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September 29, 2012 5:57 PM   Subscribe

My sister has a dental emergency -- a wisdom tooth with a wicked infection -- and we are in a rural area with no open dentist offices. What are her options?

My sister has a wisdom tooth that has been bothering her for quite some time. In the past couple days it has become unbearable and the pain is intense -- she was once in nursing school so she understands pain scales and says it's a 9. She visited a clinic today that was open on Saturday. The doctor there told her that wisdom tooth (it has not yet broken through) was horribly infected and and she's running a fever. He gave her a prescription for an antibiotic and a 500 mg Vicodin which is not even touching her pain.

It's so bad at this point that she can barely talk and is sobbing, has been for hours now and did so through the birthday party of my niece that she hosted a few hours ago.

We are in a rural area with just one local dentist and they are not open on weekends. I've called every dentist within a 100 mile radius and none will take emergency patients unless they're regular patients. She does not have a regular dentist.

My question: What the hell does she do here? She is uninsured. She could go to the ER for something to manage the pain better than 500mg Vicoden every 8 hours but is that cost effective or should I just encourage her to stick it out? Do you know of any home remedies that might help with this? Thus far, heating pads and hot bags of rice haven't helped.
posted by youandiandaflame to Health & Fitness (22 answers total)
 
ERs and local urgent care practices will usually extract. Is she determined to save the tooth?
posted by availablelight at 6:01 PM on September 29, 2012 [2 favorites]


A dry tea bag between the gum of the affected tooth and the inside of her cheek--let her own spit soak it-- will take down the swelling.
posted by brujita at 6:05 PM on September 29, 2012


Is she determined to save the tooth?

No one wants to save a wisdom tooth.

I really have no idea if Urgent Care places do dental work, but I suspect at least some must. It couldn't hurt to call and ask, as it's sure to be more affordable than a hospital ER.
posted by drjimmy11 at 6:11 PM on September 29, 2012 [1 favorite]


ER for antibiotics? Painkillers yes, but you mentioned an infection. That makes this an emergency. They'll probably do intravenous antibiotics and send her home with some.
posted by vitabellosi at 6:11 PM on September 29, 2012 [10 favorites]


vitabellosi's right, this is not a dental emergency, it's a medical emergency. having a toothache is one thing, but having an infected jaw/potential septicemia is another. get her to a hospital.
posted by facetious at 6:15 PM on September 29, 2012 [37 favorites]


Good points above: I didn't consider how serious infections can be. She should go to the hospital.
posted by drjimmy11 at 6:19 PM on September 29, 2012 [1 favorite]


vitabellosi and facetious are right. The fever indicates infection, and an infected wisdom tooth is a medical emergency. She needs IV or injected antibiotics. Go to an ER.
posted by werkzeuger at 6:20 PM on September 29, 2012 [3 favorites]


Look, I'm a healthcare person, and I constantly tell people to stay at home and suck it up and shit -- but a grossly infected tooth with a fever can become really serious really fast (yeah, infected jaw, and that shit is just too close to home, and by home i mean your brain and blood vessels and useful stuff like that).
Obviously I don't know what the doctor saw on examination, but if she's feverish (how high are we talking about? >100.4? ) and has an abscess? (again, not sure what he saw), then it's a medical emergency.

***oh, and, i can speak from experience that they will often treat people coming into the ER with dental pain as drug seekers. so, stress that this is an infection. and if they take her temp and it's less than a hundred, stress that she's been taking vicodin (as directed), and vicodin has tylenol in it (which lowers her temperature, eg masking the fever).
I am so sorry she's uninsured, it's an awful situation.
posted by circle_b at 6:22 PM on September 29, 2012 [2 favorites]


She could go to the ER for something to manage the pain better than 500mg Vicoden every 8 hours but is that cost effective or should I just encourage her to stick it out?

I would never encourage someone to "stick it out" when their pain isn't being managed by Vicodin, "cost effective" or not.

Also yes she needs antibiotics right away.
posted by bleep at 6:22 PM on September 29, 2012


Seriously, the complications of dental abscesses are rare but can be a very big deal. Did the doctor at the clinic raise the possibility of going to the ER if she wasn't improving? Because it's not just about pain relief but about containing the infection.

Home remedy: She can try irrigating the area with a small amount of tepid/warm water with as much salt dissolved as it will take, to help draw down the edema in the gums and provide a bit of disinfection, but she should be gentle, and careful not to allow any of the irrigant to run up the back of her mouth/throat into her sinuses. (Not just because ow and yuck, but because of the risk of carrying infectious material up into the sinuses and beyond.)
posted by gingerest at 6:36 PM on September 29, 2012 [1 favorite]


For clarification: you said your sister was given a prescription for antibiotics today--has she been able to fill it and start taking them yet?
posted by hurdy gurdy girl at 7:00 PM on September 29, 2012 [2 favorites]


As important as the long-term complications of infection and abscess are, no one should endure the kind of dental pain you describe. Those who haven't experienced it don't know. A hospital emergency room is your option.
posted by LonnieK at 7:15 PM on September 29, 2012


When I was in a similar situation, I used a lot of clove oil. It really helped. But if you live in a rural area, I'm going to assume there's no way you can find a hippie store that sells the stuff. This page has some other home remedies.

But at this point, I'd go to an ER.
posted by jenfullmoon at 7:17 PM on September 29, 2012


The max dose of Vicodin is 1000mg/4 hours, so she can double up and halve the waiting between doses if there isn't any contraindications for her (liver problems, ulcers, etc.). 500 mg/ 8 hours is a really light dose.
posted by Sidhedevil at 8:27 PM on September 29, 2012


Another vote for the ER. No sense in waiting.
posted by dawkins_7 at 9:04 PM on September 29, 2012


Maybe it's a regional thing but where I am NO urgent care center is equipped or staffed to do an extraction. Did she fill the antibiotic prescription and start taking them? If not, she needs to start right away. Pain medication will not treat an infection. It may make her feel better but if the infection is untreated it will only get worse. Dental abscesses can be fatal, don't screw around with this.

The advice about Vicodin dosing is not really correct. Vicodin (Hydrocodone) is dosed x-y mg where x is the narcotic and y is Acetaminophen. The value of x is important. If the pills are 5-500 she can take 2 every 4 hours (this is the most likely dose). If they are 7.5-500 I won't comment because that's easy overdose territory unless she uses narcotics regularly. If they are 10-500 she only gets one every 4 hours. If that's not enough pain relief, she can take 400 or 600 mg of Ibuprofen (again assuming normal kidneys and liver) with or between doses. She should not take any extra Tylenol, that can get dangerous very easily.

If she started the antibiotics as prescribed and she's getting worse, get her to a hospital. Now.
posted by karlos at 9:55 PM on September 29, 2012


Absolutely she should go to a hospital. People do die from dental infections.

Meanwhile, something that often helps when I have a tooth infection is to swish a strong mouthwash around every couple of hours. They contain alcohol and other anti-bacterial things that can at least kill any bacteria that are exposed to the mouth. It won't do much for what's under the gum, though.
posted by lollusc at 10:08 PM on September 29, 2012


karlos, that is dangerous advice. The upper limit on acetaminophen for 24 hours is 4 grams, and if you take 2 Vicodin 5/500s every 4 hours you exceed this maximum dosage and risk Tylenol overdose. I know that some people write Vicodin prescriptions this way but it actually is not a safe dose - and the FDA is considering outlawing the Vicodin combo type pill because of too many cases of liver failure due to misdosing.

The the original poster, really her only option is the ER here, but don't go with the expectation that she will absolutely get anything different than what she's already gotten. IV antibiotics may be given in a case like this, or they may not. It depends on what the actual physical examination, vital signs, etc. are. At some ERs, there are doctors who are trained in dental nerve blocks and this could really help her with the pain control until the antibiotics kick in, but in a rural area your chance of finding a doc with this training is lower.

Really, the treatment for the pain (as noted above) is the antibiotics, and usually by the 2-3rd dose of the antibiotics, the swelling and pain start to improve. It sounds like she may have only had time to take one dose so far, so it might be that all she needs is time.

IANYD and if there is any question of worsening, especially with the systemic symptoms, facial swelling, difficulty with swallowing or breathing, then I would go to the ER right away, but just pointing out here that depending on the other details of this situation, she may already be on the proper treatment (after all, the physician who gave her ORAL antibiotics was aware of the fever and did not decide to give her IV), and it may be more of a pain management issue, which is also important but is not a life or death situation.
posted by treehorn+bunny at 10:10 PM on September 29, 2012 [1 favorite]


There are no 'home remedies' for this. teabag: ridiculous. Anbesol: inneffective. Narcotic pain meds: seldom give any relief.
I would hesitate to make any sort of definitive diagnosis based on internet info, but most likely she has pericoronitis.
Antibiotics will help, eventually, but they take time. Debridement in addition to the antibiotics is best. if you can get to a pharmacy get a monoject syringe. mix up some salt water and flush the area around the tooth as best you can. if there is a flap back there get under it and flush thoroughly. it may bleed but it will help.
cold is better than heat, so an ice pack on/off every ten minutes might help as well.
get to a dentist first thing monday if no one will see her over the weekend. plan on having the wisdom tooth out.
posted by OHenryPacey at 10:11 PM on September 29, 2012 [2 favorites]


The teabag worked for me when I had an abscessed tooth.
posted by brujita at 10:20 PM on September 29, 2012 [1 favorite]


Try putting some garlic or garlic oil on the area. It acts as a natural antibiotic and might start helping before the prescribed antibiotic kicks in.
posted by parrot_person at 12:53 AM on September 30, 2012


Aside from going to ER, etc. and just to address the pain part, The Red Cross Toothache Kit can really help. You can buy it at a drug store and it is essentially just clove oil. But I believe it is the same thing as what dentists use to pack wisdom tooth holes after pulling.

It numbs the area pretty darn well. I used it during my extractions and the infected abscess that followed.
posted by Vaike at 9:48 AM on September 30, 2012


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