Dental Pain and Tooth Extractions
Dr Brett Robinson BDS LDS FDS PhD MBA Dip Ed GKT
Every year nearly half the population will experience some form of dental pain or discomfort and 25% will eventually be driven to seek dental treatment as a result.
Dental pain and toothache
There are various levels of toothache ranging from occasional discomfort caused by early tooth decay, or periodontal (gum) disease, to the more severe, constant pain caused by advanced tooth decay and dental abscesses. In this latter case you may not be able to bite your teeth together properly and eating may be difficult or even impossible.
Dental pain may occur following dental treatment. For example it is not uncommon after a large, deep filling has been placed, a dental extraction or root treatment. The degree of the pain is related to the amount of damaged dental tissues e.g. the surgical removal of an impacted wisdom tooth can lead to several days of discomfort. Your dentist will advise you on the best medication to take and a special routine to follow that will minimise this discomfort and speed up the healing process. It is most unusual for post-operative pain to last for more than 5-7 days and in the vast majority of cases medication will not be required for more than 3 days or so.
There are other causes of dental pain that resemble toothache in people who otherwise may have good oral hygiene and excellent teeth. For example sinusitis can cause pain to the upper teeth that can feel just like toothache. Other, deep-seated aches in the jaws may also indicate the pr cc of diseases such as an abscess or a cyst. In these cases diagnosis may not be easy but it is very important to see a dentist who may have to refer you to a consultant for further tests. It is possible to avoid most causes of dental pain by regularly visiting your dentist for routine examinations.
Tooth extractions
At some stage of their lives, most people will need to have one or more of their teeth removed. This can be for a number of different reasons and can be done under local or general anaesthetic.
Local anaesthetic is when an injection is given in the gum, close to the tooth to be removed, to completely numb the area. The patient is awake during the procedure and although they may feel a little pressure during the extraction, they will feel no pain.
General anaesthetic is when the patient is ~put to sleep’ temporarily whilst the tooth extraction is carried out and so will be unconscious during the procedure. This method is usually only used if the extraction is likely to be particularly complicated, if the patient is very nervous or has special needs. Most general anaesthetics are performed in hospital.
Why would I need to have a tooth removed?
There are four main reasons for removing teeth:
- Impacted — this means that the tooth has been prevented from growing into the correct position, by bone or other teeth. This is the most common reason for wisdom teeth extractions.
- Orthodontic treatment — sometimes teeth will have to be removed to make room in an overcrowded mouth to allow the remaining teeth to come through straight.
- Severe decay or damage — sometimes teeth may have to be removed because they are so badly damaged or decayed that extraction is the only option.
- Gum disease — gum disease can progress so far that the teeth become loose and have to be extracted.
After the extraction
Once your tooth has been removed it is important to allow time for a blood clot to form in the hole (tooth socket) where the tooth was, to begin the healing process. It is therefore important that you do not disturb the extraction site, or rinse your mouth for at least 24 hours.
Your dentist may encourage you to bite on a gauze pad to encourage the clotting process and healing to begin. You will also be advised to avoid vigorous exercise, smoking and eating food on this side of your mouth for 3 to 4 days.
You can gently clean your teeth with a soft toothbrush during the first few days after the extraction, but avoid the extraction site itself. Your diet should be restricted to soft foods for two weeks after any dental extraction. Your dentist will also encourage you to use hot salty water mouthwashes the day after your tooth was extracted (one teaspoon of salt to a small tumbler of hot water).
It is quite normal to experience some swelling to your face after a tooth extraction and an ice pack may help to reduce this. You may feel a little pain or some discomfort after the extraction but your dentist may prescribe some medication or pain killers for this.
What medication should I take?
There are many factors that influence the choice of medication for dental pain control. Young children and older people will require extra care together with those who may already be taking medication for other medical or dental conditions. Any allergies and existing medical conditions as well as short term personal or business activities may also have to be considered. You might not have pain after some simple extractions or minor procedure and therefore will not need medicine to control pain. A reduced dosed might be indicated: seek advice from your dentist for these situations.
Dental pain control
In the vast majority of emergencies dental pain can be controlled in the short term by simple medicines — such as paracetamol, aspirin or ibuprofen. All can be purchased without the need for a prescription and are known as Over The Counter (OTC) medicines. Only a minority of dental cases will need access to more powerful Prescription Only Medicines (POM) that have to be supplied by your dentist or doctor.
It is sometimes advisable to take a medicine to control dental pain before you start your treatment. Always discuss this possibility with your dentist first. Suitable medication would comprise a single dose of 600mg ibuprofen, or 1 gram paracetamol for patients who cannot take non-steroidal anti-inflammatories (NSAIDs).
Paracetamol is effective in offering pain relief as well as reducing raised body temperature in a wide variety of situations that include headaches, muscular pain, neuralgia, influenza and dental pain. It has remarkably few side effects and is well tolerated in those situations in which aspirin or ibuprofen have to be avoided, including young children.
Aspirin and ibuprofen are both (NSAIDs). They have powerful analgesic properties. Both can modify the blood clotting mechanism, which must be recognised as an unwelcome side effect in many cases.
With all painkillers it is essential to take them at regular intervals as instructed by your dentist. When taking paracetamol, you should take the medication regularly, three times a day for the first day, then four times a day and no other painkilling tablets should be taken. When taking ibuprofen, if you are still in pain despite taking the tablets, you could additionally take paracetamol (not alternatively). Always take the advice of your pharmacist or dentist if you are unsure. If your pain severe or increasing on the third or fourth day, you should return to the surgery.
Aspirin should not be given to children under the age of twelve, women during pregnancy, asthmatics, people with peptic ulcers, people with a tendency to allergic reactions or following surgery. The practice of placing an aspirin tablet beside a painful tooth can cause burns and bleeding of the mucous membrane and is to be discouraged.
Ibuprofen, like aspirin, has mainly pain relieving properties when taken at the recommended dose of up to 1200mg per day. It is effective in lowering a fever and relieving pain. It should not be used when people have gastrointestinal problems, or after surgery. Some patients who have asthma must not take ibuprofen. However, if you have asthma but have taken ibuprofen before, for example to control the occasional headache, you can take ibuprofen to control dental pain.
If you are in any doubt as to which medication is best for you, speak to your dentist or doctor.
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