Severe toothache and dental pain are amongst the worst of pain that you will probably suffer in your lifetime. Let us look at the things that we can do to help with the pain. But first, what are the causes?
The main causes of severe toothache and or dental pain
The vast majority of dental pain is caused by dental decay also known as Dental caries. Early Dental Caries does not produce any symptoms but only causes pain once the pulp or the nerve of the tooth is affected.
This usually happens when the dental caries is approaching near or is in the pulp itself. The name of this condition is called pulpitis. Dental pulpitis is inflammation of the pulp.
There are 2 types which are reversible pulpitis and irreversible pulpitis.
Reversible pulpitis is characterised by sensitivity to mildly hot, sweet or cold foods or drinks but it increases in severity if treatment is not undertaken. Eventually, the pulpitis becomes irreversible and typical symptoms that arise are severe toothache which lingers on even after the stimulus has been removed.
If it is still not treated, the pulp itself becomes infected and toxins within the pulp chamber are produced which irritate the periapical tissues. This irritation of the periapical tissues causes the tooth to be tender to percussion. Typically, you will not be able to bite down on the tooth as it is extremely tender.
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Even if this is not treated, the infection can spread into the surrounding bone and soft tissues. This is where you end up with a fat swollen face as a dental abscess.
- Although severe toothache is most commonly caused by Dental caries, gum disease is also a common cause. It is only the latter stages of gum disease which will cause toothache to appear. At this stage, the tooth will often be mobile and the periapical tissues will also be inflamed and infected.
- Apart from dental caries and gum disease, the remaining causes of severe toothache or dental pain are less common. One of these causes is something called bruxism. Bruxism is the term defined to describe grinding your teeth and unconsciously when asleep. Bruxism causes many symptoms and can mimic a severe toothache.
- The cracked tooth syndrome is a condition where are a tooth becomes separated by a fracture or fracture line which can propagate into the enamel and the dentin of the tooth. Responses within the dentinal tubules to stimuli cause the sensation of pain. This type of pain is exacerbated when biting or when ingesting hot, cold or sweet substances.
- Severe toothache or dental pain can also occur as a result of trauma including post-operative dental treatment. Examples of post-operative dental treatment causing severe dental pain or toothache include extractions, deep fillings, extensive extra coronal restorations such as crowns and bridgework, dental implant treatment and gum surgery.
- Finally, very rarely do you get non-dental causes but a dentist is always wary of these. One of these is a condition called trigeminal neuralgia which mimics dental pain and it is important for the dentist to recognise this in order to avoid unnecessarily losing otherwise healthy teeth.
For any kind of dental pain, it will ultimately be necessary to see a dentist however we will discuss what you can do whilst you are waiting to see your dentist. You may also be in a situation where you are away from home or you are not registered with any dentist or your dentist is closed so cannot see you.
The first port of call should be to ring the NHS 111 line. Failing that, you may have to look in the Yellow Pages or online for an out-of-hours emergency dentist privately. If you are on a dental plan, you should be able to get your costs back from the insurance company.
As all this may still take time, you will need to take painkillers.
Which are the best painkillers for a toothache?
In this section, we will discuss which painkillers or oral analgesics you can buy over the counter without a prescription and what dosages you can take to get rid of your pain.
Painkillers are known as analgesics which are substances to eliminate or reduce pain.
Analgesics are divided into two broad categories. The two categories are labelled non-opioid analgesics and opioid analgesics.
Opioid analgesics are stronger and generally recommended for pain that does not respond to non-opioid analgesics but their accessibility is very limited as an over-the-counter medication.
Non-opioid painkillers such as paracetamol and non-steroidal anti-inflammatory drugs reduce prostaglandin production from the central nervous system. They reduce prostaglandin synthesis and the prostaglandin is implicated in the inflammatory response as a response to tissue damage. Prostaglandins are implicated in pain, swelling and fever.
Opioids have a different mechanism of action within the central nervous system. They bind onto receptors which inhibit the release of neurotransmitters. Opioids mimic the endogenous opioid receptors reducing the pain response
The only opioid analgesic that you can buy over the counter in the UK is one that contains a mixture of paracetamol and dihydrocodeine. Each tablet only has as 7.46 mg of dihydrocodeine. This means that if you typically take two tablets, you will be ingesting a dose of 15 mg which will have only very limited effect.
But if a doctor prescribed you dihydrocodeine, the starting dose would be at least 30 mg going up to 100mg. Therefore, we will disregard combinations of paracetamol and dihydrocodeine in this article.
The second class of analgesics are called none opioid analgesics. Within this class are painkillers such as paracetamol, aspirin and NSAIDs.
Should I take paracetamol or aspirin?
Paracetamol and aspirin both have the same efficacy however aspirin does have more side effects such as being more irritant on the stomach especially if you already have stomach problems. Aspirin can also thin your blood so you need to be careful if you are already on blood-thinning medication such as warfarin.
Paracetamol generally is well tolerated and has lower side effects but you can easily take an overdose. In any 24-hours, you should not take more than 6000mg of paracetamol. Each tablet of paracetamol comes as 500mg and you would take two tablets at a time which equal 1000mg. If you take two tablets every 4 hours, in any 24-hour period you would be taking 12 tablets which equal 6000 mg. The side effects from the toxic dose of paracetamol are severe and it can easily cause liver damage.
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs is an abbreviation for non-steroidal anti-inflammatory drugs and these are typically painkillers such as ibuprofen.
Ibuprofen has the advantage of being an anti-inflammatory. The normal dosage for a tablet of ibuprofen that you buy over the counter is 200mg however if you specifically ask the pharmacist, they can supply you with 400 mg per tablet dosage. Even if they do not have that, you double the dose of 200 mg.
Unlike paracetamol, you can take fairly high doses of ibuprofen assuming that you do not have any contraindications such as stomach ulceration or any bleeding disorders.
It is quite safe to take two 400 mg tablets every 4 hours which means that in any 24-hour period, you can take a dose of 4.8g. Although this should be the top end, you should initially try to take 600mg and perhaps increase that 800 mg at any one time. National guidelines for Health and Care Excellence (NICE) do not recommend a daily dosage of more than 2.4g.
Taking paracetamol and ibuprofen together.
There are many studies which show that taking paracetamol and ibuprofen together is better than taking each of the medication separately. So for mild to a moderate dental toothache or dental pain, a suggested regime is to take two 500 mg paracetamol tablets and one 400 mg tablet of ibuprofen every 4 hours.
If this does not eliminate the pain sufficiently, the ibuprofen can be increased to 600 mg at a time with the paracetamol. The paracetamol dose must not be exceeded due to the risk of over toxicity as mentioned before.