Toothache!
What can I do for the pain?
Here are a few options you could try before, ideally getting to your dentist!
Toothache has many forms but the most common severe conditions include “PULPITIS”. This is where the nerve inside the tooth is irritated by either a cavity, an old filling or decay, eventually becoming sensitive to hot or cold drinks. The second is PERIODONTITIS, where the tooth has also become tender to touch and pain is more spontaneous, coming on without warning.
This can often lead on to an infection under the tooth (an abscess) with associated swelling. If it reaches this stage, then some people would like to take the tooth out themselves if they could!
The occasional niggle is not unusual, especially if you have an ageing dentition or one that is heavily restored. However, if pain persists, I suggest you contact your dental professional for more specific advice. In the meantime, you can try several things to alleviate your symptoms…
1. Avoiding any stimulus that brings the pain on (heat, cold, sweet, pressure etc.). This may seem obvious but is a good start!
2. Applying an external compress. Use an ice pack or fill a food storage bag with ice, cover it with a thin cloth and apply it directly to the tooth or the cheek area. Be sure to cover it with a towel so your skin is protected. Depending on what sets your pain off, you could also try the same with a heat pack or hot water bottle – not too hot though!
3. Taking OTC (“over the counter”) medication. If the previous measures do not work then I suggest the use of analgesics (painkillers) are probably the most effective way to relieve the pain.
There are so many medications available it would be counterproductive to explain the pros and cons of each kind here. So I advise my patients to consider the following simple regime whilst you are waiting for definitive treatment to be carried out…
Take the recommended doses for their age (written on the container) of any painkiller that you can purchase over the counter at your chemist/pharmacy/drugstore. If it has worked to relieve a headache previously, it will probably also work for dental pain. The most common and readily available medications are:
Ibuprofen. (Brand names include Nurofen, Actiprofen, Advil, Anadin & Brufen).
Paracetamol (Acetaminophen or APAP in the USA). (Brand names include Panadol, Calpol & Tylenol).
Personally, I find ibuprofen works for my headaches rather than paracetamol. If you are unsure about which one to choose then go for one of the newer blends of medication:
The synergistic or combined effect of taking both of these medications at the same time has also been shown to be of great benefit for the relief of moderate to severe pain and these preparations are also readily available. (Brand names include Maxigesic and Nuromol).
Warning: Do not place an aspirin tablet next to the tooth. This is likely to give you a nasty burn in your mouth. Only swallow the tablet as directed on the container.
Also, be aware that whilst drug companies provide a fantastic product that benefits millions of people daily, they are in it to make money! Drug companies (via personalised advertising campaigns) have successfully convinced consumers to pay up to five times more than they have to for the generic ingredient of ibuprofen or paracetamol. This information is based on a report from Choice Magazine, reporting on prices at supermarkets, chemists and online in April 2014. Nothing much has changed…
So, if you are faced with two Brand Names, one saying it is good for targeting ‘back pain’ and the other to target ‘tension headache’ or ‘toothache’ then just look at the ingredients! If they contain the same active medicament then they will have the same effect. Confirm the contents with the chemist and maybe choose the cheaper, non-branded one! You do not have to have ‘Nurofen’ or ‘Panadol’ just because they spend millions on advertising!
There are also many other combination painkiller preparations containing codeine and caffeine (e.g. Panadol Extra, Nurofen Plus, Panafen Plus, Prodeine, Panadeine Aspalgin, Disprin Forte and more). As you can see it can be tricky to pick the most appropriate medication to suit your particular situation so please ask your chemist or pharmacist for advice. This is especially important if you have allergies, existing medical conditions or are taking other medications. Please note, supermarket assistants are not qualified to advise you of these interactions!
A typical scenario…
Patients often ring for an appointment when they have had toothache for a while and it is becoming more intense or not subsiding. This pain is initially set off by hot or cold drinks but the OTCs are becoming less effective.
By the time they get an appointment, the patient often reports the acute symptoms have subsided and whilst the intense pain may have gone, the tooth just feels a little tender.
What has happened in this case is that the nerve inside the tooth has been irritated or damaged to the point where it has become highly inflamed. This leads to pain which is often not relieved by any medication and is the time you are likely to contact a dentist!
Over the next few hours or days, the nerve unfortunately dies, which lessons the acute pain. However the tooth often remains tender and in some cases, you can get swelling of the gum beside the tooth or a little ‘gum boil’ appearing.
The treatment now depends on whether you wish to keep the tooth. If so, then the removal of the nerve by the dreaded “root canal” treatment is necessary. However, if you don’t want or need the tooth then just have it extracted.
This unfortunate scenario can often be avoided by seeking early treatment. i.e. when you first get the niggle that lasts a few weeks. You know, the situation when you are thinking of your tooth when you are eating rather than your food!
I particularly advise my patients who have old restorations to pay attention to their symptoms! A niggle, usually to sweet, hot or cold stimuli which lasts more than a week, is often a sign there is something not quite right! Also if it hurts enough to need “painkillers”, then I advise them to return to have it checked out. More often than not, the symptoms can be treated more easily in the early stages of pain. This may involve just a simple repairing of a fractured tooth, restoring a lost filling or removing decay and placing a filling!
Most serious dental problems (root fillings and extractions) arise if these initial symptoms are ignored.
Seasonal pain…
It’s not an official condition but this is a term I have coined for people experiencing sensitivity to cold stimuli at certain times of the year. Notably Winter!
Here in Australia, the temperature only needs to drop 5-10 degrees and we think we are having an Ice Age! It is remarkable to think that winter catches so many people by surprise each year!
Well, the significance to the teeth is that they appear to be more sensitive. Patients often report that they need to warm the water when brushing their teeth and they are even sensitive when breathing the colder air. The symptoms can sometimes be quite severe but thankfully, not long lasting. As soon as the mouth warms up, the pain subsides. It often occurs in patients who have exposed root surfaces either from disease or from brushing too hard. It is called “dentine hyp
ersensitivity” if you want a posh term!
So why should I include this in a blog about “toothache”?
Whilst I would not say most people complain of “toothache” per se, it can often be quite debilitating. Patients still want it checked out and my usual advice is:
- Avoid what stimulus causes the pain as far as possible!
- Avoid acidic drinks (thins the enamel) such as Apple Cider Vinegar and Lemon Juice which tend to be en-trend at the moment!
- Use a soft brush and gentle action (prevents recession of gums).
- Switch to a proprietary “anti- sensitive” toothpaste such as “Sensodyne F” or “Colgate Sensitive” throughout the colder months. Relief should come after a few weeks of use. The active ingredients to look for the packet are STANNOUS FLUORIDE and POTASSIUM NITRATE.
- Rub a particular cream on the exposed root surfaces and sides of the affected teeth for a minute at a time, daily. Patients often feel much better for doing so. An example of such a preparation would be “Sensitive Pro-Relief” (Colgate).
If sensitivity persists or is brought on with heat or sweet stimuli and anti-sensitive toothpaste is not cutting the mustard, then your dental professional may need to check that all is correct. They will be able to exclude other causes and ‘paint’ on some varnishes that may help.
Just a word on the “home remedies”…
I know of no scientific evidence for the relief of pain from remedies such as garlic, onions, salt and pepper. They do however make you feel better if you take them after heating with your favourite meat and vegetables in a wok!
Just because someone has reported that these remedies worked ‘x’ amount of hundred years ago does not make it true! If you do want to try it though, I cannot see how it can do any harm! Let me know what works for you!
If you are reading this blog and still in tears, contact your dentist!!!
Cheers,