Help me manage my dental pain
September 14, 2021 5:16 PM   Subscribe

Saturday night I lost a crown.

When I went to the dentist Monday not knowing that, but not feeling good, he said, "Oh, did you know you lost a crown?" This irritated me because they had put it back in July. Unless it was super old, I would think it would last longer than a month and a half.

I can't get into see anyone until this Thursday and I've had a LOT of pain (the kind that makes you draw breath and/or howl, 9 on a scale of 10, sometimes) and of course you can only take so much Tylenol. I can't do NSAIDs or aspirin either. (Is it better to take 2 Tylenol every 6 hours, or 1 every three hours, or does it even matter?)

I'd welcome any home remedies (no matter how strange) or anything else you know of. (My doc gave me two Tylenol 3, "one for tonight and one for tomorrow.") Well alrighty then.
posted by intrepid_simpleton to Health & Fitness (10 answers total) 2 users marked this as a favorite
Try clove oil, topically, or simply bite a whole clove as close as you can get to the affected tooth.

If you can get it, I've had good luck with Dentemp (I believe it actually contains clove oil). Since you've already seen a dentist it would probably be a good idea to check with them to make sure it's ok in this situation, though. I think of it as an emergency repair for *before* you can get to the dentist.
posted by pullayup at 5:40 PM on September 14 [2 favorites]

Orajel is amaaaaazing. There’s directions on the box but you pretty much rub some of the goop on your gums and it numbs the area. Brings toothache down to a dull roar. Available otc at any drugstore.
posted by mochapickle at 5:47 PM on September 14 [4 favorites]

Dentists often recommend combining Tylenol and Advil for dental pain: see instructions here.
posted by OneSmartMonkey at 6:02 PM on September 14 [3 favorites]

In some countries a combination of codeine and paracetamol/acetaminophen is available over the counter. If you can’t take NSAIDs I’ve found that’s the best way to deal with short term severe pain without a doctor’s prescription.
posted by sizeable beetle at 6:35 PM on September 14 [1 favorite]

A doctor once told me that the problem with Tylenol is that the therapeutic dose is not that different from the toxic dose, so I would absolutely not mess with dosing. Also, apologies if you know this, but don't drink alcohol when you're taking Tylenol. That's how people end up with liver damage.

Are you sure you can't find an emergency dentist in your area? This amount of pain for that long really sounds intolerable.
posted by FencingGal at 6:48 PM on September 14 [3 favorites]

I would never suggest anyone take prescription drugs that weren’t prescribed to them. But I will say that when I recently had severe pain due to a poorly constructed crown, I borrowed a Percocet from a friend who had some left over from a surgical procedure, and it helped me tolerate the time until my appointment.

And yeah, before I got the appointment I was using Anbesol topically.
posted by ejs at 8:55 PM on September 14

Gargle with salt water for a brief moment of relief.
posted by aniola at 10:19 PM on September 14

> combining Tylenol and Advil

However, just in case you didn't know, Advil is ibuprofen, which is an NSAID. So don't do this if you can't tolerate NSAIDs due to, for example, kidney issues.

Based on a few relative's recent pain experiences, here are the things that seem to help:

* acetaminophen & NSAIDs, which do work better if used together & alternating. However you can't use an NSAID which leaves you with just acetaminophen

* Opioids. These work better in combination with acetaminophen and/or NSAIDs - all three have a different mechanism of action, so they do add up. However, as other commenters have mentioned, for a tooth you probably don't have to go all the way up to oxycodone to get decent relief. In general, the least dose/potency you can get away with and still negotiate the pain - probably not complete pain relief but enough that you can somewhat get along day to day - the better off you'll be in the medium to long run.

Here is a list of opioids graded by potency. Of the medications you're likely to encounter in the U.S., codeine is least potent (1/10th strength of morphine) and might work just fine. Hydrocodone is next (2/3 strength of morphine) and oxycodone next (1.5-2X morphine strength).

Of course you know there is an opioid panic and related crackdown in the U.S. right now and that is one reason your dentist doesn't just prescribe you enough to last until your appointment right off. And if I were to call I wouldn't ask for any opioid by name. I would just say, since the percocet wore off I just haven't been able to function at all due to the pain (assuming that's true, of course. It probably will be.) Is there anything else you can do? Is there anything stronger than tylenol but not as strong as the percocet - I'd like to do the minimum possible to still function, but right now I can't even XYZ. And so on like that.

* Medical marijuana. This is surprisingly helpful though my relative with stage 4 bone cancer says it more makes it so you don't care about the pain as much, as oppose to just eliminating it.

* Topical anesthetic/analgesic. The ones i know about are cloves, lidocaine, and benzocaine. There might be some others. These can work pretty well, though likely only short term.

* Gabapentin. This seems to be growing in popularity, perhaps partly because of the opioid crackdown. Example.

* If the crown fell off there is a very good chance it is infected. A very, very good chance. And if that is the case, the infection is the ultimate cause of the pain. So there is a good chance a course of antibiotics will help the pain A LOT once they have had a chance to kick in (a few days).

* HOWEVER. The only real way to kill the pain is to treat the tooth. So you need to get into the endodontist or whoever is going to treat it, as soon as possible. NB: It will likely hurt quite a bit for several days after they treat it as well. However, even at that point it might be a big improvement over what you're feeling right now.

I would call the endodontist back, tell them you're in excruciating pain with the tooth that has gotten worse since you first talked to them, and is there any way they could get you in to fix it any earlier at all. You're willing to come in first thing in the morning, later in the evening, or whatever is necessary.

If they don't have an opening even with that, I'd start calling around to every other endodontist in town until you find one with an earlier opening.

When they do a root canal - which I assume they have since you have a crown - they completely remove the nerve within the tooth. So there is NO PAIN there. If there is pain, it is because the entire area around the tooth is inflamed and painful, most likely because of an infection that grew starting within the tooth or the area where the nerve was supposedly removed (but, probably not, or not sufficiently, or not sufficiently sanitized, if it has failed this soon), and which you could not feel at first because you don't have any nerves in that tooth at all.

So now the infection has grown and spread to the extent that it is affecting the bone and tissue surrounding the tooth with the root canal and the whole area now hurts, not just the tooth itself.

There are two ways to treat this situation:

#1. Remove the tooth entirely

#2. Go back in & drill out/clean out the nerve pathways & any rotten stuff stuff again, disinfect it (hopefully more thoroughly this time - they can do it with a chlorine wash, lasers, and maybe some other ways), maybe pack it with some infection-killing stuff and leave it for a few weeks (maybe a highly alkaline packing material or such), and maybe give you a course of antibiotic

Source: I just barely had this happen to me. Like a funny feeling had been building for a couple or three months (infection starting but no pain thanks to there being no nerve left in that tooth), then it became quite painful for just a couple of days before the endodontist appointment, then it was quite painful for maybe 3-4 days after the appointment (they drilled it out & did the procedure I outlined above), and now it is down to a level of just slightly annoying.

All the facts & procedures I outlined above are from my own case, not yours, so yours might be something different entirely. But my understanding is, that is a very common course of events for older root canals or newer ones where, for whatever reason, the interior part of the tooth wasn't quite sufficiently cleaned & disinfected.

Here is a dentist explaining the above.

When I called the endodontist, one question they ask me was whether I was in pain. I said no (because I wasn't, yet) and they got me into the office about a week later. However the premise of asking the question was that they could have gotten me in a lot earlier if I was in a lot of pain.

So again, I would definitely check on this with your endodontist and/or start calling around to others to get a sooner appointment, because getting it treated is ultimately the only solution to the pain.

Also, they don't schedule one appointment to diagnose and then another a week or two later to treat - at least my endodontist didn't. Very, very likely if they look at it and it needs treatment (which is 100% certain given the pain you are in) they will just treat it right then & there.

So moving up the appointment to a day or two from now means the treatment/relief will be that soon as well.
posted by flug at 11:19 PM on September 14 [2 favorites]

Swish with a solution of half water and half hydrogen peroxide. It cleans out any gunk and reduces the spread of bacteria, both of which can contribute to inflammation and pain.
posted by champers at 3:32 AM on September 15

Response by poster: Advil is an NSAID and I can't take those
posted by intrepid_simpleton at 6:00 AM on September 15

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