Dental Bridge, Root Canal, Ibuprofen

[tgotch]

I had a bridge put in by my family dentist a few months ago. Shortly after, I started experiencing discomfort/tooth pain. He tried a few "adjustments", and finally referred me to an Endodontist. The Endodontist says I need to have a root canal performed on the tooth under the bridge (did some reading and find that this happens occasionally with bridges - I assume there is no recourse with family dentist).

In the meantime, my family dentist said I could take 800mg of Ibuprofen 2x per day to ward off pain. This seems to be working, although I still can't chew on that side without minor discomfort, but the pain is in check.

As a result of the bridge, and some other dental work, my dental insurance/flex spending is maxed out. The root canal will cost ~$900 out of pocket.

So I have a few questions/thoughts:
I would like to wait until 2013 so my insurance/flex spending will cover the entire procedure.

Are there any hazards with taking this amount of Ibuprofen for 6-7 months?

I understand that the pain may get worse, and/or the Ibuprofen may lose effectiveness, but anyone see any issues with waiting to have this procedure, or any recommendations?

 

[ziggy29]

I use ibuprofen for occasional discomfort but my understanding is that excessive or long term usage of it may contribute to liver and kidney problems, or at the very least make them worse if you already liver or kidney problems. I'd want to make sure my liver and kidneys were healthy and fully functioning since the evidence suggests that if these organs are impaired, ibuprofen has the potential to cause more problems.

Unless I was destitute, there's no way I wouldn't fork over the $900 to get this fixed the right way ASAP rather than trying to medicate your way through seven more months which may or may not even be sufficient until January. Just having this hanging over my head for seven months, and the worry and dread it would leave in my life for that long, would be worth paying to get rid of.

 

[easysurfer]

Sorry to hear about dental pain. I had a bad tooth from many years ago. Had a root canal, then several crowns--that eventually would only last a year or two before falling out. About a couple of years ago, I the bad tooth became a toothache from hell. Finally, my dentist said, we could pull what's left of it (there was mostly just roots and little tooth left, yet plenty of pain). That'll stop the pain. After one attempt of trying to save it, I said no more, pull it.

Fast forward to today, for that bad tooth I decided to get an implant. (Takes about a year for the entire proceedure). On June 22, I'm scheduled to have the final part of the proceedure done. I can't wait. I wish I would have had that tooth pulled sooner.

As for the questions, I would be concerned about taking Ibuprofen for 6-7 months. Perhaps making sure to not exceed the daily dosage would be okay, but 6-7 months is a pretty long time.

As for the flexible spending account. Perhaps you can ask the dentist to spread out the payments in monthly installments? That way, only a part would not be covered by your FSA.

 

[Midpack]

I had a bridge put in by my family dentist a few months ago. Shortly after, I started experiencing discomfort/tooth pain. He tried a few "adjustments", and finally referred me to an Endodontist. The Endodontist says I need to have a root canal performed on the tooth under the bridge (did some reading and find that this happens occasionally with bridges - I assume there is no recourse with family dentist).

In the meantime, my family dentist said I could take 800mg of Ibuprofen 2x per day to ward off pain. This seems to be working, although I still can't chew on that side without minor discomfort, but the pain is in check.

As a result of the bridge, and some other dental work, my dental insurance/flex spending is maxed out. The root canal will cost ~$900 out of pocket.

So I have a few questions/thoughts:
I would like to wait until 2013 so my insurance/flex spending will cover the entire procedure.

Are there any hazards with taking this amount of Ibuprofen for 6-7 months?

I understand that the pain may get worse, and/or the Ibuprofen may lose effectiveness, but anyone see any issues with waiting to have this procedure, or any recommendations?

I read a couple of answers online (evidently GI bleeding and kidney damage are potential risks), but why wouldn't you ask your dentist/doctor and follow his/her advice instead of asking here?

Is it safe to take 1600 mg of ibuprofen daily long term?

The over-the-counter maximum daily dose of ibuprofen is 1200 mg/day. Long term use of even the maximum amount is associated with certain health risks There are some disease states which require high doses of anti-inflammatory medications for treatment. If you are currently taking ibuprofen as directed by your doctor, you will probably be fine. If this is so, it is important that you see your doctor regularly so that he/she can monitor the effects of the drug on yourbody (i.e. blood tests to assess kidney function, etc). Your doctor may choose to prescribe a prophylactic dose of a proton pump inhibitor (Nexium, Prilosec, Protonix, Aciphex) or H2 antagonist (Zantac, Pepcid, Tagamet) to prevent an NSAID induced ulcer. If you have heartburn-like symptoms or notice that you bleed/bruise easily, feel exteremely fatigued, or have bloody or "black as coal" stools, see your doctor immediately.

If, however, you are taking 1600 mg/day longterm and are not under a doctor's care, your risk of eventually having these side effects is high. It is important that you let your doctor know that you are needing to take this much. Whatever problem is causing you to need to take this amount of ibuprofen on a regular basis should be addressed by a doctor.

 

[Bestwifeever]

If the pain is caused by an abscess, I don't think you want to wait even if the pain is managed by the ibuprofen.

 

[ziggy29]

If the pain is caused by an abscess, I don't think you want to wait even if the pain is managed by the ibuprofen.

Good point. Toothaches that become infected can cause serious health problems on their own.

 

[easysurfer]

If the pain is caused by an abscess, I don't think you want to wait even if the pain is managed by the ibuprofen.

Good point as the ibuprofen would just mask to pain if the cause is more.

In the case of my terrible toothache. My dentist first prescribed an antibiotic and the pain stopped for a few weeks then came back. I tried again (another round of antibiotics) and the same, pain subsided for a bit then came back. Then I said, no more, I want an implant.

 

[Mulligan]

I was told I needed to get a wisdom tooth pulled last year because it hurt a little bit and it had a cavity in it. I thought I didn't want to spend the $300 then and I would just blow it off for a while. Then a month later the pain became worse, so guess what I did that day? Money isn't as important as relief of pain is! Spread out the payments and get it done. Concerning teeth, just when something surely cant get more painful, you may find out it most certainly can.

 

[braumeister]

I still can't chew on that side without minor discomfort, but the pain is in check.

Knowing it won't get any better, and may very well get considerably worse, you want to put up with this for another seven months to save a little over four bucks a day?

Sounds to me like what my grandmother called "penny wise, pound foolish".

 

[Texas Proud]

You also have to remember that it is not a $900 decision, but only the taxes you would save on $900...

if in the 15% bracket, $135
25% = $225....


I would not wait to save a couple of hundred bucks...

 

[powerplay]

I would go ahead and get it done. The $900 will be minor in the long run and feeling well is the best life has to offer. The large dose of ibuprofen on a long term basis would concern me as I have only taken large doses like that for a few days at a time (pulled muscle in neck and wisdom tooth extraction). What if you find yourself in extreme pain on a weekend and end up getting emergency treatment that runs into the $1,000's then the $900 would seem like not a big deal. Only you can decide what level of pain/discomfort and risk you are willing to tolerate. I wish you well on your decision.

 

[Richard4444]

Tgotch ... It sounds as if your pain level is under control right now. There is a good chance than in the next 8 months, one morning you will wake up in severe pain and need to begin the root canal that day. And if so, there is a higher chance that you will have more discomfort after it is completed for a while than if you have it done now. This is what gives root canals the assocaiation with pain: You are usually in pain when you need one, not while (you are numb) and it is being performed. Good luck !

 

[FIREd]

It's a long time to wait... Personally, I don't think that ibuprofen is an innocuous as most people think it is and I would not take it routinely for months at a time. In addition, pain is a sign that something is wrong and masking the pain with drugs could leave more serious problems like an infection go undetected.

I wouldn't wait.

 

[Dimsumkid]

Are there any hazards with taking this amount of Ibuprofen for 6-7 months?

I understand that the pain may get worse, and/or the Ibuprofen may lose effectiveness, but anyone see any issues with waiting to have this procedure, or any recommendations?

I tried to wait on a cavity (6 months) and my insurance didn't kick in until Jan 2012. I never needed any pain meds and had no symptoms until I went in for my 6 month dental checkup in Dec 2011. The tooth just decided to explode on it's own the next day. The endodontist recommended Ibuprofen every 3 hours and switch to Naproxen (Aleve) every 3 hours before and after the root canal. They even had to give me more Novocaine after the procedure before I left the chair.

$900 for a root canal sounds pretty reasonable, my cost was $1200 out of pocket. I couldn't wait, turns out when he went to relieve the pain, blood gushed out and Dr. said I had an infection and I had to wait 10 days to get the root canal finished.

After having a few fillings redone, I had sensitivity issues with these teeth and found relief using a sensitive toothpaste like Sensodyne (or Crest and Colgate versions). I found using these helped with sensitivity after 3-4 weeks of use. You're not supposed to rinse for 20-30 mins after brushing for max. relief.

They also looked at an old root canal and recommended a redo of the old root canal for $1875! The endodontist I used charges more the farther back you go in the mouth. Good luck on whatever you decide, the pain caused by root canals is never good.

 

[Richard4444]

They also looked at an old root canal and recommended a redo of the old root canal for $1875! The endodontist I used charges more the farther back you go in the mouth.

That's because back teeth (molars) have 3 or more roots, while front teeth usually have just one and sometimes two.

 

[Richard4444]

okay okay who will teach the Dryer Sheet Aficionado the proper way to use quotes?

 

[ziggy29]

$900 for a root canal sounds pretty reasonable, my cost was $1200 out of pocket. I couldn't wait, turns out when he went to relieve the pain, blood gushed out and Dr. said I had an infection and I had to wait 10 days to get the root canal finished.

I was thinking the same thing. I had a root canal in 2006 and I paid almost $700 out of pocket, and that was with insurance paying 50% of it! Less than a grand with no insurance at all seems pretty cheap to me.

As for the pain, though, I was pretty lucky: I was never in pain, either with the bad tooth or with the root canal. Apparently mine abscessed without pain at the roots, and I noticed it only when I started tasting pus in my mouth in one spot on the roof of my mouth (yuck). By the time I went to my dentist and he referred me to an endodontist for a root canal, the nerve was 100% necrotic (dead) and thus I felt *no* pain at all during the procedure.

Another thing to consider is this: Wouldn't you typically need a crown after doing a root canal? I would think that the combination of a root canal and a crown in the same calendar year would exceed your insurance benefit (usually $1000-1500 a year) anyway.

 

[ziggy29]

okay okay who will teach the Dryer Sheet Aficionado the proper way to use quotes?

Fixed it for you.

 

[Alan]

Are there any hazards with taking this amount of Ibuprofen for 6-7 months?

I wouldn't continue at that level for so long without a Dr's consent. Ibuprofein can have serious side affects.

Ibuprofen Official FDA information, side effects and uses.

Cardiovascular Risk
· NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk

· Ibuprofen tablets are contraindicated for treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery
Gastrointestinal Risk
· NSAIDS cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events

 

[Richard4444]

Thanks for the repair ziggy29. Usually root canaled teeth do require crowns, but this tooth has a bridge already on top of it (which is a number of crowns), so unless the bridge gets ruined in the procedure, it can continue to be used.

 

[Dimsumkid]

Thanks for the repair ziggy29. Usually root canaled teeth do require crowns, but this tooth has a bridge already on top of it (which is a number of crowns), so unless the bridge gets ruined in the procedure, it can continue to be used.

I would ask about this, since they don't normally reuse a crown or bridge when the underlying tooth gets changed. My guess is they need to make you a new bridge

 

[Dimsumkid]

I should comment that some endodontists will not bill the insurance until after the procedure is complete. So, you can have the pain removal portion completed and then wait to finish the work. In this scenario, you could start in late Nov or Dec, then finish in 2013. Of course, check w/the endodontist first.
You could also wait with the temp for months at a time, if you're careful and don't chew on that side. I had to do this when the endodontist and dentist wanted to monitor my tooth for 6 months to make sure the problem was resolved before puttin in a crown.

 

[Richard4444]

I would ask about this, since they don't normally reuse a crown or bridge when the underlying tooth gets changed. My guess is they need to make you a new bridge

If the bridge is removed and the underlying tooth has been changed at the margins of the tooth (where the tooth meets the gum), and not where access to the root canal system is, then this is correct. Most likely the root canal procedure will be done right through the bridge without removing it. I've done a few thousand or so

 

[tgotch]

Thanks for all the feedback.

The Endodontist said he could perform the root canal through the bridge without any damage to it, and will just "cap it" when done.

I am scheduled to have the root canal June 5, and will most likely do it then (The Endodontist has been on vacation all week, so I have not had a chance to discuss this more with him). The wuss part of me is just procrastinating...I had an emergency root canal several years ago from a "yellow pages" dentist that was working on the weekend. The pain during the procedure had me in tears it hurt so bad!

My only other concern, which I did not mention in my original post, is that he thinks the tooth that is giving me problems may be a wisdom tooth (lower jaw). I had my wisdom teeth taken out in high school, but for the life of me don't remember which ones they were. The Endodontist said wisdom teeth have "funky" roots, and he may not be able to get all the root, which may also not solve my pain problem.

Worst case - root canal does not work, they yank the tooth, eliminate the bridge, and look into implant(s)..ugh!

 

[Midpack]

Very good call IMO...best of luck.