How bad does it need to get?
September 3, 2016 7:26 PM   Subscribe

My dentist is in no hurry to deal with agonising pain - what to do?

I went to my dentist for a emergency appointment the Friday before last after after biting down on something hard resulted in a few days of toothache. She did some x-Ray's, poked about, said she couldn't see anything so to come back in a fortnight for fuller investigation.

Over the last weekend the pain escalated to the point where I couldn't sleep and over-the-counter painkillers weren't cutting it. After one particularly agonising night I went to the acute care unit at the local dental hospital. They did many more tests, still couldn't locate anything specific so told me to head back to my dentist in a week's time once the pain had 'time to localise' for an exploratory removal of an old filling, with much fretting (from them) about removing the wrong tooth by accident. All discussed in an entirely academic manner whilst I writhed on the chair in agony. No discussion of how to manage pain whatsoever.

The next day things got worse so I went back to my dentist, now with a swollen face and a temperature and pain so intense I could barely talk. She prescribed antibiotics and sent me away again with recommendation to keep at the standard painkillers with a follow up appointment for a week's time (next Friday).

It's now three days later, the swelling is worse still, the pain is unabated, swallowing is difficult and I don't know if I can wait another five days. I don't know how to explain to my boss that I need to be off work because my face is twice it's normal size and hurts like hell but there's no plan or timeframe for it being fixed, or how to get someone - anyone! - to take the damn tooth out.

Am I missing something? Is it normal to have to wait? At what point should the dentist be acting on what is clearly a growing abscess? I am too pain maddened to think this through clearly, so am turning to the hive. What should be my next step in this situation?
posted by freya_lamb to Health & Fitness (19 answers total) 4 users marked this as a favorite
Emergency room? Tell them about the other 3 appointments...

Is it possible this is not a tooth thing?
posted by jbenben at 7:30 PM on September 3, 2016 [5 favorites]

Please go to the emergency room as soon as you can. Now.
posted by anastasiav at 7:37 PM on September 3, 2016 [14 favorites]

Emergency care at a hospital, stat.

Also, when you say the acute care unit did more tests, did that include an X-Ray of your face?
posted by Hermione Granger at 7:40 PM on September 3, 2016 [1 favorite]

Yes go to an emergency room now. Something is very wrong and it might not necessarily be a tooth problem.
posted by a strong female character at 7:45 PM on September 3, 2016

I've had three lymph node infections inside the lower right side of my jaw over the last two years. Each time I initially thought it was a toothache, so I guess I'm also wondering if it's not a tooth. I would definitely get in as soon as you can and insist on more helpful pain control.
posted by worldswalker at 7:46 PM on September 3, 2016

Hermione: yes, they x-rayed my jaw. At the time they couldn't see any infection - the swelling came in the day after. My temperature went down pretty much as soon as the AB's kicked in but nothing else has changed. It's 4am here now (London) but I can head to ER in the morning. What do I tell them?
posted by freya_lamb at 7:59 PM on September 3, 2016

Swallowing being difficult due to swelling is an ASAP ER thing, not a wait till morning.
posted by AlexiaSky at 8:15 PM on September 3, 2016 [19 favorites]

Tell them it hurts like hell, that you've started antibioltics, it hurts like hell, you don't know what's wrong and it hurts like hell and you are having difficulty swallowing.
posted by AlexiaSky at 8:19 PM on September 3, 2016 [21 favorites]

This is right this second important because if the swelling continues to increase it can inhibit your ability to breathe.
posted by AlexiaSky at 8:21 PM on September 3, 2016

Did they just X-Ray your jaw, or did they do your sinus cavities/throat too? If not, be sure to tell that to the ER so they know. Is your nearby ER not 24 hours?
posted by Hermione Granger at 8:54 PM on September 3, 2016 [1 favorite]

Yes, ER would be the next step. Also, modern medical care is getting stingy about prescribing controlled substances these days, so your story doesn't (unfortunately) surprise me. The default response from most providers these days is to see if a patient can get by without it. You need to find a way to have a discussion with a person in the ER in such a way that you can disarm this initial prejudice. What I found worked for me was to say, "I would much rather not use anything that isn't over the counter, but I have to ask, and strongly, because the pain is so bad." I think what doctors/dentists/nurses are concerned about is people faking pain and shopping around for meds (which is a concern), so to offset the initial skepticism regarding possible intentions can be helpful.

This is a horrible trend in modern medicine, and I felt it personally when I had surgery this last year. There was an obvious and overly regulated effort to provide the absolute bare minimum, rather than thinking about genuine pain management as a basic patient right. (And their medical literature before surgery talked about them having a "zero pain" philosophy of pain management to make you feel good about having surgery there, which ended up not being the case.) I don't know exactly how far up the ladder the pressure is coming from, but I've been noticing it a lot more these days, and unfortunately, one of the main jobs of any patient now if finding a way to advocate for themselves the need for controlled pain medication. I'm not sure if this is what is happening in your situation, but I would go in thinking that this may be the default response of most people you run into, and to not feel ashamed to ask for more serious consideration.
posted by SpacemanStix at 8:56 PM on September 3, 2016 [2 favorites]

You have a serious infection somewhere. You don't want pain meds, you want to find and treat the source of the infection. Start there.

Tell them dentists could find nothing, but that the symptoms are getting worse and interfering with your breathing! This is serious! Go to the ER!!
posted by jbenben at 9:08 PM on September 3, 2016 [4 favorites]

When you say over-the-counter painkillers - do you mean cocodamol? If not, get some 12.5mg preferably and some ibuprofen+codeine (you'll probably have to go to 2 different pharmacies) and take them both.
Are you having difficulty breathing or does swallowing just hurt like hell? Which anti-biotics did they give you? Some are stronger than others and will work quicker, if they've given you a 10-14 day course, it will take longer for them to really kick in.

If you're genuinely having trouble breathing, and the swelling is continuing to get worse, you should go to A&E (actually since its 9am now, I hope you're already there!)
posted by missmagenta at 1:11 AM on September 4, 2016

Go to the ER nownownow. Also, please report back so we know you're ok. (We have had people post before with what sounded like emergencies that never updated or posted again and you always are afraid for the worst.)
posted by Jubey at 2:46 AM on September 4, 2016

Nthing that you need to go to the ER right now. And if you are in that much pain, do not play it tough. Be a drama queen. Scream and writhe. You need to get this dealt with immediately.

All of this is not to say that you are definitely going to die soon! Try not to panic. This may well turn out to be some minor thing with nasty symptoms. But these are nasty symptoms indeed and you need doctors taking it seriously, right now.

It sounds awful and scary. Really hoping you're feeling better soon!
posted by Ursula Hitler at 2:48 AM on September 4, 2016

Hi all, thanks so much for the advice. I've been at A&E most of day but now been seen and sorted with intravenous AB dose, prescription painkillers and guidance on next steps. Feeling better but am slightly terrified that I nearly knackered my liver by trying to treat this over-the-counter - the (fantastic, kind, NHS) doctor said they see overdoses of co-codamol/ibuprofen/paracetamol all the time due to tooth pain (is that not a clue that dentists need to be able to prescribe better meds?!). Will still need tooth out but happy there is now a plan in place.

Anyway, thanks all for lending perspective when I was not capable!
posted by freya_lamb at 7:38 AM on September 4, 2016 [21 favorites]

I hope, once you feel better, you can get a new dentist.
posted by superior julie at 9:39 AM on September 4, 2016 [4 favorites]

I'm so glad you are doing better! And on the good stuff. Best wishes for a speedy recovery.

doctor said they see overdoses of co-codamol/ibuprofen/paracetamol all the time due to tooth pain (is that not a clue that dentists need to be able to prescribe better meds?!).

Not helped by how insanely cheap and easy to obtain they are. Nearly overdosed on paracetamol myself as teen, didn't realise how dangerous something so easy to get could be. And it's been a decade since i lived in the UK but pack was like 20 pence or something then - cheaper than chocolate!
posted by kitten magic at 2:08 PM on September 4, 2016

For those who are becoming angry about the trend towards fewer narcotics being prescribed (and "zero pain policies" being rolled back), I just wanted to make it more clear why this is happening.

It's because opiates are not only addictive, they kill people. In 2014, about 7000 deaths occurred in the USA due to prescription opiates. It's estimated that only ~300 people in the US per year die of acetaminophen/paracetamol overdose. I just want to be clear that opiates are not safer than Tylenol.

Not only that, but in the particular case of dental pain, there have been multiple studies showing that opiates do not perform as well as over the counter medications in managing the pain.

So I'd conclude there was nothing wrong with the management of pain in this instance, but increasing pain with facial swelling and difficulty swallowing that are worsening despite oral antibiotic use suggest that the dental infection has not been adequately treated, which can be a life threatening problem.
posted by treehorn+bunny at 10:09 PM on September 5, 2016 [2 favorites]

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