pain albeit a milder version that led to the root canal being done in the first place and as I said earlier I have recently been admitted to hospital for a post dental procedure infection recently so I'm pretty wary of it.

At the initial appt I was given amoxicillin and told to make a follow up appt with my own particular dentist within the surgery who had done the root canal. I have that appt to come on Monday afternoon.

I am in London for the week with work and although initially the tooth was bearable, by yesterday it had deteriorated to the point that I was a gibbering wreck, I attended a further emergency dental appt organised by 111 where they prescribed the metronidazole as detailed upthread somewhere and I got through an awful night pain wise which led me to here moaning at the tail end of it. The pain I currently have is a moderate throbbing of the tooth (settled from severe overnight and this morning with the commencing of abx I assume) however if any pressure applied to the tooth, even just accidental knocking from the bottom teeth I am on the ceiling with the pain. I have tenderness externally up to the area including the bottom of my eye socket but no visible swelling beyond a small pea sized lump on my gum.

[GentleOnMyMind]

You have my sympathy dental pain is the worst. Hope you get some relief soon and your dentist gets to the cause of it, sounds like you've had a rough time of it.

[PurpleMcPants]

I had my root canal recleaned again today, pain is better but have disgusting taste in my mouth (I think from antibiotics they put in the tooth?). 5th time lucky!!

[AnneTwacky]

If you started taking the metronidazole yesterday the pain should start easing soon.
You really need an extraction/ more work on the tooth to stop the infection reoccurring though.

[BobbyNoggle]

Dental pain is hideous; as the all the OOH dentists & their patients will attest to! Children & Adult Special Needs patients with severe dental pain are especially heart-rending -they often can't even communicate their distress & failure to thrive/ withdrawl into themselves is common.
Usually best for the dentist to find a practical intervention solution for relief of patient symptoms. But your specific pain situation is tricky to solve unless you're willing to have an extraction; because It's just not that easy to remove the existing root-filling and re-root treat a multi-rooted tooth, like a pre-molar & molar. It's very unlikely that an OOH dental facility would carry all the equipment to facilitate this. In fact, this is getting into specialist endodontics territory.
GPs don't generally get involved with any sort of dental pain/swelling this days; so that avenue is an unlikely one.
Dental hospitals urgent / casualty depts tend to be very particular about who they will see& treat. Mainly unregistered patients (those without a regular General dentist) & with visible facial swelling etc. The Dental hospital emerg depts often re-direct other patients with pain to local NHS dentists who are commissioned to see Urgent Care patients. There will only be a finite no of these appointments available, so essential to be an early riser!
Best dental pain-relief=combo regime of co-codamol 30/500mg +diclofenc 50mg.
Co-codamol 30/500mg 2tabs 6hrly with diclofenac 50mg 8hrly. Unfortunately dentists can't prescribe the former, OTC strength is 8/500mg co-codamol. More effective than plain paracetamol. Dentists can prescribe diclofenac -so as long as you're ok with Non-Steroidals generally-do ask for it. Dihydrocodeine tartrate 30mg -is also dentist- prescribable -but isn't brilliant for dental pain.
Hope it all settles down for you quickly.

[WashBasketsAreUs]

I feel for you! I had a sinus infection last week, then got neuralgia in the right hand side of my face. My teeth felt like they'd been punched, waves of pain were ricochetting round from all the top teeth on the right hand side round to the bottom. I was taking everything I could lay my hands on, including my prescription codeine tablets (strongest ones available ) plus paracetamol and ibuprofen. Like you I was clock watching to see when I could take the next lot.
The nerve pain is getting better, I can nearly chew on that side now but OMG it was hideous. I was at work last week, someone asked me how I was and after taking shit loads of painkillers, smacked out of my tits was an apt description!

[AlbertoFrog]

Worst pain ever (next to childbirth but that was worth it) was an abscess. I remember hitting my head off a brick wall (yes literally) to try and take the pain away from my jaw. A&E wouldn't treat me and emergency dentist didn't open for 8 hours or so and was 20 miles away.

'pea sized lump on gum' sounds very much like the abscess I had. If so, draining it helped me.

Best of luck OP

[Darlink]

I used to run the out of hours dental services in one of the biggest health boards in the country.


There are only three things that will fix the problem
Extract ( I get why you are not keen )

Remove the old root filling and redo, with a healing interval when the tooth is dressed with a medicated dressing.

Apicectomy (let's not go there )

Prescribing ABs in the absence of fever or spreading infection/cellulitis is extremely bad practice.

[Darlink]

And what's more, will do no good whatsoever.
Antibiotics might appear to work because over time things will usually calm down anyway.

And it is absolute nonsense that an infected tooth needs antibiotics 'to clear the infection' before any work gets done on it. This is a myth that many DENTISTS continue to perpetuate

[Darlink]

Sorry there is a fourth thing - if there is a well defined swelling above the tooth it needs incised to drain .

[Darlink]

Incising an abscess is done in conjunction with one of the three things I mentioned if treatment is being deferred for whatever reason.

[MrsLouisTomlinson]

The out of hours dentist did consider incising but as the swelling appeared quite small thought better of it as unlikely to give much relief. Why will abx not do any good? I'm assuming there is infection there that is causing the pain (and probably eroding the jaw bone and turning everything into a horrible pulpy mess) so won't the abx help get rid of that if nothing else? There is a definite reduction in my pain levels which I have to be grateful for, no matter what reason it has come about.

Btw my dentist did say the plan would likely be to redo the root canal. I'd have it extracted if I could comfortably afford an implant but it would be an expensive luxury for me. That I know I would put off as there is always something more important to spend the cash on despite the fact the gap would make me thoroughly miserable.

[liz70]

Would you consider a false one until such time as you may be able to afford an implant, OP? My mum has one at the front, I think you soon get used to it. I know it might make you feel like an old hag(!) but noone else would know. I was lucky in that mine was a back molar so not visible usually. I haven't replaced it with anything. I just wanted it out, and my dentist said it was beyond salvage anyway as it was dying off. It's horrible, isn't it. I'm sure my teeth have gone worse since I went through menopause, too.

[Marynary]

I just had my tooth taken out too and I'm really glad I did. It caused me so much trouble and as you can't see it (back molar) I really couldn't see the sense in keeping it. I haven't got any fillings now thankfully.

[MrsLouisTomlinson]

I think I will talk to my dentist about my options if the tooth was to come out. I can't cope with this again. It's much improved now but still very painful if any pressure applied. I thought a root canal would ensure not having to deal with this but it obviously hasnt.