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Tooth Abscess
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Wisdom Tooth Infection
Root / Dentin Sensitivity
More Toothache
(Broken Filling ,Tooth  Decay, "Cracked Tooth," Clenching / Bruxing, Sinus Infection, TM Joint Pain, Sores and Ulcers, Cardiac and GI Pain)
Drugs for Dental Pain
Fear of the Dentist
When There IS No Dentist
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Toothache

Lynne Heckert, DDS, JD

What Medicines Work Best for Tooth Ache Pain?

Most if not all studies that suggest that the non-steroidal anti inflammatory drugs (i.e., Advil, Motrin, Ibuprofen and its family)  are best for dental pain.  If you buy Advil or the store brand Ibuprofen over the counter, it will come in 200 mg tablets and the directions on the box will tell you to take two every 4-6 hours.  In fact,  this is a low over-the-counter dose and it is more effective to take four tabs at once (800 mg).  This is the dose you would get if you were given a doctor's prescription for the same drug.  Acetaminophen does not seem to be very effective for dental pain but some people cannot take aspirin or NSAIDs.
       Sometimes narcotics are used for dental pain.  Studies have shown that ibuprofen is as effective as an aspirin and codeine combination or an acetaminophen and codeine combination. 
     Codeine is a prescription drug and a controlled substance. Another controlled substance, oxycodone, may be prescribed for severe pain.  You will need to have a prescription in hand at the pharmacy for this. The dentist cannot call it in to the pharmacy.  My own feeling is that I would rather get through a pain situation with non-narcotics if possible.  Taking too many at once can cause severe vomiting and they can leave you quite constipated for days.

       One thing should never, ever, be done:  You should not chew an aspirin (it can dissolve enamel)  or place it on the soft tissue in the mouth next to a painful tooth (Aspirin burns can be very nasty and aspirin does not work that way).  It's a good drug (an alternative to Ibuprofen that some prefer)  but it is meant to be swallowed with a full class of water.

Treat the Cause

           Extraction or Root Canal:  Of course, one of the best ways to relieve the pain from an abscessed tooth is to remove the infection that is causing the inflammation and pain.  If the tooth is not slated for extraction, root canal (alone or with an antibiotic) may be an option.       When an infected tooth is extracted, relief is usually instant, since the focus of infection (the thing the bacteria were living in, i.e., the tooth) is gone, and drainage is immediately established. The first visit of a root canal, when the infected, or sick, nerve is removed, likewise relieves pain.

          Antibiotics: It is not unusual to see the pain of an abscessed tooth start to diminish precipitously after an effective antibiotic is given. (Most dental abscesses respond to amoxicillin, (For those not allergic) to the penicillin family--the alternative first choice is erythromycin) and for the few infections (around 10%) that do not respond, clindamycin is the drug of choice.  (In some cases, dentists will use clindamycin as a first choice but its side effects are a bit worse than amoxicillin.  Erythromycin can cause stomach upset.)

             Low dose, short term, steroids:  Suppose a toothache is caused by a deep cavity, but there is definitely no infection?  Low does steroids (dexamethasone seems to be most dentists' choice) will work to temporarily relieve the pain.  This is something that may be useful to 'get one through the night,' but only a dentist familiar with the patient's condition should prescribe.   Why?  Steroids can make the situation worse if the problem is infection. Some people should not have steroids and side effects of long term use can be serious.

What Not to Do for Dental Pain

Here are a couple of serious warnings. Do not ignore dental pain and avoid the dentist!  If you have a serious dental phobia, admit it, and consider an anti-anxiety drug for appointments.  (Valium and it's progeny are God sends for some people and there is no shame involved in using these drugs for dentistry. See Dentist-Fear.com)

Some people with abscessed teeth have learned that if they can get their hands on some antibiotic they can take it to avoid the dentist.  Don't do this.  The bacteria in an infection change over time and become resistant,  the tooth will continue to disintegrate, making an extraction or restoration more difficult, and dental infection can spread.  The tooth will come back to haunt you; count on it.  If you are see a dentist and abscessed tooth is diagnosed, and root canal recommended,  dot not delay having the root canal because the infection resolved.  Without the root canal, the infection will return.

If the problem is a gum (periodontal abscess, or around wisdom tooth), antibiotics will probably help, but pain relief is faster if a dentist can clean out the area between the tooth and gum also.


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Please remember that information on these sites is not all-inclusive and it may or may not apply to your situation and you need to call your own dentist.  A dentist needs to see the tooth, take and x-ray, etc. to diagnose and treat.   I cannot respond to email inquiries or phone calls.  Thanks for visiting!