Hi,

First let me thank you for posting your query here. Next apologies for the delay to answer it.

You have reported of a throbbing tooth ache which has not responded to multiple analgesics.

Often such terrible tooth ache may not respond well to oral medications. I would suggest injectable antiinflammatory medication at the ER for better pain management followed by a course of prescription NSAIDS.

I am also concerned if you have dental abscess, in which case drainage of the abscess effectively reduces the pain.

I would hence suggest you to visit the ER. Discuss with your dentist of a possible abscess formation which needs drainage.

Hope I have been some help to you. Should you have any more concerns, I am available for follow ups.

Regards

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Dear XXXXXXX

Thanks again.

Yes, abscess can be identified by physical examination. Significantly large abscess usually presents with visibly large mass with severe throbbing pain and high grade fever. And such abscess are the ones that concerned me. I presume you did not have these symptoms then.

If abscess has been ruled out, amoxicillin is effective in most gram positive and few anaerobic bacteria which are the usual suspects associated with dental infections. It usually takes 2-3 days to produce effective control of infection. A change of antibiotic or addition of cloxacillin / clavunate / or similar antibiotic is entailed if you develop swelling, fever or worsening of pain.

Now with respect to pain, you have tried combination of over the counter antiinflammatory medications. Since they have not been very effective, stronger NSAIDs (prescription medication) can be tried as they are more efficient in relieving pain. I wish you could consult a general practitioner or the doctors at ER to obtain these useful drugs.

Hope this answer has been informative, useful and appreciable to you.

Wish you a speedy recovery.

Regards

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