Expert: Ronald Levy, M.D. - 7/30/2010

Question
Hi there, thank you so much for taking the time to answer my question.

After four nights of awful toothaches, I sucked up my pride, and visited a dentist. Turns out I need two, possibly three root canals, in addition to a myriad of other problems that will need eventual treatment. I was told getting everything taken care of would cost me roughly $6,000. I do not have $6,000. Fortunately, I am going to Turkey, and a family friend will be able to treat me on the cheap in ten days.

In the meantime, I have managed my pain by combining my prescribed amoxicillin (500 mg, four times a day), ibuprofen (as needed), and heavy use of benzocaine.

I've been lightly coating my gums and teeth with 20% benzocaine every few hours, as the pain begins to return. It just occurred to me to look into potential risks of such heavy use, and I discovered some medical literature linking benzocaine to methemoglobinemia. So how much is too much? Am I putting myself at risk here? If so, what else can I do to subside the unbearable pain? What symptoms should I be on the lookout for, and am I in the clear if I don't have them?

Thanks again!

Answer
Too much is how much you are taking right now! You should not be self-medicating with Benzocaine since it is relatively easy (particularly at 20% concentration) to either overdose or cause methemoglobinemia. You are definitely putting yourself at risk. Unfortunately, short of strong pain medications, there is not much you can do for this since the pain is at the nerve level (thus a topical won't help much). I strongly suggest stoppping the Bezocaine but if you choose to continue (At your own risk), the signs and symptoms of methemoglobinemia include shortness of breath, cyanosis, mental status changes, headache, fatigue, exercise intolerance, dizziness and loss of consciousness.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston