pain control

May 24, 2007 12:19 PM

Vicodin is not working for my post-wisdom tooth holes, what do I do?

Appointment was at 8:20, was home at 10:30. Took Vicodin (5mg hydrocodone and 500mg acetaminophen) #1 at 10:49. Then I took a nap and woke up at 12:20 at which point I was in a lot of pain. I changed the stupid bloody gauze and took Vicodin #2. Vicodin #2 did not get rid of very much pain and I was still feeling pain and crying after taking it.

Now it is 2:17 and my former teeth hurt quite a bit but I am being told not to take more drugs for some absurd amount of time. What do I do? Can I just take two now and hope that it works?

posted by mustcatchmooseandsquirrel to health & fitness (33 comments total)

Your problem is the parcetamol (acetominophen), which rapidly gets toxic if you take too much.
posted by NucleophilicAttack at 12:31 PM on May 24, 2007

I would pop another one, but there might be some sound medical reason not to do this that I am not aware of.

I presume you've called your doctor and told him the vicodin isn't cutting it? He might be able to give you something that is stronger and/or works differently.

Not that that helps you RIGHT NOW.

Pain sucks. You always forget how bad it is.
posted by bluenausea at 12:33 PM on May 24, 2007

Man, this is the kind of thing that asking non-doctors for advice about can get you into trouble.

My first thought was to suggest some topical anesthetic such as ambesol, but I have no idea if using it with the other drugs you're taking is smart.
posted by crickets at 12:35 PM on May 24, 2007

This is an important thing to know. But I am not a doctor, and this is not medical advice.

Do not, under any circumstances, take more than 1000mg of acetaminophen in any 6-hour period. It's nice to have a liver that works right, and acetaminophen above that dose very quickly becomes very bad for your liver.

That is the end of my serious advice. What follows is speculation.

On that note, I thought most prescriptions of Vicodin have 325mg of acetaminophen leaving the max dose at 3 pills. But if you have 500mg per pill, don't take a third until at least 6 hours after the first.
posted by chimaera at 12:43 PM on May 24, 2007

NucleophilicAttack is right about the acetominophen; call your dentist and he may give you some additional narcotics without the acetominophen. Also, you may have a dry socket which can be pretty painful; either way, you dentist should know you are hurting.
posted by TedW at 12:43 PM on May 24, 2007

I'm no doctor, for sure, and hepatoxicity isn't cool by any means, but I've certainly taken more than 1000mg of acetaminophen as a result of eating excessive amounts of Vicodin, and I'm not dead. I can't speak to long term ills, but I'd be willing to bet that my liver has more to worry about than an occasional high dose of tylenol. I'd eat 4 of them vicodin and go to sleep. Or call the doctor and tell him the vics ain't cuttin' it.
posted by solipsophistocracy at 12:47 PM on May 24, 2007

500mg of Acetaminophen = 1 Extra Strength Tylenol. The recommended over the counter dosage for extra strength tylenol is 2 tablets every 4-6 hours.

10mg of hydrocodone may make you sleepy or nauseous. No driving for you.

Also, cool compresses on your cheeks help a lot.
posted by jamaro at 12:48 PM on May 24, 2007

Call your doctor.

Pain (and painkiller) thresholds can be way different for individuals. He'll probably tell you (basically) to power through it, rather than give you a stronger prescription. Unless something went wrong with the surgery, you'll be fine. I'm sorry you still hurt. My wisdom teeth extraction was a painful experience as well but it only lasted a day or so.
posted by elendil71 at 12:55 PM on May 24, 2007

Frozen peas make the best cold compresses post-wisdom tooth extraction. Buy four bags and rotate between freezer and face. Believe it or not, the ice can make a big difference with pain.

Don't take more drugs. Just ice your face. You'll be fine.
posted by summit at 12:57 PM on May 24, 2007

Seconding the concern about dry socket—I wasn't in awful pain after my extractions at first, but dry socket knocked me on my ass.

Call your dentist regardless. I was told that dry socket is not particularly dangerous, but it's damned painful and treatment was a snap (medicated gauze packed into the socket) and relief pretty much instant.
posted by cortex at 12:59 PM on May 24, 2007

AnecdoteFilter-
Vicodin didn't do a damned thing for me when I had my wisdom teeth out, and I've heard the same thing from a few other people I know. I later read somewhere that Vicodin doesn't do the trick for some people. I ended up just using Ibuprofen, which took the edge off a lot better than the Vicodin I was given.
posted by lekvar at 1:19 PM on May 24, 2007

ibuprofen is a different class of drugs - i'd ask your dr. if you can pop a few of those in between the vicodin
posted by wayward vagabond at 1:19 PM on May 24, 2007

I had the same experience when I had my wisdom teeth out- terrible pain even w/ the narcotic painkillers- I called and spoke w/ a nurse at the oral surgeon's practice and she said to intersperse (in my case, percoset) w/ ibuprofen- which took care of the pain completely. I would call immediately and ask if you can do this...
posted by mistsandrain at 1:24 PM on May 24, 2007

Maybe try those big orange Motrin? An anti-inflammatory may be more what you need, not so much painkillers at this point.

Hope you feel better soon. :)
posted by Carnage Asada at 1:26 PM on May 24, 2007

I have to second that Vicodine did nothing for my first wisdom teeth, when I got the last one taken out I took Tylenol with Codine, that seemed to do more for me.
posted by cftarnas at 1:50 PM on May 24, 2007

Seconding the Motrin 800mg. I likes me some vicodin, but the motrin kills this type of pain more effectively for me. Did you know you can stagger them (1 vicodin, 2 hrs later the motrin)? Ask your dentist about it before you try it, however. When my youngest son got a bad fever, this is what was recommended to us (but with regular tylenol, not the vicodin).
posted by IronLizard at 2:00 PM on May 24, 2007

Call and ask the dentist to phone in a prescription for something stronger, as the vicodin is inadequate. If he refuses, inform him that he just lost your business and pay a visit Urgent Care. They'll usually take good care of you.
posted by mullingitover at 2:04 PM on May 24, 2007

I know this may be an illegal suggestion that offends some people, however, I have had great results with pain relief with marijuana. Since it involves smoke, it would best if you could use an evaporator (smokeless to prevent infection). I have not used it for tooth pain but I have to help me through three herniated disks and I have a friend that uses it for her MS pain.

Just a suggestion….one that one cause liver damage.
posted by birdlips at 2:34 PM on May 24, 2007

one that won't cause liver damage that is
posted by birdlips at 2:35 PM on May 24, 2007

Something that always seems to help when I had dental pain (including post wisdom teeth extraction) was to eat something. I know it's difficult to eat anything, but for whatever reason, having a full stomach seems to make pain killers more effective.

I first noticed it when a dentist mentioned, after the fifth shot of novocaine[1] still hadn't worked. He said being on an empty stomach can do that. The only time since I've had issues with pain killers taken effect was when I forgot to grab lunch before a dentist appointment.

I have no idea why this would have an effect, but it seems to.

[1] or whatever pain kill they inject into you...
posted by alikins at 2:41 PM on May 24, 2007

Definitely take some ibuprofen and call the dentist to get something prescribed that doesn't have as much acetaminophen.

And if you're getting up near the maximum of acetaminophen you should have in a day (4000 mg), AVOID ALCOHOL. Acetaminophen gets metabolized in the liver into something that binds irreversibly to liver cells and kills them, if you overwhelm the body's capacity to neutralize it. Alcohol gets metabolized by the same pathway. So you can be taking tylenol and drinking shots and be just fine... till suddenly you overwhelm your body's reserves, and wham. Liver cells will be popping like bubble wrap under a steamroller.
posted by selfmedicating at 2:42 PM on May 24, 2007

Cloves are a very useful long-lasting topical anesthetic. If you can find a bottle of clove oil, a drop on the painful spot will help for hours. If you can't find the oil, hold a whole clove on the spot.

My mother and sister used to stick cloves into oranges to put in closets (to make a nice smell) and their thumbs used to be numb for more than a day.

For "slipped disk" back pain I find rum + vicodin helps me sleep, and as above, you can take vicodin and ibuprofen together.
posted by anadem at 2:47 PM on May 24, 2007

Call your pharmacist and tell them it is not working. They may be able to call the dentist and get a new prescription for a different drug that will work for you. The pharmacist should be able to recommend a drug to the dentist that will work.

Hydrocodone is a prodrug - that means it has to be metabolized in the liver into the active drug. Some people don't have the right enzymes to do it, so get NO effect. A lot of asians have this gene, but it could be anyone. It's called being a poor metabolizer of CYP 2D6.
posted by selfmedicating at 2:50 PM on May 24, 2007

oops ... reading selfmedicating's warning ... my run + vicondin days are over
posted by anadem at 2:57 PM on May 24, 2007

Vicodin has never had any effect on me under any circumstances (to the point where I asked the pharmacy if they didn't give me the wrong pills), whereas Percocet usually works quite well. Also, it is my understanding that codeine is a good drug for dental pain.

Don't despair - you have options for other medications if you call your dentist. In the mean time, ice and hang in there. Dry socket is a definite concern, because I don't think you should be in such pain that you're crying after taking one of the Vicodin (presuming it did take the edge off a bit).
posted by Iamtherealme at 3:01 PM on May 24, 2007

no, acetaminophen overdose will override it's elimination mechanism and your liver will start to produce a toxic metabolite during the breakdown that will start to kill off your liver cells. Call back to the office or pharmacist and see what else you can take (probably NSAIDs)
posted by uncballzer at 3:01 PM on May 24, 2007

I had this problem last year when I had my wisdoms taken out, and it was an infection. My doctor prescribed a really strong drug (can't think of the name, and i'm at my boyfriend's, so I can't go check) to take care of the inflammation. It REALLY scared me when the bottle said "exceeding dose can harm your liver". Blue capsules. That's all I remember. Anyhoo, that was my problem. So until I was able to get in to see him, they made me take 2 tylenol, then two hours later 2 aleve, then two hours later more tylenol, etc and so on. I was told that that's a near-standard - I really didn't care if it was or not. All I know is that it worked wonders for me. Combined with hot chocolate (holding a sip on the side where the pain was - obviously waiting for it to cool a bit), a heating pad and a woobie and my Pookie (er, blanket and stuffed animal, respectively), I was AOK over the weekend.

Oh, don't get the hot chocolate into the hole because OUCH. I'm speaking gospel here, trust me.
posted by damnjezebel at 4:09 PM on May 24, 2007

My wife had her wisdom teeth out just last week and like you, the Vicodin haven't touched the pain. On the other hand, when I had mine out about ten years ago, I got Tylenol with codeine and have only happy memories of the recovery process. :)
posted by Doofus Magoo at 4:15 PM on May 24, 2007

I had no wisdom tooth pain until the socket got infected, and then serious painkillers did no good. If you're experiencing awful pain and there is also a bad smell, you might want to get it checked out.
posted by tomble at 5:04 PM on May 24, 2007

Well if it makes you feel better, after my first nap after surgery I started screaming in pain. But the pain started slowly getting better until I was stupid and ate solid foods. I would use a warm compress for one. Two if you have dry socket...I feel for you. I had it in two spots. It felt like someone was punching me over and over. In that case, you need to do the following:

1. stop eatting any solid food if you are (I was dumb and ate things like eggs, pizza, etc. Seriously, don't do that!) luke warm soup may become your new friend.

2. make an appointment for the surgeon again. They put what looked like gummy worms in the holes which numbed the spot. They also gave me something that you put water into to clean the holes out after each meal (it was gross but it felt alot better afterwords)

Other than that, I can't think of any other advice. Good luck!
posted by slc228 at 5:53 PM on May 24, 2007

Ice.
posted by BeaverTerror at 7:14 PM on May 24, 2007

Jack Daniels is your friend, or perhaps you are pals with Johnny Walker. Not too much and tomorrow you will feel better, and the day after tomorrow even better still.
posted by caddis at 8:54 PM on May 24, 2007

followup: Couldn't stomach the pain so took two Vicodin after posting question. Then promptly fell asleep. Since then have been taking pills every 4/5 hours as directed by doctor. It was just that first time that was awful. (well, and the nausea is still awful. but that's a different issue)

Thanks, all.
posted by mustcatchmooseandsquirrel at 10:38 PM on May 24, 2007