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Medical Forum / General / Dentistry / September 2008

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Alternate Tylenol/Codeine and Ibuprofen for pain?

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PRW - 24 Sep 2008 23:15 GMT
I've posted a few threads here under a different name (I'm away from
home, posting through Google instead of via Outlook Express on my own
computer) about my phobias as far as dental procedures that stem from
what has been a problem in getting my mouth dead enough, especially
when there's drilling involved. My dentist, who I've been seeing for
30+ years, and I are doing a lot better along those lines, the last
few times I've been have been a breeze. He's taking a few more pains
with his injections and is making sure to really pour on the water
when doing fillings. (We have determined that the biggest factor
that's giving me problems with the drilling is heat.)

Anyway, I have to go there in the morning, probably to have an
extraction done, and I'm counting down the minutes looking forward to
sitting in that chair, because this time I really don't care what he
does to me, anything is preferable to this pain.

Although I'm paying for not taking his advice and getting this tooth
pulled as a proactive measure, because he told me a year ago that this
tooth needed to come out. It's a wisdom tooth, I'm not sure exactly
which one, but it's an upper one on my left. The problem is that it
has been moving slightly when I bite down. It's caused some issues
with the teeth below it (had to have a filling repaired) and the
biggest issue is that food, etc., kept getting constantly impacted
around it, I was having to floss seemingly all the time.

My dentist said because of the tooth moving and some other factors, he
would recommend an extraction instead of trying to salvage the tooth
with a root canal.

However, it was not giving me any pain or anything, so I wasn't
exactly in a hurry to have a tooth extracted although I had pretty
much committed to do it before year's end (before my deductible kicked
in again on my insurance).

Big mistake ... it started getting a bit tender on Monday ( I recall
biting down on something over the weekend and it feeling really weird
and funny, that probably triggered it). It was more tender on Tuesday,
so I called my dentist and canceled the cleaning appointment I had for
Wednesday and made an appointment for next Tuesday to get the tooth
taken care of. I thought I could tough it out if the pain didn't get
any worse, but it got horribly worse Tuesday night, I woke up in agony
two hours after taking two Ibuprofen (200 mg each, total 400 mg). The
pain was radiating up into my jawbone and almost to my ear, and
actually down into my lower jaw even though I'm sure the problem is
that upper tooth.

I called the dentist back today and he's going to work me in tomorrow
a.m., plus he called me in some Tylenol/Codeine and some Erythromycin.

And I'm sorry for the long lead-in but I'm getting around to my
point ... the Tylenol/Codeine is not really taking the pain away any
better than the Ibuprofen. I have heard that if you alternate the two,
at two-hour intervals, you can get better results. Is that the case,
or should I just stick to one or the other? Thanks in advance for any
help.
Mark & Steven Bornfeld - 25 Sep 2008 00:48 GMT
> I've posted a few threads here under a different name (I'm away from
> home, posting through Google instead of via Outlook Express on my own
[quoted text clipped - 51 lines]
> or should I just stick to one or the other? Thanks in advance for any
> help.

    I've recommended alternating 400-600 mg ibuprofen with 600 mg
acetaminophen (no codeine) every 3 hrs.; IOW ibuprofen now,
acetaminophen in 3 hrs, ibuprofen in 6 hrs, etc.
    The codeine will increase the chance of nausea (and constipation).  I
also wouldn't take the ibuprofen more than every 6 hrs.
    My stomach will not hold up to regular ibuprofen for over 2-3 days, but
your stomach may be stronger.  Also, the usual admonition to avoid
alcohol when taking acetaminophen.  (Alcohol also increases stomach acid
secretion, and alcohol and acetaminophen together isn't good for the liver).

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

PRW - 25 Sep 2008 00:56 GMT
I actually do have gastric issues which would concern me about taking
Ibuprofen long term. I do take Mobic regularly for arthritis pain. My
gastroenterologist recommended not mixing the two. So I only take
Ibuprofen if I need it, because usually it's been the best pain
reliever (and fever reducer) for me, and when I do take Ibuprofen I
discontinue the Mobic.

I know Erythromycin is also supposed to be hard on your stomach, but
I've never, ever had any problem with it.

I'm just looking for something to do tonight to get through this
evening at work (I work second shift and am having trouble focusing
because of the pain) and tonight in bed until I can get this seen
about in the a.m. And I'll learn to listen to my dentist. :)

On Sep 24, 6:48 pm, Mark & Steven Bornfeld
<bornfeldm...@dentaltwins.com> wrote:

>         I've recommended alternating 400-600 mg ibuprofen with 600 mg
> acetaminophen (no codeine) every 3 hrs.; IOW ibuprofen now,
[quoted text clipped - 12 lines]
> Brooklyn, NY
> 718-258-5001
Steven Bornfeld - 25 Sep 2008 02:24 GMT
> I actually do have gastric issues which would concern me about taking
> Ibuprofen long term. I do take Mobic regularly for arthritis pain. My
[quoted text clipped - 10 lines]
> because of the pain) and tonight in bed until I can get this seen
> about in the a.m. And I'll learn to listen to my dentist. :)

Good luck.  BTW, I no longer use erythromycin (I'd have to check to see
if it is even still generally available) because after about 50 years of
use they seem to have discovered that it promotes cardiac arrhythmias.

Steve

> On Sep 24, 6:48 pm, Mark & Steven Bornfeld
> <bornfeldm...@dentaltwins.com> wrote:
[quoted text clipped - 15 lines]
>> Brooklyn, NY
>> 718-258-5001
Greg Bailey - 25 Sep 2008 14:12 GMT
Following up ... and using my regular account at home which is the reason
for the different name ... last night before bed I had the worst pain of
this whole experience, it was absolutely like someone was jabbing an ice
pick into my jawbone and twisting it. I took the Tylenol/Codeine and after
45 minutes the pain had not been lessened one iota. So I crossed my fingers
and popped one 200 mg Ibuprofen as well, I figured even if there was the
possibility of it making me sick, it was worth it to try to stop the pain.
And it worked, I got a decent night's sleep. I don't plan to do that again,
will alternate them. My appointment with the dentist is in 50 minutes,
hopefully the only pain I will be having to deal with afterward will be the
average post-extraction discomfort (but since I've gotten so much
pain-killer in my system already ... I set my alarm and got up in the middle
of the night and took the next Tylenol/Codeine on schedule ... maybe I'll be
ahead of the game there).

Good luck.  BTW, I no longer use erythromycin (I'd have to check to see
> if it is even still generally available) because after about 50 years of
> use they seem to have discovered that it promotes cardiac arrhythmias.
[quoted text clipped - 23 lines]
>>> Brooklyn, NY
>>> 718-258-5001
Greg Bailey - 25 Sep 2008 16:13 GMT
Followup No. 2 ... tooth's out, hopefully this will bring relief. Took SIX
shots to get me numb ... I'm hard to numb but I don't recall ever needing
that many, could it have had something to do with how inflamed and possibly
infected things up there could have been that was causing me so much pain
... but my dentist said the tooth came out "very easily" in his words, and
as long as I follow the usual post-extraction protocols (which will not be a
problem, especially since I don't smoke and because of the gastric issues
never drink out of a straw anyway), he doesn't expect any complications
(knock on wood, LOL!).
Mark & Steven Bornfeld - 25 Sep 2008 16:47 GMT
> Followup No. 2 ... tooth's out, hopefully this will bring relief. Took SIX
> shots to get me numb ... I'm hard to numb but I don't recall ever needing
[quoted text clipped - 5 lines]
> never drink out of a straw anyway), he doesn't expect any complications
> (knock on wood, LOL!).

    If there weren't a lot of pick axes and chisels going in there, it's
likely you will get relatively rapid relief.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Dartos - 25 Sep 2008 19:21 GMT
Great indication for a stabident injection.

Give a regular block, and if the patient isn't numb enough,
one stabident does the trick.

D

> Followup No. 2 ... tooth's out, hopefully this will bring relief. Took SIX
> shots to get me numb ... I'm hard to numb but I don't recall ever needing
[quoted text clipped - 5 lines]
> never drink out of a straw anyway), he doesn't expect any complications
> (knock on wood, LOL!).
Mark & Steven Bornfeld - 25 Sep 2008 16:43 GMT
> Following up ... and using my regular account at home which is the reason
> for the different name ... last night before bed I had the worst pain of
[quoted text clipped - 10 lines]
> of the night and took the next Tylenol/Codeine on schedule ... maybe I'll be
> ahead of the game there).

    Thanks for the update.

Good luck,
Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Dartos - 25 Sep 2008 19:19 GMT
> I know Erythromycin is also supposed to be hard on your stomach, but
> I've never, ever had any problem with it.

I think Steve B. mentioned cardiac (heart) issues are now the concern.

I also quit prescribing it.

D
Mark & Steven Bornfeld - 25 Sep 2008 20:07 GMT
>> I know Erythromycin is also supposed to be hard on your stomach, but
>> I've never, ever had any problem with it.
[quoted text clipped - 4 lines]
>
> D

    The FDA alert system works in funny ways.  I figure erythromycin must
have been around since about 1950.  For 50 years they found no serious
problems.  Then they found that taken in combination with the
antihistamine Seldane (I think it was the first so-called "non-drowsy"
antihistamine) cardiac arrhythmias could occur.
    So they took Seldane off the market.  Whoops--they kept getting the
cardiac arrhythmias with erythromycin alone.
    Funny how that works...or not.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Greg Bailey - 25 Sep 2008 20:09 GMT
The problem is that I'm badly allergic to penicillin, which rules out
amoxicillin, which from what I've seen online would most likely be the
alternate drug of choice here. That's probably why my dentist prescribed
what he did, because he asked me about allergies before phoning in the
scrip.

>> I know Erythromycin is also supposed to be hard on your stomach, but
>> I've never, ever had any problem with it.
[quoted text clipped - 4 lines]
>
> D
Mark & Steven Bornfeld - 25 Sep 2008 20:40 GMT
> The problem is that I'm badly allergic to penicillin, which rules out
> amoxicillin, which from what I've seen online would most likely be the
> alternate drug of choice here. That's probably why my dentist prescribed
> what he did, because he asked me about allergies before phoning in the
> scrip.

    Generally, the antibiotic used now in dentistry for penicillin-allergic
patients is clindomycin.  It also carries a risk of gastrointestinal upset.

Steve

>>> I know Erythromycin is also supposed to be hard on your stomach, but
>>> I've never, ever had any problem with it.
[quoted text clipped - 4 lines]
>>
>> D

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Greg Bailey - 25 Sep 2008 21:13 GMT
I've had clindomycin before and it hit my stomach like the proverbial ton of
bricks. I'm going to finish out the erythromycin, because it's always worked
well for me in the past and has given me no trouble (and I realize there's
always a first time), but based on what I've learned from you folks, if the
situation arises again I'll talk with my dentist about something else.
Thanks!

>> The problem is that I'm badly allergic to penicillin, which rules out
>> amoxicillin, which from what I've seen online would most likely be the
[quoted text clipped - 16 lines]
>>>
>>> D
 
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