Root Canal

Lynne Heckert, DDS, JD

Most if not all studies that suggest that the non-steroidal anti inflammatory drugs (i.e., Advil, Motrin, Ibuprofen and that family of drugs)  are best for dental pain.  If you buy Advil or the store brand Ibuprofen over the counter, it will come in 200 mg tablets and the directions on the box will tell you to take two every 4-6 hours.  In fact,  this is a low over-the-counter dose and it is more effective to take three tabs at once (600 mg).  Trake it before the pain starts, every six hours to get the right level of drug in your bloodstream. This is the dose you would get if you were given a doctor's prescription for the same drug.  Acetaminophen does not seem to be very effective for dental pain but some people cannot take aspirin or NSAIDs.
       Sometimes narcotics are used for dental pain.  Studies have shown that ibuprofen is as effective as an aspirin and codeine combination or an acetaminophen and codeine combination. Narcotics can cause mental fogginess so you cannot use them and drive or operate machinery. Too many will make you vomit and constipation is a very annoying effect.
     Codeine is a prescription drug and a controlled substance. Another controlled substance, oxycodone, may be prescribed for severe pain.  You will need to have a prescription in hand at the pharmacy for this. The dentist cannot call it in to the pharmacy.  My own feeling is that I would rather get through a pain situation with non-narcotics if possible.  Taking too many at once can cause severe vomiting and they can leave you quite constipated for days.

       One thing should never, ever, be done:  You should not chew an aspirin (it can dissolve enamel)  or place it on the soft tissue in the mouth next to a painful tooth (Aspirin burns can be very nasty and aspirin does not work that way).  It's a good drug (an alternative to Ibuprofen that some prefer)  but it is meant to be swallowed with a full class of water.

           Extraction or Root Canal:  Of course, one of the best ways to relieve the pain from an abscessed tooth is to remove the infection that is causing the inflammation and pain.  If the tooth is not slated for extraction, root canal (alone or with an antibiotic) may be an option.       When an infected tooth is extracted, relief is usually instant, since the focus of infection (the thing the bacteria were living in, i.e., the tooth) is gone, and drainage is immediately established. The first visit of a root canal, when the infected, or sick, nerve is removed, likewise relieves pain.

          Antibiotics: It is not unusual to see the pain of an abscessed tooth start to diminish precipitously after an effective antibiotic is given. (Most dental abscesses respond to amoxicillin, (For those not allergic) to the penicillin family--the alternative first choice is erythromycin) and for the few infections (around 10%) that do not respond to amoxicillin, clindamycin is the drug of choice.  (In some cases, dentists will use clindamycin as a first choice but its side effect profile is more worrisome than amoxicillin.  Erythromycin and clindaymcin can cause stomach upset and intestinal disturbance.)

             Low dose, short term, steroids:  Suppose a toothache is caused by a deep cavity, but there is definitely no infection?  Low does steroids (dexamethasone seems to be the dentists' choice) will work to temporarily relieve the pain.  This is something that may be useful to 'get one through the night,' but only a dentist familiar with the patient's condition should prescribe.   Why?  Steroids can make the situation worse if the problem is infection. Also, some people should not have steroids.

Here are a couple of serious warnings. Do not ignore dental pain and avoid the dentist!  If you have a serious dental phobia, admit it, and consider an anti-anxiety drug for appointments.  (Valium and it's progeny are God-sends for some people and there is no shame involved in using these drugs for dentistry. See Dentist-Fear.com)
If the problem is a gum (periodontal abscess, or abscess around wisdom tooth), antibiotics will probably help, but pain relief is faster if a dentist can clean out the area between the tooth and gum also.

A dry socket is an unfortunate occurrence that comes 4-5 days after an extraction. It occurs because the clot in the extraction site is dissolved. No one is sure why this happens and there is no way to predict it. It does happen more in lower molar areas and in smokers diabetic patients.  The usual scenario is this:  A tooth is extracted and everything seems fine.  Then, usually on day four or five,  a gnawing  pain starts in the jaw.  Usually, time heals this but the pain ranges from mild to horrible.  A dentist may be able to pack the socket and relieve the pain somewhat and after a day or two the pain does go away. 

Please remember that the information on these site is not all-inclusive and it may or may not apply to your personal situation. For dental advice you need to call your own dentist who needs to actually talk to you and examine you before giving advice or treatment. If, in your mind, you are questioning your dentist, get a second opinion, or a third ...
I do not take new patients and cannot respond to email inquiries or phone calls.  Thanks for visiting!

Disclaimer: Ads on Dental Smarts Sites (in the margins) are generated automatically and not chosen, reviewed or endorsed by me.

Please remember that information on these site is not all-inclusive and it may or may not apply to your situation and you need to call your own dentist.  A dentist needs to see the tooth, take and x-ray, etc. to diagnose and treat.   I cannot respond to email inquiries or phone calls.  Thanks for visiting!