Introduction
Tooth root inflammation is the colloquial term for pulpitis or tooth pulp inflammation. The innermost part of the tooth, the pulp, which is traversed by vessels and nerves, is inflamed in this case. Since the pulp is surrounded by enamel and dentin, the inflammation has no chance to drain away and pressure builds up, which we perceive as pressure pain.
Often affected persons feel a throbbing of the tooth. The nerve dies due to the inflammation and a purulent secretion is formed, which spreads underneath the tooth and in the soft tissue. Since there is no possibility of drainage in the beginning, the old familiar “thick cheek” (abscess) forms.
The purulent secretion can also find its own way out through a fistula tract. The inflammation causes a very unpleasant pain. Which painkiller should one therefore take?
General information about root canal inflammation
The x-ray does not show anything abnormal or even pathological in an acute pulpitis. Clinically noticeable are the sensitivity to knocking and pressure and the strong reaction to cold. In most cases, initial caries is the cause of the pulpitis, which has gradually spread through the individual layers of the tooth (enamel, dentin, cement) to the pulp.
The bacteria of caries only attack the soft tissue of the pulp and inflame it. If the tooth is not treated, the inflammation also spreads to the surrounding tissue, the tooth becomes loose and an abscess develops. This abscess can spread if the secretion it contains is not drained and can end systemically to a life-threatening condition called sepsis.
What painkillers are available?
The range of painkillers is almost immeasurable. There are always different trade names from thousands of manufacturers that confuse the buyer. If one looks at the active ingredient, the remedies of choice for dental root inflammation are limited to a handful.
From acetylsalicylic acid, diclofenac, paracetamol to ibuprofen and Celebrex®, low-dose tablet forms of the drugs are even available without prescription in pharmacies and often people do not know exactly which of the painkillers is the right one in the case of a dental root inflammation. This is dangerous, because some painkillers can cause bleeding and should not be taken in anticipation of a possible surgical intervention at the dentist because of the acute risk of bleeding (e.g. acetylsalicylic acid known under trade names such as Ass, Aspirin and Tomapirin). The active ingredient acetylsalicylic acid, which is known by the trade name Aspirin, is like Diclofenac a Cox inhibitor, which has a blood-thinning effect and is therefore generally not recommended for toothache.
If surgery is required because of the pain, the bleeding tendency is a danger and the aspirin often has to be discontinued before surgery can be performed. Usual single doses in tablet form are 75mg to a maximum of 325 mg per day. Contraindications for taking acetylsalicylic acid are bleeding disorders, bronchial asthma, kidney disease and especially the last third of pregnancy.
Diclofenac is a Cox-2 inhibitor and like Celebrex it has analgesic and antipyretic effects. It is known to many in ointment form as a folk healing ointment for all kinds of muscle and joint pain and is an indispensable part of the medicine cabinet in almost every German household. Available single doses are 50mg- 150mg in tablet form.
150mg is also the maximum daily dose. The excretion takes place through the liver, which is why caution is advised in case of liver diseases. Ibuprofen is the most commonly prescribed pain medication in dental offices.
It is taken in tablet form and has an anti-inflammatory effect as well as pain relief, which is why it is considered the drug of choice. Available single doses are 400mg- 800mg. The maximum dose is 2400mg for adults and adolescents from 16 years of age.
Over-the-counter 400mg are available in tablet form in pharmacies, any dose beyond that is available only on prescription. Ibuprofen is excreted via the liver and is therefore not recommended for patients with liver disease. Paracetamol is primarily the remedy of choice for headaches and fever, as it not only relieves pain but also reduces fever.
It is therefore not prescribed in dental practices unless there are intolerances or allergies to other painkillers. The maximum daily dose is 4000mg, 500mg are prescribed in tablet form. Like ibuprofen it is excreted via the liver and is therefore not the drug of choice for patients with liver disease.During pregnancy, paracetamol crosses the placental barrier and enters the child’s bloodstream, therefore contraindicated.
Celebrex is the all-rounder among painkillers and not familiar to many. It belongs to the COX-2 inhibitors, has an anti-inflammatory effect, lowers fever and is mostly used for rheumatic diseases, joint pain and fever with flu. There are Celebrex in tablet form 100mg and 200mg. Normal daily dose is 200mg. The painkiller is not suitable for children, nor during pregnancy or lactation.
