What to prescribe after Endo or EXT

[Hawkeyez]

Hey dental students,

Just wanted to know what you guys prescribe normally. I know you look at the medical history and allergies but I often get confused on when to prescribe a certain medication. For example, after a surgical extraction, I get confused with Vicodin, T3, Percocet, etc. I know all the differences in the make up of the drug but I don't know how it actually applies to what the patient needs. If medical history is non contributory, what do you look at when prescribing things?

Also, what do you prescribe for endo? 1 appointment or 2 appointment endos?

I know for simple procedures, OTC ibuprofen is good enough but when we start needing to use the stronger stuff, how do we know which to pick? I normally just do what the professor says but I just wanted to learn for my own good and for the future. Thanks for reading.

---

Members don't see this ad.

 

[KillaCam]

550 grams of pure Fluoride IV stat. I think that should fix pretty much anything in the body.

Fluoride is curative.

 

[UltimateHombre]

I am not qualified to answer this, but i do work in a CHC where we do a ton of extractions.

Most simple extractions the docs wont prescribe anything for and general Ibuprofen will do the trick. Same with RCT, most endos wont prescribe anything.

On half mouth extractions+ or on surgical extractions with bone loss, they will usually prescribe a few Vicodin. They will also prescribe an antibiotic to prevent infection.

 

[HupHolland]

As long as the patient can take NSAIDs, almost always recommend a combination of 600mg ibuprofen + 500mg acetaminophen q6h prn.

The only rx pain med I will write for is vicodin 5/325 q6h. This is following a surgical ext that was more involved then just sectioning the tooth and a little buccal bone. Occasionally, I will rx tramadol if the patient has had a bad experience with vicodin.

The research shows iburpofen + acetaminophen to be more effective for dental pain, but some patients just feel better having the narcotic "just in case." I have no problem writing for it, I just tell them to start with my initial OTC cocktail and add vicodin for breakthrough pain only.

hup

 

[molareffer]

It wouldn't hurt to ask your patient what has worked for him in the past. Post-op pain control is not always a "cookie-cutter" approach. However, Hup's recommendations will probably work for most of the population.

 

[Hawkeyez]

Thanks! What do you think about endo? Molar vs Anterior? Single vs multiple appointments? Do you have a go to solution for people in pain from endo?

 

[jay47]

Usually don't need too much, unless abscessed or lots of swelling. Once the nerve is gone, then you shouldn't have too much trouble, molar or anterior.

Single Vs. Multiple does not show much of a difference.

" Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for
endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod.
2008 Sep;34(9):1041-7. doi: 10.1016/j.joen.2008.06.009. Review. PubMed PMID:
18718362."

http://www.ncbi.nlm.nih.gov/pubmed/18718362

"Twelve studies were included in the review. No detectable difference was found in the effectiveness of root canal treatment in terms of radiologic success between single and multiple visits"

Endo pain is like any other pain, remove the source and give analgesics. Remove the nerve, then get rid of the pain. Abscessed teeth have peripheral inflammation and pain that needs to be taken care of- incision and drainage of the acute purulent exudate will help along with endodontics.

 

[Cold Front]

For me...

Amoxicillin 500 tid + Vicodin 5/500 1-2 po q 4-6 h as needed. This worked all the time for me, even if there were some post-op issues.

For abscess with significant involvement in other spaces...

Amoxicillin 500 + Metronidazole 500 tid each, for quick and effective solution.

 

[goffdent]

we are taught 5/325 hydro/APAP for involved surgical extractions, not 5/500 because some patients will likely overdo the APAP if they're taking 2 pills 5-6 times a day. We also almost never Rx narcotics for endo procedures. Additionally, unless a patient has a dangerous "facial space infection" not including an abscess that you can I & D, don't prescribe them ABX. Best treatment is debridement/extirpation/extraction.. But that's what we learn.