Hi everyone. This is my first time posting here in the dentistry forum (regular member on the RSD forum).

On Monday I had 4 teeth pulled, two on the lower left side, one on the lower right, and one on the upper left. The dentist told me to take 2 Tylenol and 2 Advil every 4 hours for pain. How long is the pain typically this bad? I'm sure it's normal to still be hurting but at what point should I become concerned. I thought by now I could at least cut back on the pills (I don't take any pain meds for my RSD so my tolerance is pretty high for pain generally). But I find that at the 4 hour mark my mouth (the left side mostly) is just pure agony and I HAVE to take something for it...and even then it sometimes takes a while for the relief to kick in.

I really don't like taking so much medicine...been there done that with the RSD and it concerns me. I don't think a week will kill me or anything but I guess I just want to make sure this is normal for having teeth pulled. When I had my 4 impacted wisdom teeth out (years ago...when I was a teenager) I was feeling normal about 2 days later. I'm guessing it's worse because the two on my lower left side where it hurts the most were side by side plus the one on the top over there too. The right side really isn't bothering me at all...but that left side is just a killer.

Thanks for any advice or assurances about this. I'm not scheduled to go back to the dentist until Feb 21st to follow up on the work they did Monday...but if I need to call sooner than that then I will.

[ I am surprised he didnt tell you to rinse gently with warm salt water . that always helps

He didn't and it wasn't in any of his at home instructions either (which I have read several times to make sure I am doing everything). Someone at work mentioned this the other day though and I have been doing it for the past two days...though perhaps not enough?

Hi catra,

My first question is... why did you have both sides of your mouth done at the same time? Was it your decision or the dentist recommendation? What and how are you eating?

It's different to have 4 wisdom teeth removed because they are way in the back and eating is difficult but can be done more easily than what you must be experiencing.

The pain you are having on the left side can be due to any number of things. Yes, it can be more painful post operative when you have 2 teeth side by side removed at the same time. But I'm wondering if your getting food trapped in some of these areas. Also, it has to be difficult to brush your teeth properly with all these open wounds. Which means that you may be building up plaque around adjacent teeth which could cause throbbing pain and inflammation. You also could be developing dry socket(s)... especially in the area where the 2 teeth were extracted.

With regard to the pain meds...... if you are not accustom to taking these meds, then you have not built up a tolerance to them. Therefore, you really may not need all of that. Someone who routinely takes pain meds.... advil, motrin, tylenol .. etc.... builds up a tolerance that would require them to take more to achieve pain control. But others like yourself, can usually get away with half of the recommended dosage with no problem. This way you could always increase the dosage if necessary. I really dislike when dentists prescribe such large amounts of meds... they really need to ask the patient what their OTC habits are before prescribing.

With regard to rinsing.... warm salt water 3-4 times a day until all of the wounds have closed over. No mouthwash what so ever because they ingredients in them can actually disturb the healing and cause problems.

If you are still in throbbing pain (or you feel you have food trapped in any of the wounds) by tomorrow, Monday, go see the dentist to rule out dry socket. Did you have these done by an oral surgeon or a general dentist? Also, if you were icing the areas.... definitely stop. That is only recommended for the first 24 hours and can be a hindrance if done longer than that.

Let us know how you're doing.....

Bryanna

Thanks for the reply.

I need a lot of dental work done and the dentist was the one who decided to do all 4 teeth at once. It was a general dentist but it was under sedation (oral meds, not IV).

Eating has been...difficult. I started out with just soup for a few days. I tried some pasta and rice...the rice did get stuck in my open wounds and was difficult to get out. I also had some oatmeal and a couple of bananas. I am VERY hungry...but am doing the best I can. Even with soft stuff it's very painful to even open my mouth wide enough to put a spoon in. The right side of my mouth is feeling normal...a little tender but I've been trying to chew on that side because it doesn't hurt...but generally have avoided foods that require much in the way of chewing because the one time I tried I couldn't really keep the food on that side.

Brushing is difficult...especially with the missing teeth on both sides and on the top of the left side too. I've been doing my best but I wouldn't doubt that it's not as thorough as I would like.

I've been rinsing with the warm salt water a couple of times a day but will try and do it a little more.

As for the meds...I wouldn't say that I am not accustomed to them. With RSD (reflex sympathetic dystrophy) I have been on lots of meds and went through a 3 month period where I was taking the max amount of Tylenol every day (as directed by a doctor). In the beginning of my RSD (almost 4 years ago now) I was also prescribed lots of advil so that's not "new" to me either. But I made the decision last year to go off of all meds because I was concerned about long term side effects and now only use lidocaine patches (for pain) and clonidine patches (to regulate blood pressure since my sympathetic nervous system is all wacky).

But in terms of pain...the Tylenol and advil are hardly helping anymore. They do help a little but now after 2 hours the pain gets really bad and I won't take anymore until 4 hours have passed. The pain is definitely getting worse...two days after the Tylenol and advil if taken every 4 hours kept the pain at manageable levels. Now they just help a little and not for long.

I cannot use ice...my RSD makes that a big no-no even in areas where I don't have RSD as it could contribute to spread of the RSD to those areas.

I will definitely be calling the dentist on Monday. The increase in pain is just more than I can deal with and I don't want to keep taking meds like this. It's fine if it's needed short term but this just seems to be taking much longer than normal and getting worse instead of better.

Thank you so much for all the advice. I will definitely keep you posted.

Called the dentist's office this morning and I am going in at 10:30 this morning. Here's hoping it's something simple.

Hi catra,

Please let us know what the dentist suggests to you today

Bryanna

Just got back from the dentist (well...technically the pharmacy since he had me get some prescriptions filled).

The biggest issue is what I expected...that I have a dry socket in one of the spots in the lower left side of my mouth. His treatment for it is to have me flush it 3 times a day with hydrogen peroxide (they finally gave me something to do this with) and flush it with warm salt water as needed beyond that. He gave me an Rx for Norco and 2 RXs for antibiotics to take at the same time for the next week (Amoxicillin and Metronidazole). He said if the pain does not get better by Wednesday morning then I should call them and they will have me come in Wednesday afternoon to pack it. His reasoning, he said, is that packing it will prolong the healing process and be more invasive. He says that usually he ends up not having to with just flushing the wound with hydrogen peroxide (vile tasting stuff BTW...he did it while I was there...yuck!).

The other 3 wounds seem to be healing well. There was a bone chip working it's way out of the gum where the tooth was pulled in the upper left that was causing some discomfort but it's been removed now. There was also some food trapped in the wounds so I am to use the syringe thing they gave me to flush those out as well. I have no idea why I didn't get one after the initial extraction...seems like this would be a pretty common problem.

At any rate...I feel about 1000% worse right now after my visit. The pain is all the way up into my left ear and radiating out into my cheek. I feel very weak and nauseous...and that's before I have taken any meds which I suspect will probably aggravate the situation. I called off work tonight because between the pain and the potential side effects of the meds I don't think the 1 hour commute each way (in snow storms no less) and the 9 hour shift at work would be remotely possible. Once the pain goes down and I know how the meds affect me I can see if I can go in tomorrow. I HATE calling off but I just don't see how I could avoid it today with everything going on.

My mouth has also swollen badly since I left the dentist and I can hardly talk. I think the poking around and all that caused the swelling to get worse...

I hope the Norco kicks in quickly. I took it for my RSD pain but it didn't have any affect on that. I'm hoping it will for this...

I also have a follow up scheduled for next Tuesday so IF I don't need to come in this Wednesday then I will still be seeing them in a week to check on things.

2 hours after taking it the Norco has barely made an impact on the pain. This is very frustrating. I'm definitely light headed and feeling a touch out of it...but the PAIN...holy cow! My ear feels like it's going to explode...no joke. And perhaps the worst is that I can't even lay down as the pain is worse when I lay down vs sitting up. UGH! Today is not going well...

Catra,

I don't understand why he did not pack the site. That may have given you instant relief. The fact is, it is going to heal slowly because of the dry socket... not the packing of it. Oh boy.......... :/

I am not a fan of irrigating an extraction site, especially a dry socket, with hydrogen peroxide. A dry socket occurs when the blood clot does not form properly or it gets disturbed and falls out. This causes the bone to become exposed, and that is what causes the pain. Peroxide is only meant for infection and it can actually prevent the growth of new tissue. So if it were me, I would not irrigate this with peroxide. I would go back to him or another oral surgeon and have that site packed with a medicated packing at least twice within the next few days.

Believe it or not, the Amoxicillin is probably just in case the area becomes infected from you irrigating :/ The Metronidazole is just in case the amox gives you an intestinal problem and the Narco is tylenol with hydrocodone which can cause you to have dry mouth... which is the last thing you need right now.

Seriously, this should have been handled differently. Can you see a different oral surgeon tomorrow to help you? The packing will make it feel much better and you may not need the narco.

I am so sorry you are going through this.... sometimes I wonder where dentists get their license to practice :/

Keep in touch with us please.
Bryanna