Open Mike: Yowzuh! (And a Word of Advice for Under-40s)

Wednesday and Thursday of this week were hard for me. I was completely unprepared for how bad the pain of an untreatable nasty toothache can be. The pain was really kicking my ass! The whole side of my head hurt, and around the afflicted tooth, an area about the size of a ripe plum, was a fierce steady burning pain. It really derailed me from my usual groove—it was tiring, distracting, tough to endure. Almost disorienting. So when I heard that the local oral surgeon doesn't have an opening until September 8th, that was not good news. It's the constant, unrelenting aspect of such pain that makes it so hard. I had a difficult time just getting through the one night between Wednesday and Thursday, and a whole month of the same thing was an appalling prospect.

I've got the pain under control now thanks to a wonderful wise doctor in the nearby town of Canandaigua. The trick is to take the proper dosage of ibuprophen like clockwork. She suggested that 600mg (a prescription-strength dose, exactly replicable, of course, by taking three over-the-counter tablets instead of two) was better than 400, but that 800 wasn't much better than 600. And then, take it every six hours on the dot so the prostaglandins can't get fired up and the pain can't get started again. She said if you wait until the pain takes hold again, it will take up to two hours for the ibuprophen to have its effect—which was exactly my experience. She even suggested I set my alarm for the middle of the night so I could take a dose on schedule. (I did that last night.) Thank you Doctor ma'am!

Twenty-four hundred milligrams of ibruprophen a day is far more than you'd ever want to take on anything but a temporary, emergency basis—it has its own risks, and they're serious—but it's still less than the 3200mg per day upper limit. And it works! Like magic, actually. My toothache pain is not just more bearable, it's more or less gone. Whew! I'm on a waiting list for next week to have the tooth extracted, and I should be able to cruise along fine till then. Or even till September 8th, if I have to.

The relief is somewhat exhilarating. Like that old joke about when you stop banging your head against the wall. Really illustrates the contrast between feeling afflicted and being your old self again.

A word of advice for anyone in any stage of life that could be described as "young"—take good care of your teeth. Dental problems are a significant issue for many people in later life. There's no upside—such problems are thorny and troublesome to deal with, physically painful, and they can be very expensive—never welcome for people on fixed incomes or whose incomes are declining. So a.) find a dentist you like, b.) see your dentist annually or twice a year*, c.) be scrupulous about daily care and watch the amount and timing** of your sugar intake, and d.)—perhaps most importantly—take care of any problems immediately, or at the earliest possible opportunity. When you reach your seventh decade, or even earlier, it could make a big difference in your quality of life. And quality of life, not just the literal length of it, looms large in our later years.

Finally, a sympathetic shout out to anyone within the reach of these words who's dealing with chronic pain. I have always known that chronic pain is a special torture that requires real fortitude to endure (I remember a school friend's mother, whose back never stopped hurting), but I have a renewed respect for it this morning, having taken only a brief dip into that particular hell. Sincere condolences to all those who have to put up with it.

Mike

*The dentist I trusted the most told me that two visits a year is ideal but that they seldom try to recommend that because of patient compliance—people won't do it. So the common "once a year" recommendation is a compromise in hopes of getting people to actually schedule a regular checkup.

**Eat or drink sugar only after meals and brush your teeth shortly afterwards.

Original contents copyright 2017 by Michael C. Johnston and/or the bylined author. All Rights Reserved. Links in this post may be to our affiliates; sales through affiliate links may benefit this site.

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Comments

[James Weekes]

I have felt your pain. Absolutely takes your life over. I am 71 and was lucky enough to have a really good proactive dentist when we moved here to Florida. She set my mouth up to last. I go to be checked every two months,due to some gum issues, but the twice a year is really good advice. Hope it resolves quickly and easily.

[Ranjit Grover]

Mike,
My sympathies with you. Here in the urban areas of India, we are much better off. We have access to some doctor in less than an hour, any time of the day. The doctor may not be super efficient, but we get some relief. Once the emergency is over we can find a better place to get better treatment. Of course in the rural areas of India it is an altogether different story, better not told.
I understand it is very expensive there in US to see a doctor. Though it is expensive here too, we have a choice of going to less expensive but less efficient services. That saves us a lot of trouble.

[Michael Perini]

" Be True to Your Teeth, or in time they will be False to You".........

Ps Re "We can't fix that , and there is nothing we can do about the pain" Is ridiculous, on it's face.
I'd be more than a little concerned by a dentist who didn't know enough or care enough to recommend the ibuprofen protocol. OR call ahead for you to get an emergency appointment at an Endodontist. They do that ALL the time.

A quick check of Endodontists near Rochester shows about 25.
One of them can see you before Sept 8

[Frank Petronio]

Sister is a dentist. The stories are gross and wonderful!

[Dave Kee]

Floss before bedtime every day. My dentist told me it "disturbs the bacteria". I like the idea of disturbing bacteria.

[Richard]

Mike - just FYI from a non-medical professional who nonetheless has had to read a significant amount of research regarding NSAIDs, you might want to pay special attention to your stomach while taking the 2400 mg/d of ibu. The ibuprofen, like other drugs in its class, is very hard on your stomach lining. It sounds like you know this, but I've heard that taking the meds with food to the extent possible or even using something like Prilosec (if approved by your doc) can help prevent any damage to the stomach. Hope you feel better!

[I'll take it with food except the dose in the middle of the night. I'll ask whether Prilosec helps. --Mike]

[Jeff]

But beware that they'll likely want you to stop taking NSAIDS at least 3 days before dental surgery.

[Stan B.]

Teeth are probably the biggest genetic F up in the human body- I mean, the rest of our organs deal considerably better with all the abuse we heap upon them each and every day. As for chronic pain, I dealt with shingles for 5 months last year- hats off to anyone and everyone who has to deal with chronic pain over a lifetime...

[Pat Coddington]

I went through the same thing last year - when I went in for a root canal, the oral surgeon said the pain goes away because the nerve eventually dies. The next stage is an abscess.

And yes, if your under 40, take good care of your teeth.

[Tom]

I found your dentists thoughts on patients' reactions to the prospect of two visits a year very interesting. Here in the UK, where we have the reputation of having bad teeth, two visits a year would be the minimum. My dentist recommends four visits a year, alternating with the hygienist. She's also a client of mine, so we are locked in an arms race where we try to break even with each other by the end of the year. The tip about taking the Ibuprofen for a time is good, most people don't realise there is a therapeutic dose and that takes a while to reach. Popping a couple to cure a headache, most of the relief probably comes from the glass of water. My dentist actually recommends Paramol for dental pain (probably have to Google this for US readers) and I can vouch that over a weekend away from help where I thought I couldn't possibly endure the pain it worked better than any painkiller I've ever taken.

[Mike R]

Mike, you may appreciate the poem 'Oh, I wish I'd looked after me teeth' by English poet Pam Ayres

http://pamayres.com/index.php/category/poems/

(second poem down).

Hope you are well soon.

[Alan Kett]

Mike:

I had exactly the same problem in July, 2016: cracked tooth below the gum line. In my case, it was a tooth that had had a root canal and crown done several years before. The pain was, as you describe, intense. It took several weeks, 3 courses of antibiotics to fight the infection, and 2 visits to an endodontist before I got the correct diagnosis.

I had the tooth pulled last September, and had a post inserted into the jawbone in March of this year. (Interesting process that included the use of a miniature mallet and a socket wrench.) I'm due to have the cap applied in September and will get a new crown in January, 2018. All-in-all, an 18 month process that will cost around $6000 U.S.

As I commented to the periodontist who did the extraction and post insertion, women have babies in a lot less time than it's taking to birth my new tooth!

And I'm with you on the oral health thing. 2 dental visits a year, daily flossing and brushing with a Water Pik and electric toothbrush. As I approach my 7th decade, I want good teeth to last. I hope this will be my one and only extraction.

Good luck with the extraction. Next to the pain of a cracked root, it's nothing. And I assume you're on antibiotics for the swelling and inflammation. Once they kick in, they actually help with the pain. The problem is, the crack is a continuing source of infection and, once the course is done, the site gets reinfected.

[hugh crawford]

Alas evolution only optimized us to live long enough to reproduce and ensure the survival of our children.
Chewing our own food for 60 years, or even living that long is irrelevant, and human teeth are outstanding examples of evolution not optimizing for long life.

Something to keep in mind when someone goes on about natural living is that from the perspective of an individual, nature is indifferent at best, and more likely is trying to kill you.

[mike plews]

A couple of observations. About four years ago I had to have my two back lower molars yanked as they were badly diseased and were causing significant bone loss.
Before the extractions I had been suffering serious gum disease for years. It felt like a losing battle. Deep cleanings are no fun, trust me. After the two bad actors were gone the gum disease went with them. I am back to my regular dentist twice a year and he says the turn around is amazing.
On the subject of NSAIDs, learn to be a diligent label reader. Because multi symptom over the counter drugs often have acetaminophen in them, mixing such drugs with Tylenol or it's generic equivalent can bump you up over four grams a day which can lead to fulminate liver poisoning.
And finally when those two teeth got their walking papers the surgeon offered me opioids for the pain. I opted for OTC Ibuprofen and was just fine.
Very sorry to hear about your tooth. It doesn't sound like much fun.

[Alan Berkson]

I'm so sorry that the availability of someone to help you avoid the wait for an extraction to relieve the infection and discomfort is so prolonged. I am a periodontist/photographer following this blog for many years and never thought that there might be something I could contribute an opinion about. Here's my take - insist that you be seen immediately as you are in such agony that your well-being is severely compromised. A compassionate surgeon [ oral or periodontal] will advise the staff that your situation overrides the waiting period and will find a way to get an appointment sooner. And if that does not work - take a ride to my office in Connecticut and I'll take care of you.

[David Boyce]

I definitely agree with your comment about taking care of your teeth when you are young. I didn't. Now I think I have paid my dentists kids school fees and bought him his latest Leica. And with what needs doing I think I'm buying him some lenses.

My wife looked after her teeth. Now she goes once a year and has the dentist go, "OK, nothing needs doing, see you next year to tell you the same thing".

[Ilkka]

A bit strange. Tooth extraction doesn't take long. It is not like root canal and crown. One would think that a dentist should be able to fit in an emergency procedure within a day or two. That has been my experience every time.
But I don't live in the USA.

[Rene Theberge]

Hi Mike,

I've been through the teeth problems resulting in 3 implants and, as they say, I feel your pain. The issue of chronic pain has been with me for several years now resulting from herniated disks. It took a year of Physical Therapy, yoga, acupuncture, meditation and a few other modalities to get the pain level down from suicidal to the point where I can pretty much live a normal life as long as I do my daily hour of exercises. About the time that got under control, the arthritis in my hands started up (advice: don't get old). Tumeric is your friend. It's an effective natural anti-inflammatory that even my rheumatologist recommends. For me, all this chronic pain changed my photographic life. Just when I was about to give up as I could no longer carry my heavy SLRs and medium format camera/lens, mirrorless cameras and M4/3 came on the scene which has given me another 5 years of photography (and no end in sight) that I would have lost altogether.

[René]

I hope you use stomach protection like Omeprazol, otherwise you run a serious risk of getting a peptic ulcer. One can get a perforated peptic ulcus within a week with these kind of prescriptions. If you don't use it you should get it as soon as possible.

[According to my research the benefits of taking PPIs with NSAIDs is very questionable. I hope to only be taking this dose of ibuprophen for a short time—I'm going to try to have the tooth pulled next week one way or another. --Mike]

[YS]

A couple of years ago I lost a pre-molar because I didn't take care of my teeth well enough. It was a very good lesson; I now regularly visit the dentist for checkups and brush my teeth with far greater care.

I hope you get that tooth out soon with minimal fuss!

[Owin Thomas]

Be careful with that High a dose of ibuprofen it'll cause serious damage to you stomach, according to my GI specialist.

[Frank Petronio]

I know that the axiom of going to busy restaurants because they must be good also applies to healthcare providers but a well run office allows for a number of last minute acute patients every day. And sometimes doctors and dentists need to work late, I know my wife does. So perhaps it's time to shop for a new dentist that can see you today or tomorrow? Drive to Rochester for goodness sake.

[Angela Weil]

Mike, this is story that is hard to believe. Not that one could have a severe dental problem at any age but that prompt care in a modern industrialized nation would not be available. Wait until September 8th with pain? Take medication with known serious side effects until then? This kind of issue can be taken care of same day and is no big deal - takes a few minutes. How can you not find a different dental care provider in the region? The one with the September date should reconsider his/her behavior and his/her responsibility to the patients.
Best wishes, Angela