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What with?
I hear you ask.

Dammed Bank Hollidays!

On Friday just gone, I developed a toothache on the stump of a tooth one left from my upper incisors.
When I was 20yo, as an apprentice, the tooth was very achy, and I had a root canal treatment done.

Fast forward 30+ years, and the top bit of the tooth broke off. No pain, no worries.
20years after that, the toothache appeared.

I had excruciating pain on the Saturday. We had some out of date Co-codamol, so I took one every four hours ........ and went to bed. You shouldn't take out of date drugs ................. but any port in a storm.

Mrs Mick F found that Boots in Tavistock yesterday Bank Holiday Monday was open, and she bought some Ibruprofen/Codeine tablets for me ........... and I took one of those every four hours. Max dose is six in 24hrs, but I had eight from 4pm to 4am.

The toothache subsided quite a bit, so I had no more, but within a couple of hours, I had Cold Turkey and was shaking and freezing cold, then boiling hot. Two or three hours later, I was just about ok but weak.

I spent much of the whole weekend in bed.

Meanwhile Mrs Mick F called 111, and it was a pointless exercise. She called her dentist in Liskeard where I went, but because I hadn't been to them for ten years, they wouldn't see me. They gave her the Health Centre dentist telephone number in Truro and I had an appointment at 14:30 this afternoon. 55miles each way. I was in no fit state to drive, so Mrs Mick F did the driving.

The stump was extracted, and I'm feeling MUCH better now!

Meanwhile I'm knackered. Aches and pains - all from the stress.
I've hardy eaten since Friday evening, but tomorrow should see me back into some sort of normal ............. whatever that is.

PS:
The above is very much a précis of the whole story.
I've lost much of the weekend and it's all very hazy and muddled.

Crikey! Toothache has that ability to make a chap suffer. Glad to hear you're on the mend. I hesitate to mention it but there's another bank holiday coming along soon! D'you think you'd better stock up with painkillers now, while you have the chance?

Sorry to hear that. I hope that you're better soon.

It's a useful reminder for all of us to check our kit at home. NHS advice:
https://www.nhs.uk/common-health-questi ... t-aid-kit/

Mick F wrote: ↑9 May 2023, 6:38pm We had some out of date Co-codamol, so I took one every four hours ........

Co-codamol contains paracetamol. It's very important not to take more than recommended, and there are risk factors and conditions that should cause even greater caution:
https://www.nhs.uk/medicines/co-codamol-adults/

Jonathan

Yep, I’m very averse to taking any medicine, and a stickler for following the instructions if ever I have to, but what caused me to abandon all that and eat nurofen likes smarties?

Severe toothache over a bank holiday, Christmas and new year about five years ago specifically. I’d had a lot of work done on one tooth, and the dentist said “Do you really, really want me to do this in the week before Christmas? There is some risk that it will cause complications and lead to discomfort,”. “Press on!” says I, forgetting that when a dentist says ‘some discomfort’, what he means is ‘debilitating agony’.

You have my genuine empathy. Hope you feel properly better very soon.

Thanks Nearholmer.

I went to bed at 19:30 yesterday evening, woke up for a pee at 03:00, and then slept solidly again and got up at 05:30.
Time for a pot of tea.

I feel human, and i'm ready for a big breakfast!

A relative had 3 hour dental surgery under local which she found out she was immune to. She felt everything but the dentist didn't believe her and carried on. The pain left behind lasted several weeks and the psychological damage even longer. There's a reason why dental work is used as torture in some dictatorships!

Toothache can be extreme and pain from having work done too.i hope your better now mickf.

Jdsk wrote: ↑9 May 2023, 7:17pm Sorry to hear that. I hope that you're better soon.

It's a useful reminder for all of us to check our kit at home. NHS advice:
https://www.nhs.uk/common-health-questi ... t-aid-kit/

Mick F wrote: ↑9 May 2023, 6:38pm We had some out of date Co-codamol, so I took one every four hours ........

Co-codamol contains paracetamol. It's very important not to take more than recommended, and there are risk factors and conditions that should cause even greater caution:
https://www.nhs.uk/medicines/co-codamol-adults/

Jonathan

I don’t doubt that you are technically correct, but when in a lot of pain people understandably (well understandably to me) bend the rules. So that we can all learn from his unfortunate experience what would the better way forward (in pain relief, etc) have been?

Carlton green wrote: ↑10 May 2023, 8:40am

Jdsk wrote: ↑9 May 2023, 7:17pm ...
Co-codamol contains paracetamol. It's very important not to take more than recommended, and there are risk factors and conditions that should cause even greater caution:
https://www.nhs.uk/medicines/co-codamol-adults/

I don’t doubt that you are technically correct, but when in a lot of pain people understandably (well understandably to me) bend the rules. So that we can all learn from his unfortunate experience what would the better way forward (in pain relief, etc) have been?

The problem with paracetamol is the liver damage that it causes when taken in excess. But it has an unusual toxicity pattern: no or mild side-effects and then the liver damage. That means that you can't titrate the dose against any detectable side-effects and have to rely on the advised dose limit. It is very unwise to exceed this.
https://en.wikipedia.org/wiki/Paracetam ... se_effects
https://en.wikipedia.org/wiki/Paracetamol#Overdose

Here's the NHS advice for managing pain from toothache:
https://www.nhs.uk/conditions/toothache/

And the NICE guidance on mild to moderate pain:
https://cks.nice.org.uk/topics/analgesi ... rate-pain/
https://cks.nice.org.uk/topics/analgesi ... analgesic/

And of course many people have views on which analgesics work and don't work well for themselves.

Jonathan

PS: I don't know what you mean by "technically". The liver damage can be irreversible and can be fatal.

Jdsk wrote: ↑10 May 2023, 8:52am

Carlton green wrote: ↑10 May 2023, 8:40am

Jdsk wrote: ↑9 May 2023, 7:17pm ...
Co-codamol contains paracetamol. It's very important not to take more than recommended, and there are risk factors and conditions that should cause even greater caution:
https://www.nhs.uk/medicines/co-codamol-adults/

I don’t doubt that you are technically correct, but when in a lot of pain people understandably (well understandably to me) bend the rules. So that we can all learn from his unfortunate experience what would the better way forward (in pain relief, etc) have been?

The problem with paracetamol is the liver damage that it causes when taken in excess. But it has an unusual toxicity pattern: no or mild side-effects and then the liver damage. That means that you can't titrate the dose against any detectable side-effects and have to rely on the advised dose limit. It is very unwise to exceed this.
https://en.wikipedia.org/wiki/Paracetam ... se_effects
https://en.wikipedia.org/wiki/Paracetamol#Overdose

Here's the NHS advice for managing pain from toothache:
https://www.nhs.uk/conditions/toothache/

And the NICE guidance on mild to moderate pain:
https://cks.nice.org.uk/topics/analgesi ... rate-pain/
https://cks.nice.org.uk/topics/analgesi ... analgesic/

And of course many people have views on which analgesics work and don't work well for themselves.

Jonathan

PS: I don't know what you mean by "technically". The liver damage can be irreversible and can be fatal.

By “technically” I meant the relevant science and data. As I understand it the potential for lasting liver damage isn’t widely known - thanks for sharing that detail.

I can’t say that I thought the NHS guidance on tooth pain to be of much reassurance, I’m glad that it’s there but …

I notice that your explanations use terms that non-medical people might struggle to understand, eg. titrate. They are doubtless correct explanations but do they convey information to the intended audience …

In case there’s any doubt my comments are intended to be helpful.

Crikey - I wish you well Mick. It's a sad reflection on the times we live in when a dentist can't help someone in pain.
Some people across our land are attempting to 'fix' their own teeth, and we now have (or it's reported) the worse childhood dental situation in europe - 30 years ago we had the best childhood dental care.

I posted this recently in the 'other ' forum in response to using out of date Ibuprofen
```
Drugs degrade on storage. Regulations set the maximum amount of degradation at 5% unless other factors intervene, which would be very unlikely for an OTC/P medicine. The shelf life/Best before date is determined from the date of manufacture. The 5% limit is to ensure consistency of efficacy/performance, not toxicity. The shelf life represents the 95% lower confidence interval (or less) that the maximum degradation could have occurred under the stated storage condition over that time period. Going past this date would possibly mean that the product is less efficacious. It won't be dangerous because it either wouldn't be licensed if it was, or would be restricted to use in a medical setting.
```
Whilst I appreciate the intent of other posters it must also be realised that pack sizes available on General sale are specifically restricted in terms of the number of doses to ensure no significant issues should the whole pack be taken at once. From a legislative perspective Generl sale medicines are also restricted in terms of the number of packs and that it should not be possible to buy more than 3 packs (if I recall correctly) from any single location (Hence the implication that taking 3 packs simultaneously should have no significant issues).

So generally, there are likely to be minimal downsides to using use out of date medicines if nothing else is available. For analgesics, by all means increase the dose until the pain is relieved. A moderate increase in dose will be fine. If you need a significant increase in dose then you probably need to consult a medical professional.

As with all such advice I can't predict if you are a statistical outlier, such that just opening a pack will give the the screaming heebie jeebies followed by your head falling off.

NHS 111 still haven't got back to us.
NHS advice on toothache is pointless and misses the point entirely. https://www.nhs.uk/conditions/toothache/

This morning, it's easing. My gum is still sore, and I'm feeling weary and lethargic. Taking Ibruprofen and Paracetamol twice a day. I've bought a soft toothbrush, and that seems fine for now.

I still feel human, but not "alive" and bright. The idea of riding a bike is out of the question.

Mick F wrote: ↑11 May 2023, 10:31am ...
NHS advice on toothache is pointless and misses the point entirely. https://www.nhs.uk/conditions/toothache/
...

What's wrong with it, and what else do you think that it should say?

Thanks

Jonathan

On the occasions that the surgery hasn't stumped up prescriptions on time I've had the choice of either taking old flecainide that's years out of date, or take nothing at all and end up back on an ambulance.