Painkillers and Unruly Toothaches

[Totenkindly]

So I'm posting this here instead of my blog because maybe I'll get a few useful responses. Not sure how to proceed.

Over the last two months I've had some degree of back left molar pain (top and bottom). I have also had either caps or extensive dental fillings in that area. And since I have bad sinus cavities (I have blood relatives who also suffer from pinched sinus cavities that more easily get infected), it's not uncommon for me to have pain for a few weeks in the fall when the weather changes.

Well, I was having pain since early mid-September into mid-October -- very manageable discomfort, but still discomfort -- so I went to the dentist. I also had been blowing off my tooth cleanings for two years, so that was stupid too. Long story short, they took x-rays that didn't show any noticeable change to a weird situation I had explored 2-3 years back, where I saw the same dentist, as well as an endodontist, and a ENT doc for allergies. On the scans they all did, they saw a darkish area in my left sinuses area that didn't look quite right but none of them could decide what it was. Like, NONE of them. I got as far as a blood allergy test with the ENT after that (where I learned I was very mildly allergic to cats, not to the degree that I couldn't have them, and heavily allergic to dust mites), and then she said she'd consider surgery for my case if I did a neti pot for a year... and I tried that for a week and was like screw this.

Anyway, back to the present -- the new x-rays again showed that ambiguous area in the same place, with no noticeable change. There was nothing he could do at the moment for the acute issue, so I said I'd come in again in a week or two for my checkup/cleaning and we'd go from there. So I did that. I have do have receding gums in the back areas of my mouth unfortunately, but no noticeable cavities. We decided that I would schedule in a month or so (to catch my new FSA year) to come back, where we'd consider whether I needed to have those troublesome left back molars either recapped or refilled.... essentially excavating and discovery, in case there's something going on in there, because there's nothing obvious on the outside.

This seemed fine until Friday, then WHAMMO. I got up in the morning and by 7-8am my back two teeth (which I am guessing are fed by the same nerve) just started going kind of nutty on me. I was working from home and by 11am I just put in sick leave and then tried to deal with it. That was yesterday. it feels like it was last week due to the hellishness. I couldn't even sleep in my bed last night because having my head at the wrong angle will be "too much pressure" ... so I slept over in my reclining chair at a certain angle with blankets on me. I'm kind of amazed I made about six hours before waking the first time, then another 2 hours after popping more pills. But I still feel exhausted and keep taking 20 minute naps when I sit in the chair.

So I've got two issues. The most obvious is pain management.

1. I was controlling prior discomfort easily for some weeks with half-dosing of ibuprofin and tylenol. It was more on an "as needed" basis. The dentist knew this. Now in the last 36 hours it's been pretty much max possible dose of BOTH for adults, and the areas in the middle before I can really justify a safe dose can become a bit hellish. I'm not sure what to do in this regard. I tried this last dose just taking one ibuprofin to ease the wear-off pain of the tylenol, then take the other halfway through the dosing period. But damn. I can't even watch a movie straight through, nor sit on the sofa with a lack of backsupport. (which leads me to wonder) Anyway, how am I supposed to deal with this? I've still got tomorrow, then I'm supposed to work on Monday (and sub for my supervisor on Thurs/Fri). I'm probably already looking at only a half day at this rate. I will go mad if this keeps up for a week or more, I feel like a druggie consumed with the thoughts of my next painkiller.

2. The other question is whether anyone has ever heard of anything like this, in terms of having this deep-seated tooth pain potentially related to sinuses, where no one can figure out what is happening. Also, to complicate matters, since nerves are connected, I also had exams about my spinal column some years ago (i actually had steriods shot twice into my spin, to stop inflammation and help fix numbness I was having my fingers). I hadn't really had noticeable issues for years, but I notice that I can't lay on the sofa without it making the teeth hurt even worse or sitting/laying certain positions. The doc back then asked me if I was ever in an acute accident, because I had cartilage damage between my 6 and 7 vertabrae (which is why I got the steroid shots). No, I honestly never did. it's always been a huge mystery.

Anyway, I have no idea where even to go / what to pursue, and now I've got an acute situation to resolve. My dentist has no idea what the problem is, and at this stage ALL he can do is take out the fillings in the back teeth and see if redoing something fixes it / something is going on in there. Whee. I also tried to get a new GP a few months ago but currently do not even have one, so now I guess I'll be trying look up one tomorrow. (I wanted a GP who could prescribe ALL my meds and ended up seeing an endocrinologist in September who informed me essentially they are not my GP -- they gave me temps on any meds non-related to endocrinology and I still need to find another doctor for "my regular needs"). But who knows when I can get in to see anyone I can find, you know how new docs and waits are. (I've done walk-in's to FirstCare before and they were totally useless -- the last time I did that, they even sent me an unexpected refund check some months later because of their poor service, when I hadn't even complained... although they sucked badly. Yeah.)

So I'm left wondering whether it's a tooth issue, a sinus issue, or a nerve issue... and meanwhile I need to resolve it fast just in order to sleep. When the pain is bad enough, I feel like doing the Castaway thing / yanking the teeth out with a pair of pliers, which is insane. But that's how irritating and painful it is.

Oh, and I also have mostly untreated TMJ (which seems exacerbated right now). So toss that in.

I just need a sense of options...

 

[rav3n]

The sinus infection/back tooth ache connection appears to be a thing. There are some suggestions for home treatments on the second page, of which a neti pot is one of a few.

Sinus infection and toothache: Any connection? - Mayo Clinic

 

[Julius_Van_Der_Beak]

Well, for pain management, I haven't used it for toothaches (although some people say it works for that), but I find Orajel to be really useful when I bite my cheek, which happens fairly often, due to my expert command of my own body. I'd suggest giving it a shot. It's like a small tube you squeeze on to the affected area to dull pain.

 

[oxyjen]

Maxillary sinusitis?

Maybe a tooth abcess, I'm not sure. I would think the dentist would catch that though.

In either case, you need antibiotics and good pain meds. You can try going to walk-in acute care. You could also try your luck on tele-visit (my health insurance has offered online visits for a vastly discounted rate than in person, but I"m not exactly sure how they differentiate what they can treat via distance and what issues they need to see you in person for).

Good luck. Tooth pain is hell. I hope you can figure out what's going on, and get it treated.

 

[oxyjen]

I have a totally unfounded fear of neti pots. I'd probably have weird algae growing in my sinus cavities if I used it. Fuck a neti pot.

(I have also never had a sinus infection in my entire life, so I have never had reason to get over my disgust at pouring warm tap water in various mucousy orifices. Blarrughh).

 

[rav3n]

You mentioned a dark spot in your sinuses. Might it possibly be from a fungal infection?

Is Mold Causing Your Sinus Problems?

 

[Totenkindly]

Thanks for the suggestions.

Also, I am having some ear pain, but my personal feeling (from what I am experiencing) is simply that the nerves in that area are going crazy, and it's not really originating in my ear. I was wondering if my lymph nodes were swollen but my neck feels okay.

I also took my temperature a few times in the last day. No fever, not even close -- in fact, my temperature is only around 97.2F, it's lower than it should be. No wonder I feel cold. I hate winter.

I have a totally unfounded fear of neti pots. I'd probably have weird algae growing in my sinus cavities if I used it. Fuck a neti pot.

(I have also never had a sinus infection in my entire life, so I have never had reason to get over my disgust at pouring warm tap water in various mucousy orifices. Blarrughh).

'Yeah, I did it just for that week and just HATED it. HATED HATED HATED it. Another coworker who has regular sinus issues as well hates them.

And I am terrified of not cleaning it well enough and creating an infection in my nasal passages with it. I've read some horror stories. It's so damn close to the brain. As an unrelated thought I have been thinking this week (with this and also in terms of turning 50) i need to redo my will with my legal name and divorced status, plus my Advance Directive wishes so my kids don't have to agonize over it. (Yeah. I hate the Neti pot.)

You mentioned a dark spot in your sinuses. Might it possibly be from a fungal infection?

Is Mold Causing Your Sinus Problems?

I dunno, but thanks for the idea.... I'll read up on it. Srsly, the ENT, the dentist, and the endodontist all looked at those scans and all stated they couldn't figure out what they were looking at. They didn't think it was full of mucus, it was kind of in-between.... enough to catch their eye and think about what it might be but not sure.

Well, for pain management, I haven't used it for toothaches (although some people say it works for that), but I find Orajel to be really useful when I bite my cheek, which happens fairly often, due to my expert command of my own body. I'd suggest giving it a shot. It's like a small tube you squeeze on to the affected area to dull pain.

Thanks. I was looking at that last night, I've also considered it for canker sores; it was just $16 for a very tiny tube, so I was waiting to see if I was desperate enough. I do that cheek-biting thing more regularly than I would admit too, though.

As a side note, have you heard of proprioception? I ran across it while googling my tooth issues. Now I'm wondering how much of cheek biting is related to losing track of where my cheek happens to be before I bite?

 

[rav3n]

I dunno, but thanks for the idea.... I'll read up on it. Srsly, the ENT, the dentist, and the endodontist all looked at those scans and all stated they couldn't figure out what they were looking at. They didn't think it was full of mucus, it was kind of in-between.... enough to catch their eye and think about what it might be but not sure.

As a consideration, perhaps you can check your windows to see if they have any black mold on them. If so, put on a mask and clean them up with windex, borax or baking soda.

 

[Totenkindly]

As a consideration, perhaps you can check your windows to see if they have any black mold on them. If so, put on a mask and clean them up with windex, borax or baking soda.

I don't think there's any, honestly, although I'll give it a once over. I've also had an occasionally recurring basement leak, so I bought a dehumidifier which I run, to keep things under control. There was nothing when the house underwent inspection less than two years ago.

However, I've noticed if I don't stay on top of the kitty litter, I can smell litter when the ventilation kicks in (since it's down near the HVAC), so that's something I'm wondering.

 

[rav3n]

I don't think there's any, honestly, although I'll give it a once over. I've also had an occasionally recurring basement leak, so I bought a dehumidifier which I run, to keep things under control. There was nothing when the house underwent inspection less than two years ago.

However, I've noticed if I don't stay on top of the kitty litter, I can smell litter when the ventilation kicks in (since it's down near the HVAC), so that's something I'm wondering.

It's a consideration and an easy fix since you can move the litter box. Another consideration is your work environment, relative to mold or maybe your sinuses are reacting to the dryness of climate control and an air recycling ecosystem.

 

[Totenkindly]

It's a consideration and an easy fix since you can move the litter box. Another consideration is your work environment, relative to mold or maybe your sinuses are reacting to the dryness of climate control and an air recycling ecosystem.

Hmmm. Well, it's a thought -- there's a lot of construction in the past year, I got moved to a new location in May (so I'm not used to the area I'm in), and the ventilation is horrible/inconsistent throughout the main structure of the campus where I work.

 

[Z Buck McFate]

Just throwing some potentially stupid ideas in the pot:

Have you been adding Sudafed (or generic knockoff thereof) into your analgesic cocktail? If nothing else, I imagine whether or not it helps would be useful information, diagnosis-wise.

If you really can't stand neti pots (which should be safe if you stick to distilled bottled or boiled tap water - but it sounds like that's not your primary aversion) then you could try saline water nasal spray. There's no medication in it to interfere with anything else you're taking, and it isn't anywhere near as intensive as a neti pot. It will help move junk out of your nasal cavity though.

Do you grind your teeth? Sometimes I experience mad back teeth/jaw soreness if I either sleep without a night guard or with one that I didn't fit properly to my teeth.

I currently take prescription medication for overactive nerve pain (with no discernably damaged tissue to explain it) - the most helpful has been gabapentin (generic for Neurontin). It has really helped quiet the nerve pain without the downsides of narcotic pain reliever (very little grogginess, don't have to worry about building a tolerance, and some third thing that I've forgotten while writing the first two).

Also, have any of the doctors recommended a steroid pack? (The kind of steroids taken orally). If inflammation is a problem, it'd help with the pain.

Finally, I've almost always found swishing hot salt water around in my mouth helpful for toothaches, to hold me over until I could see someone. But it's important to hold an ice pack to your cheeks if you do - because if there's an infection, the hot saltwater will push it to the surface and you don't want the abcess forming on the outside of your cheek. Because gross.

 

[Totenkindly]

Just throwing some potentially stupid ideas in the pot:

Have you been adding Sudafed (or generic knockoff thereof) into your analgesic cocktail? If nothing else, I imagine whether or not it helps would be useful information, diagnosis-wise.

No, the only stuff I take regularly has been Montelukast (aka Singulair) and Fexofenadine (aka Allegra) and it's been fine with that. I usually don't have any sneezing fits or anything, even through the seasonal allergy season -- at most I get a bit clogged w/ sinus pressure.

If you really can't stand neti pots (which should be safe if you stick to distilled bottled or boiled tap water - but it sounds like that's not your primary aversion) then you could try saline water nasal spray. There's no medication in it to interfere with anything else you're taking, and it isn't anywhere near as intensive as a neti pot.

Thanks, that's an idea.

Do you grind your teeth? Sometimes I experience mad back teeth/jaw soreness if I either sleep without a night guard or with one that I didn't fit properly to my teeth.

Yeah, I find I grit my teeth fairly regularly and/or bite down on them. Sometimes I even put a pen between my front teeth to stop the back teeth from doing it. I don't know if I have done it in my sleep. The dentist brought it up too this time as a possibility and said they might be able to make a nightguard for me -- and the insurance company immediately rejected it (although I have two difference insurances).

I currently take prescription medication for overactive nerve pain (with no discernably damaged tissue to explain it) - the most helpful has been gabapentin (generic for Neurontin). It has really helped quiet the nerve pain without the downsides of narcotic pain reliever (very little grogginess, don't have to worry about building a tolerance, and some third thing that I've forgotten while writing the first two).

Thanks, that's something to look at.

Also, have any of the doctors recommended a steroid pack? (The kind of steroids taking orally). If inflammation is a problem, it'd help with the pain.

Thanks. No one did, although this time out it's just the dentist I was to twice in the last month, and they aren't aware yet I got slammed yesterday with all this. I'm calling them monday morning.

Finally, I've almost always found swishing hot salt water around in my mouth helpful for toothaches, to hold me over until I could see someone. But it's important to hold an ice pack to your cheeks of you do - because if there's an infection, the hot saltwater will push it to the surface and you don't want the abcess forming on the outside of your cheek. Because gross.

lol. Yah, gross. But thanks!

 

[rav3n]

Hmmm. Well, it's a thought -- there's a lot of construction in the past year, I got moved to a new location in May (so I'm not used to the area I'm in), and the ventilation is horrible/inconsistent throughout the main structure of the campus where I work.

You mentioned that this condition began in early-ish September so it might be your building. If you have a floor to ceiling enclosed office, an air purifier or humidifier, depending on the problem, might help.

Another wild possibility is diabetes II since it can impact on sinuses and nerves. Have you had your blood sugar checked lately?

 

[Totenkindly]

You mentioned that this condition began in early-ish September so it might be your building. If you have a floor to ceiling enclosed office, an air purifier or humidifier, depending on the problem, might help.

No, I'm in a large room -- like, a room with about 160 cubicles.

Another wild possibility is diabetes II since it can impact on sinuses and nerves. Have you had your blood sugar checked lately?

I had it checked in September, my blood sugar was fine. (I was concerned about Type II diabetes a few times in the last few years, esp when I was way overweight.)

 

[rav3n]

No, I'm in a large room -- like, a room with about 160 cubicles.

That's unfortunate. Did you know that you can buy a test kit for allergens in the air, whether home or office? You collect the samples and send them in for analysis.

Building Health Check Allergen Test Kit | Sylvane

I had it checked in September, my blood sugar was fine. (I was concerned about Type II diabetes a few times in the last few years, esp when I was way overweight.)

Excellent!

 

[Luminous]

I have been suffering from sinus related issues for years, but it's never been as bad as you currently have it. So with that, I'd suggest that something larger than just sinus pressure is going on.

I think getting a second opinion from a different dentist might be in order. Do you have abnormally long roots on the teeth where the problem is happening?

You could try taking a sinus decongestant and see if that helps at all?

 

[Z Buck McFate]

Yeah, I find I grit my teeth fairly regularly and/or bite down on them. Sometimes I even put a pen between my front teeth to stop the back teeth from doing it. I don't know if I have done it in my sleep. The dentist brought it up too this time as a possibility and said they might be able to make a nightguard for me -- and the insurance company immediately rejected it (although I have two difference insurances).

I currently use the kind that can be bought in a drug store, for between $10-$20. It isn't as comfortable and doesn't work as well as the one made by my dentist over 15 years ago (which only finally broke last year), but it's a lot better than trying to sleep without one. I don't have dental coverage right now and yeah, those are obscenely expensive.

The cheap drugstore guards are a pain to set (there's a thing you have to do initially to get them to fit against your teeth), they're bulkier than dentist's guards, and have only lasted me a couple months each. But it's better than nothing.

 

[Julius_Van_Der_Beak]

Thanks. I was looking at that last night, I've also considered it for canker sores; it was just $16 for a very tiny tube, so I was waiting to see if I was desperate enough. I do that cheek-biting thing more regularly than I would admit too, though.

As a side note, have you heard of proprioception? I ran across it while googling my tooth issues. Now I'm wondering how much of cheek biting is related to losing track of where my cheek happens to be before I bite?

I've thought it might be because I chew too fast. For that and other reasons, I'm trying to make a point of eating more slowly, but old habits die hard.

 

[Totenkindly]

I realized there's an ExpressCare / urgent care place literally about .3 miles away from me, I pass it all the time walking when I go in that direction. It's on my insurance and is only a $35 copay, and they let you sign up for slots ahead of time for walk-in's. So I signed up for 8:20am (they open at 8am).

So at least I can see if there's any way they can help with pain mitigation, do any routine checks (I think my ear is a residual effect, for example, but it's worse tonight, they can check all that stuff). They can prescribe/dispense on premises, etc. The copay is only about what I'd pay normally at a regular doctor, and I don't have an official doc right now, and it's better than starting to take off lots of work on Monday, so....