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Most people will suffer the undesirable effects of dental pain or toothache during their lifetime. Every year almost half of the population will experience some form of dental pain or discomfort and one-quarter of the population will eventually be driven to seek emergency dental care. Severe dental pain can be totally incapacitating. Low grade, chronic dental pain is debilitating and in both cases the primary priority must be to make an urgent dental appointment for diagnosis and treatment by a dentist. The early warning signs should never be ignored.
It is easy to understand the reason for such unpleasant symptoms. The nature of the teeth and their association with the jaws are part of a complex sensory mechanism with short nerve pathways to the brain. Pain tells the brain that all is not well.
The teeth and the tooth attachments may lead to painful symptoms as a result of decay, infection, gum (periodontal) disease or eruption problems. The pain may vary from an intermittent or fleeting sensitivity; sensitivity to hot and cold that may indicate the early onset of decay; to the more severe acute throbbing pain caused by advanced decay and a dental abscess. The pain caused by a dental abscess may even make it impossible for the sufferer to even bring their teeth together due to the pain this pressure causes.
Pain can sometimes occur following dental treatment. It is quite common to experience some discomfort after a very large and deep filling has been placed or after a dental extraction has been carried out. The degree of pain is related to the damaged dental tissues (eg the surgical removal of an impacted wisdom tooth can be associated with several days of pain or discomfort). Patients can therefore expect to be given suitable medication and advised to follow procedures aimed at promoting rapid healing whilst reducing the discomfort to a minimum. It is most unusual for post-operative pain to last for more than 10 days. In the vast majority of cases medication will not be required for more than three days.
There are other causes of dental pain that simulate toothache in people who otherwise may have good oral hygiene and excellent teeth (eg sinusitis can often mimic tooth pain in the upper molars). Trigeminal (facial) neuralgia can bring stabbing pains that can cause serious incapacity. Deep-seated aches in the jaws may also indicate the presence of disease. Diagnosis may not be easy or certain. It is imperative to see a dentist who may have to refer to a consultant for further tests if an obvious cause cannot be found.
There are many factors that influence the choice of a successful regime for dental pain control. The young and the old require extra care, together with those who may already be taking medication for other medical or dental conditions, and pregnant or nursing mothers. It is also true that everyone has a differing pain threshold and will have different needs when considering pain medication. Allergies, asthma, other contra-indications must also be considered when prescribing or recommending pain medication.
In the vast majority of emergencies dental pain can be effectively reduced in the short term by one of three simple medicines – paracetamol, aspirin and ibuprofen. All can be bought without the need for a prescription and are known as Over-the-Counter (OTC) medicines. Only very specific dental cases will require access to more powerful Prescription-Only Medicines (POM) that can only be supplied by a general medical or dental practitioner.
Paracetamol is effective in pain relief in a wide variety of situations that include headaches, muscular pain, neuralgia, influenza and dental pain. It also helps reduce the signs of fever. It has remarkably few side effects and is well tolerated in those situations in which aspirin has to be avoided, including in young children.
A useful, safe, analgesic with blood-thinning properties. The blood-thinning properties of aspirin can often be beneficial but in some cases this affect can be harmful, especially in those with digestive problems. Aspirin should be avoided in those with peptic ulcers, pregnant women and also in some post-operative situations as it could hamper the healing process. It should not be given to children under the age of 12, to asthma sufferers or those with a tendency to allergic reactions. The old fashioned practice of placing an aspirin tablet beside a painful tooth can cause burns and bleeding of the gum and is ineffective for pain relief.
Ibuprofen is an anti-inflammatory drug and is effective in lowering a fever and relieving pain. It is perhaps the most useful pain medication for dental pain as this type of pain is often inflammatory in nature. It should not be used in patients that have gastrointestinal problems, asthma or after surgery. The use of paracetamol, aspirin, or ibuprofen may well be sufficient to bring pain relief, but other drugs may be even more effective. Codeine can sometimes be an effective adjunct to other drugs. Caffeine is commonly added and may improve absorption and reduce drowsiness. Research suggests that there may be a benefit to be gained by alternating between aspirin/codeine or paracetamol/codeine combinations and ibuprofen every three hours. Some branded analgesics incorporate antihistamines such as diphenhydramine or doxylamine to improve the delivery of drugs to the site of pain.
Manufacturer's instructions should be read carefully and it should be remembered that medication is only a short-term remedy and will not solve a problem for the long-term