Pre-extraction wisdom teeth pain management

May 6, 2009 7:34 AM

I'm getting all four wisdom teeth out on May 29th. For the last month or so I have felt intense pressure in my mouth from the teeth coming in. It's been getting a little worse each week and is now causing headaches. It's only May 6th. How should I manage the pain?

I have been able to deal with it fairly well with a rotation of OTC painkillers, but I have some concerns about how safe this is. I have generally been popping 1000mg of acetaminophen when I get to work around 9:00am. This has been getting me through the morning and early afternoon. I then take 800mg of ibuprofen when the pain starts to come back. I'll usually take 600-800mg more sometime in the evening if necessary. I don't think this is too extreme, but I've been doing it for a couple weeks now and there are a few weeks to go, and that makes me uncomfortable. Is this safe? Acetaminophen in particular scares me because of how hard it is on my liver, although I've found it much more effective than ibuprofen. Additionally, it's getting to the point where it's not getting the job done anymore. I've still been hurting like hell the last two days.

Moving up the surgery is not an option due to scheduling conflicts.

Can I call the surgeon and ask for a prescription for stronger painkillers? I've never taken prescription painkillers before, really I've never been prescribed anything in my life except for some antibiotics for childhood strep throat infections. So, I'm unfamiliar with the etiquette here. Is this likely to work? Can I take stronger painkillers on a somewhat regular basis for that long? I'm just kind of clueless as to what to do since I've never been confronted with chronic pain before or dealt with a health care provider in this way.

posted by prozach1576 to health & fitness (10 comments total)

I had a prescription for Naproxen (similar to Aleve) that got me through wisdom teeth coming in. If you take it for too long (and at higher dosage), it'll start to irritate your stomach. But it does help with the pain. It's a pretty common painkiller; I imagine they'll prescribe it if you ask.
posted by puckish at 7:45 AM on May 6

I recently had pain related to wisdom teeth and was prescribed Tylenol w/Codein. I am not sure how long you can take this safely though. Have you tried Aleve? This generally works better on pain that regular otc tylenol. Either way the pain was really too much and I kept chewing on my gum so I moved up my appointment to have them removed.
posted by mokeydraws at 7:46 AM on May 6

Clove Oil
posted by kch at 8:14 AM on May 6

Discuss this with your oral surgeon; he may well be willing to prescribe something for you until you get your teeth out. He also needs to know what OTC meds you are taking; most OTC pain meds with the exception of acetominophen have antiplatelet effects and for many procedures sugeons will want them stopped for a period of time before surgery.
posted by TedW at 8:28 AM on May 6 [1 favorite]

When I had wisdom tooth issues, no OTC painkiller made the slightest difference. I ended up with a prescription for Percocet, which worked like a charm. I wouldn't hesitate to call the surgeon and ask, if I were in your position. Ouch!
posted by chez shoes at 8:35 AM on May 6

Acetaminophen is dangerous in surprisingly small doses (~5 grams) can yield permanent liver damage, moreso if you drink alcohol. Ibuprofen dosage instructions [PDF] for physicians allow up to 800mg up to four times a day - assuming no health risks (e.g. liver, kidney stomach issues) you haven't mentioned. Dosages this high may cause stomach pain.

I'd be wary of a month's worth of opiate (e.g. codeine, percoset) treatment as you'll probably experience withdrawal symptoms afterward. IANAD, you should call yours.
posted by fydfyd at 8:42 AM on May 6 [1 favorite]

CALL YOUR SURGEON!!!!

Explain to him what you just told us and he will help you...
posted by peewinkle at 9:12 AM on May 6

And, btw, opiates can cause severe constipation if you take them for a while, so be prepared for that. My sympathies. There's nothing quite like painful teeth.
posted by x46 at 9:47 AM on May 6

IAAD.
Clove oil will not work. Acetominophen is good for fevers but not great for inflammation.
In most cases inflammation is the cause for the kind of discomfort you are experiencing. 600mg of IBU 4 times a day for this short a period should do you no harm IF you are healthy and have no liver or kidney issues and no history of stomach ulcers. There are other antiinflammatory meds such as naproxen that can be effective as well.
Most docs will hesitate to Rx opiates just to alleviate pre-op pain, we want them to be effective after the surgery when they are needed, so don't get your hopes up for a quick fix of percocet.
Second the advice to call you surgeon.
Keep the area clean! bacterial plaque thrives under the gums around partially erupted wisdom teeth and is a major cause of pain prior to removal.
a prescription for chlorhexidine rinse might be indicated.
Good Luck
posted by OHenryPacey at 11:47 PM on May 6

I would definitely call your doctor - he'll probably be able to prescribe something, and at worst he'll just refuse. It's pretty normal to request painkillers. He also may be able to advise you on what OTC painkillers might work better for tooth pain than your current regimen.

One thing you could try is soaking a tiny piece of paper towel in hard alcohol (whiskey, vodka, whatever) and holding that in the painful spot for a moment - it should numb the area somewhat. I had a friend who found it more helpful than painkillers for a cracked wisdom tooth; I tried it after a root canal and didn't find it helpful, so YMMV.

Note that acetaminophen + alcohol can destroy your liver. You shouldn't actually be taking in much alcohol at all if you try this - just something to be aware of - just google acetaminophen alcohol for more info on the toxic dose and risks.
posted by insectosaurus at 8:09 AM on May 7