wisdom teeth pain

[Doc34]

Just had my wisdom teeth pulled, I am in a lot of pain but the pain killer i got was ENDOCET, a generic of percocet. Every time I take it I start to itch. I don't get any hives but i get really really itchy. Do you think I should stop taking it, or its just a mild allergic reaction that won't cause anymore problems?

Thanks for your advice.

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[speter33]

When I had my tooth pulled out last january I took the painkiller once and it gave me a huge headache and I stopped right away. I continued taking that anti-infection medication they gave me though. I don't think you need to keep taking those pain killers. Remember that every 6 hours your pain markedly goes down and once you survive the 2 day point you'll see the light at the end of the tunnel. Get better

 

[River13]

I would stop taking the endocet, call your doctor who removed the wizzies, tell him about the symptoms, and ask for a different script/directions for pain control.

 

[no2thdk999]

Endocet/Percocet is a poor analgesic choice due to it's dosing anyway.

I would quit taking it and take 800mg Ibuprofen q6h along with 1000mg Tylenol q6h on a staggered schedule so you're taking one or the other q3h

If that doesn't keep you comfortable call your DDS and let him/her know. Your pain will likely be at it's maximum on the 2nd/3rd day and then decrease markedly.

JMHO
Rob

 

[aphistis]

Endocet/Percocet is a poor analgesic choice due to it's dosing anyway.

I would quit taking it and take 800mg Ibuprofen q6h along with 1000mg Tylenol q6h on a staggered schedule so you're taking one or the other q3h

If that doesn't keep you comfortable call your DDS and let him/her know. Your pain will likely be at it's maximum on the 2nd/3rd day and then decrease markedly.

JMHO
Rob

Rob, I've always wondered about the rationale for taking such large amounts of ibuprofen & acetominophen. That's at least 2g a day of Tylenol, and 1.6 of Advil, and more than that if you're awake longer than 12 hours. What about nephro- and hepatotoxicity?

 

[no2thdk999]

Rob, I've always wondered about the rationale for taking such large amounts of ibuprofen & acetominophen. That's at least 2g a day of Tylenol, and 1.6 of Advil, and more than that if you're awake longer than 12 hours. What about nephro- and hepatotoxicity?

Hopefully it's larger doses than that. Dosing every 6 hours instead of prn keeps the blood levels up and pain down. Dosing prn by definition guarantees that the patient is going to have pain.

The maximum 24 hour dose for a healthy adult is 3200 mg of Ibuprofen and 4000 mg of Tylenol. For the typical 2-5 days of post-op discomfort following dental surgery this is a safe and effective regimen. The two have an additive effect that is greater than either alone. I especially recommend this for someone who can't risk the side effects of taking a narcotic medicine (like a single parent with a small child at home or a truck driver).

There is a great article on nonpresciption pain relievers in the March/April 2004 edition of General Dentistry (AGD's publication)

JMHO
Rob

 

[PERFECT3435]

ok since we are on the wisdom tooth topic i have a question for the wise people here.

i just noticed that my tooth #24 and 25 no longer seem straight. they appear kinda crooked and i am wondering if my wisdom teeth (17 & 32) are causing crowding.

should i be concerned and look into removing 17 and 32? i have absolutely no pain and 17 and 32 both look straight and normal.

 

[DrJeff]

ok since we are on the wisdom tooth topic i have a question for the wise people here.

i just noticed that my tooth #24 and 25 no longer seem straight. they appear kinda crooked and i am wondering if my wisdom teeth (17 & 32) are causing crowding.

should i be concerned and look into removing 17 and 32? i have absolutely no pain and 17 and 32 both look straight and normal.

This should go down as the 2nd most common "dental falicy" right behind a person with a high caries rate stating that they have "soft teeth".

Your wisdom teeth are 100% irrelevant towards the crowding of #24/24 as we age. As you'll learn in your future ortho .

So get your courses, your teeth as we age want to drift towards the mesial. You lower centrals have a small root surface area and relatively speaking can be easily "pushed" by the teeth distal to them. There are many ortho studies showing that mandibluar anterior crowding as we age is the same in people with and without 3rd molars. I'm living proof myself as I'm congentitally missing all my thirds and just withing the last few months have started to see some slight crowding of 24/25 (I finished my ortho tx 17 years ago)

So get your thirds out if you want too, it just won't have any effect on 24/25.

 

[Doggie]

This should go down as the 2nd most common "dental falicy" right behind a person with a high caries rate stating that they have "soft teeth".

Your wisdom teeth are 100% irrelevant towards the crowding of #24/24 as we age. As you'll learn in your future ortho .

So get your courses, your teeth as we age want to drift towards the mesial. You lower centrals have a small root surface area and relatively speaking can be easily "pushed" by the teeth distal to them. There are many ortho studies showing that mandibluar anterior crowding as we age is the same in people with and without 3rd molars. I'm living proof myself as I'm congentitally missing all my thirds and just withing the last few months have started to see some slight crowding of 24/25 (I finished my ortho tx 17 years ago)

So get your thirds out if you want too, it just won't have any effect on 24/25.

Actually, I think the #1 dental fallacy is "dentists have the #1 suicide rate."

 

[UNLV OMS GUNNABE]

I know I get a little itchy when I take percocet, especially with my nose. From what I've heard it's a fairly common symptom. I would go with rivers advice if the itching is too much to handle.

 

[PERFECT3435]

thank you Dr. Jeff.
learned my 1st semi lesson already. lol

 

[USC2003]

For those of you who are interested the Laska, Sunshine et al. 1986 study showed that the peak analgesic effect of Ibuprofen was at the 400mg dose. Above this dose has no real effect on increasing analgesia, just the length of duration. When I prescribe Ibuprofen I usually use the 600mg q 6h dose rather than the 800mg dose. No need to place more work on the liver than needed, even if you are only prescibing for a short duration. Anytime you prescribe medication you should aim to start with the minimum effective dose rather than starting with the max dose.

 

[no2thdk999]

For those of you who are interested the Laska, Sunshine et al. 1986 study showed that the peak analgesic effect of Ibuprofen was at the 400mg dose. Above this dose has no real effect on increasing analgesia, just the length of duration. When I prescribe Ibuprofen I usually use the 600mg q 6h dose rather than the 800mg dose. No need to place more work on the liver than needed, even if you are only prescibing for a short duration. Anytime you prescribe medication you should aim to start with the minimum effective dose rather than starting with the max dose.

USC 2003 thanks for the good dialogue.

I looked at the study you listed and at least from the abstract I'm not sure it supports your position that 400mg yields the peak analgesic effect. The way I read it, and I'll admit I'm no chi-square kind of guy, they found "that increased ibuprofen serum levels lead to increased analgesia" but (possibly due to the different formulations of 400, 600, and 800 mg tablets) a larger dose did not necessarily lead to increased serum levels. This seems to be more a problem with the specific formulations or brand they used not an indication that 400 mg yields the peak analgesic effect. It also showed that at 1,2, and 3 hours 800mg produced better analgesia than 400 or 600mg at least as I read it but I yield to you since you've seen the whole article:

"Serum levels at 1, 2, and 3 hours correlated significantly with the log dose of ibuprofen (r = 0.35, 0.49, and 0.48, respectively) and with global analgesic response as measured by the percentage of the sum of the pain intensity scores (r = 0.28, 0.34, and 0.26, respectively)"

Also this study only looked at pain intensity for 6 hours post op. If your patients only hurt for 6 hours post extraction I'm coming to watch you work one day next week.

A good deal of the post extraction pain is the result of inflammation produced by the trauma to the local tissues. A higher dose of ibuprofen will yield a greater anti-inflammatory effect and IMHO less pain.

Lastly I agree that the lowest effective dose of any medicine should be used. But we're not talking about morphine here. For the typical 2-5 days of dental pain I'm comfortable with a high dose of ibuprofen because the side effects are low and the severity of the side effects are low. Also if the 600mg dose doesn't keep them comfortable it will take more medicine to get their pain reduced than if they'd taken 800mg to start with. i.e. it's easier to keep a patient comfortable than get them comfortable again after breakthough pain.

No right or wrong on this one I think. Just what you're comfortable with clincally.


JMHO
Rob

 

[USC2003]

I agree that there probably is no right or wrong answer to prescribing 600mg or 800mg Ibuprofen as no2thdk999 has stated. In fact I have myself given Ibuporfen 800mg tid/qid in the past. I just want to point out a couple of things that I came across in my reading. Other studies have also shown that 400mg Ibuprofen lasts for 4-6 hours and if you increase the dose you can have an increase in longevity of analgesia but not peak effect (up to 800mg). After 800mg there is no real increase in longevity. There is a "ceiling" analgesic dose when it comes to NSAIDs. So giving 600mg q 6h or 800mg q 6-8h will keep the serum levels high enough for analgesic effects. These studies may only look at post-op pain for a short period of time like 6 hours, thus the order q 6h or 8h when prescribing... I also just wanted to point out that the analgesic and anti-inflammatory properties of NSAIDs work at different time intervals. Peak effects of analgesia are usually around 1-2h while it may take anywhere from 3 to 7 days for the anti-inflammatory effects to set in. I am not sure how much of a difference 800mg vs 600mg will yield in anti-inflammatory effects but would love to see a study if anybody can find one. I think we all want to keep our patients out of pain and in reality If I think the patient will be in pain after surgical extraction of thirds than I will prescribe them both Ibuprofen and Vicodin and have them alternate the dosing since opioids and NSAIDs work at different sites when it comes to analgesia, and combining the two has been shown to be more effective than just either one alone. Just my two cents and I am sure everybody has a different opinion.