Teeth are living tissues that are chemically very similar to the bones in your body. They respond to trauma in a manner similar to, for example, a broken bone or banging your leg against a coffee table. In the first example of a broken bone, pain is not necessarily eliminated once a cast is placed. The placement of the cast facilitates the healing phase as new bone grows across the break. Full function gradually returns to the injured area once the cast is removed though some residual functional limits might always remain depending on the extent of the injury. It would not be unusual for discomfort and decreased function to persist for months during normal healing of broken bones or following deep dental fillings. This information on post operative instructions for dental treatment was created in our NYC General Dentistry office.
In the second example of banging your leg against a coffee table you would expect to be sore in that area for a week or more. Right after you bang your leg you might put ice on it to keep the swelling down. The ice acts to minimize the cellular response to injury by minimizing inflammation. Placing ice on your tooth should NOT be done but the concept of minimizing inflammation within your tooth following a dental procedure is very worthwhile. This can best be accomplished with the use of anti-inflammatory pain relievers mentioned below.
There are two types of pain relievers: 1. Anti-inflammatory, e.g. Advil or Motrin and 2. Narcotics, e.g. Percocet.
1. Anti-inflammatory (ibuprofen) pain relievers like Advil or Motrin (Not Aspirin nor Tylenol!) inhibit prostaglandin synthesis which is an early event in your body’s response to pain. Take Advil or Motrin immediately after having your fillings done. Take one or two tablets every six hours up to the maximum dose listed on the bottle for the next two or three days. Gradually taper off this dosage over several days. Take this recommended dosage even if you don’t have pain because this will significantly help prevent you from feeling pain in the first place! If you wait to first feel the pain you have lost the anti-inflammatory advantage. Although these products do not contain aspirin some cross-reactions may occur in aspirin-sensitive patients! If you are sensitive to aspirin you will want to take Tylenol instead but you give up the anti-inflammatory benefit Advil or Motrin provide. You should not drink alcohol with these drugs because in combination they can be highly toxic to your liver!
2. Narcotic pain relievers – typically this will be Percocet that is similar to Percodan but it does not contain aspirin. Take one tablet every four to six hours for pain if the non-narcotic pain reliever (like Advil, Motrin or Tylenol) is inadequate. Percocet may be taken along with these non-narcotic pain relievers. Do not drink alcohol, take other medications without approval, perform activities that require eye-hand coordination or drive a motor vehicle when taking this narcotic.
Drug Dosage – Anti-inflammatory pain relievers and narcotics can be taken together but some people might find they get a sensitive stomach. If this happens then consider spreading out your pill taking to give your stomach a break. Drugs are easier to handle with food in your stomach. Dentists need to know in advance if a patient has drug allergies or specific medical conditions which might interfere with these drugs!
All patients need to personally communicate with their dentist for specific information. Also recognize that the above recommendations are for post op (i.e. after dental treatment). Some of the medications discussed above may act as blood thinners that should be avoided before periodontal and oral surgery so again discuss this info with your personal dentist.
–Dr. Jeffrey Dorfman, Director