Severe Tooth Pain: Seeking Advice on Treatment and Antibiotics

Severe toothache (medication consultation)

Hello Doctor, three days ago I experienced severe tooth pain that kept me awake at night.
The pain radiated to my entire left face, ear, and neck, occurring every hour for about 10 to 30 minutes each time, then subsiding as if nothing happened.
However, the intense pain returned every hour.
I can clearly feel that the source of the pain is a tooth on the lower left that has undergone root canal treatment (it feels like a needle is stabbing the nerve of that tooth, causing pain throughout my left face, ear, and neck).
The next day, I visited a dentist who found a cavity in the upper left tooth.
X-rays confirmed inflammation at the root of the lower left tooth that had undergone root canal treatment.
The dentist indicated that both areas could be the source of the pain, but since the root canal tooth is complicated to treat, they decided to address the cavity first.
After drilling the cavity, the dentist mentioned that this tooth might also require root canal treatment, but since it had been partially treated, if the pain lessened after returning home, it could confirm that this was the cause of the left facial pain.
They also prescribed a three-day course of antibiotics (12 pills).

That day, after taking two doses of antibiotics, the pain and frequency did not decrease, so I returned to the clinic that evening.
The attending dentist, who happened to be the clinic director, believed that the source of the pain was not from the lower left tooth (even though I insisted it was).
They then prescribed a muscle relaxant and steroids.
I asked if I could stop the antibiotics, and they said yes.
That night, I intended to take the muscle relaxant and steroids before bed, but I was too tired and fell asleep without taking any medication.
I slept through the night without being awakened by pain and woke up the next morning, which led me to believe my symptoms had improved.
Therefore, I continued taking the original medication (antibiotics and painkillers) until today, the third day.

On the second day, the pain still appeared intermittently, but the frequency and intensity seemed to lessen.
However, today (the third day), it seems to be worse than the second day, especially after eating and brushing my teeth.
I would like to ask the doctor how long I should take the antibiotics before I notice a significant improvement in the pain? Or can I follow the clinic director's advice and stop the antibiotics without finishing the course? Should I switch to taking the muscle relaxant instead? Or should I consider visiting another clinic? There are still two days until my next appointment, and I feel a bit lost, so I wanted to consult with you first.
Thank you!

chian, 30~39 year old female. Ask Date: 2018/03/07

Dr. Huang Tingfang reply Dentistry

Dear Ms.
Chian,
Hello! Tooth pain that causes discomfort in the face, ears, and neck indicates severe pain and requires a thorough examination to determine the underlying cause.
It is not advisable to rely solely on medication.
Please communicate more with your physician.
Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2018/03/07

More Info

Severe tooth pain can be a distressing experience, especially when it disrupts your sleep and daily activities. Based on your description, it seems that you are dealing with a complex dental issue involving a previously treated root canal tooth and a potential cavity in an adjacent tooth. Here’s a comprehensive approach to managing your situation, including the use of antibiotics and pain relief strategies.

Understanding Your Pain
The pain you are experiencing could be attributed to several factors:
1. Infection: The inflammation at the root of the tooth that has undergone root canal treatment may indicate an infection. This can cause referred pain, which is why you feel discomfort in your face, ear, and neck.

2. Cavity: The newly identified cavity could also be a source of pain, especially if it has reached the pulp of the tooth.

3. Muscle Tension: Sometimes, pain can be exacerbated by muscle tension in the jaw, particularly if you are clenching or grinding your teeth.

Antibiotics and Their Role
Antibiotics are typically prescribed to combat bacterial infections. In your case, the dentist prescribed a course of antibiotics for three days. It’s important to complete the full course of antibiotics as prescribed, even if you start to feel better. Stopping antibiotics prematurely can lead to a resurgence of the infection and contribute to antibiotic resistance.

However, if you notice no improvement in your symptoms after a few days of taking antibiotics, it’s crucial to communicate this to your dentist. They may need to reassess your condition and consider alternative treatments or further diagnostic imaging.

Pain Management Strategies
1. Over-the-Counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce inflammation and alleviate pain. Acetaminophen can also be used for pain relief but does not have anti-inflammatory properties. If you find that acetaminophen is not effective, you might want to try ibuprofen, provided you have no contraindications to its use.

2. Muscle Relaxants: If muscle tension is contributing to your pain, muscle relaxants may be beneficial. However, these should be used under the guidance of a healthcare professional.

3. Cold Compress: Applying a cold compress to the affected area can help reduce swelling and numb the pain. Use it for 15-20 minutes at a time, ensuring you have a barrier (like a cloth) between the ice and your skin.

4. Warm Salt Water Rinses: Rinsing your mouth with warm salt water can help soothe inflamed gums and may provide some relief.

5. Soft Diet: Eating soft foods can minimize discomfort while chewing and prevent further irritation to the affected area.

When to Seek Further Help
If your pain persists or worsens despite taking antibiotics and pain relievers, it may be time to seek a second opinion from another dentist. Different practitioners may have varying approaches to diagnosis and treatment, and another dentist might provide insights that could lead to a more effective treatment plan.

Conclusion
In summary, while antibiotics are essential for treating any underlying infection, managing your pain effectively is equally important. Utilize over-the-counter pain medications, consider muscle relaxants if appropriate, and maintain communication with your dentist regarding your symptoms. If your condition does not improve, do not hesitate to seek further evaluation. Your oral health is crucial, and timely intervention can prevent complications.

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