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What is the cause and treatment for severe toothache?

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Posted on Tue, 22 Jul 2014
Question: I have been on Subutex for years. Usually 4mg aday. Down from 8mg a day.I am having severe toothache pain. SAw the dentist today. Doesn't see any infection. Maybemy bite needed adjustment, he did so, if no improvement may be a cracked root canal. He gave me vicodin but I know it won't touch the pain. Is there anything that will help until it is resolved. It is just pure pain. anti-inflammatories, acetaminophen, no longer work. It has been 36 hours. Any suggestions?
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Answered by Dr. Ashok Kumar (51 minutes later)
Brief Answer:
Local anesthetic agent can be used

Detailed Answer:
Hi,
Thanks for using healthcare magic.

I understand that tooth pain is very severe for most of us and can create havoc in anyone's life. Being on Subutex your assumption that Vicodin is not going work holds partially true as subutex does not block completely the analgesic properties of other opiod agents lke hydrocodone of Vicodin..
In my view there are three options for your pain relief which can be discussed with your treating doctor.
1. A higher dose of current medication can be effective for you. Talk to your dentist he will understand your concern and will prescribe accordingly.
2. The second option for you is a combination of two anti inflammatory agents or using a stronger anti inflammatory agent. Among the anti inflammatory agents the drug Ketorolac have the almost similar efficacy to opiods and its action is not blocked by Subutex or any antagonist of opiod receptors. The drug is recommended for short term use in presence of severe pain and where opiods are contraindicated or in individuals who have history of addiction and have high likelihood of relapse.
3. The third option for you is use of local anesthetic which will relieve your pain instantly and does not have any risk of addiction. Your doctor will probably do the skin testing to rule out any allergy to proposed agent and after due consideration of risk factors will prescribe same.

To conclude I assure you there are multiple options are available for pain relief. What I discussed can be prescribed on out patient basis and does not require any kind of serious monitoring. In case you need to discuss more intensive treatment that probably not required in your case feel free to contact me.
If you have any further questions I will be happy to help".
Thanks


Above answer was peer-reviewed by : Dr. Prasad
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Dr. Ashok Kumar

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Practicing since :2000

Answered : 3242 Questions

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What is the cause and treatment for severe toothache?

Brief Answer: Local anesthetic agent can be used Detailed Answer: Hi, Thanks for using healthcare magic. I understand that tooth pain is very severe for most of us and can create havoc in anyone's life. Being on Subutex your assumption that Vicodin is not going work holds partially true as subutex does not block completely the analgesic properties of other opiod agents lke hydrocodone of Vicodin.. In my view there are three options for your pain relief which can be discussed with your treating doctor. 1. A higher dose of current medication can be effective for you. Talk to your dentist he will understand your concern and will prescribe accordingly. 2. The second option for you is a combination of two anti inflammatory agents or using a stronger anti inflammatory agent. Among the anti inflammatory agents the drug Ketorolac have the almost similar efficacy to opiods and its action is not blocked by Subutex or any antagonist of opiod receptors. The drug is recommended for short term use in presence of severe pain and where opiods are contraindicated or in individuals who have history of addiction and have high likelihood of relapse. 3. The third option for you is use of local anesthetic which will relieve your pain instantly and does not have any risk of addiction. Your doctor will probably do the skin testing to rule out any allergy to proposed agent and after due consideration of risk factors will prescribe same. To conclude I assure you there are multiple options are available for pain relief. What I discussed can be prescribed on out patient basis and does not require any kind of serious monitoring. In case you need to discuss more intensive treatment that probably not required in your case feel free to contact me. If you have any further questions I will be happy to help". Thanks