Expert: Zev Kaufman, D.D.S. - 12/26/2009

Question
I found a wonderful new dentist that is going to start repairing 10 years of damage from my previous dentist who apparently wasn't doing a very good job. I went in for a crown that had became loose and painful. The dentist prepared the tooth for a new crown but said it was a 50/50 chance that I would need a root canal (and the pain during the prep was pretty intense, but I cannot have epinephrine). He is on vacation for another week and a half, but I have been having bad pain since he did the temp. The pain radiates up my jaw and into my head. I have had a horrible pressure headache for the last few days and I don't know if it is a by-product of Tylenol and Advil, or if it is just the nerve that obviously needs a RC. The pain is wearing me down and I feel nauseous and sick. I have fibromyalgia, so my nerves and reactions to medical problems are always intensified as it is, so I tend to minimize how serious everything is. However, this time I am feeling so bad and I cannot wait another week and a half. I don't know if this is normal and simply needs the RC or if it sounds like an infection may be coursing through? I can't take Rx painkillers because they make me feel much like I feel right now already...sick. Please help. It is Christmas and I don't want to end up in the ER. Thank you.

Answer
Dear Amanda:
Your question is the last one I answer before I go on a small vacation myself, so it is good that you caught me.
The pain that you are having is probably due to the proximity to the "nerve".  You should really have no pain during dental procedures, since there are wonderful anesthetics on the market without epinephrine.
I do not know where you are located, but if you go to www.aae.org you will find a link to an Endodontist--a root canal specialist near you.  
In your condition, the dentistry you get, should be the best that you can afford.  You do not want to redo dentistry often.  The stress is too much.
If you read many of my previous answers, you know that I am a big supporter of specialty care.  The prime barriers to specialty care are mostly financial, location availability, and not knowing that the specialist exists.  In this economic climate, many general/family/cosmetic dentists, tend to do "everything" for the patient and not refer to the specialist if he/she (the dentist) feels that they can do the work.  The problem is that statistically, the specialists do provide a higher level of care.  
Go through the American Association of Endodontists website and try and locate one who will be open tomorrow (Saturday).  It might be hard to find, but most will have an answering and paging service.  You might have to pay more for the emergency, but you sound desperate.
If you cannot locate an Endodontist, try and see if your new dentist has someone to "cover" for him/her while they are away.  If not, you can either try and locate any dentist who is open, or go to a local hospital based dental residency program--go to the ER and ask to see the dentist on call.
Do not live with this pain.  It sounds like you are not doing too well with it.
After this is resolved, do yourself a favor and go for a second opinion to the specialist in restorative, cosmetic, and implant dentistry--the Prosthodontist.  Even if you cannot afford one, at least you will have the expert's opinion on what you need to  have done. www.prosthodontics.org will have a link to locating a Prosthodontist near you.
Short of seeing you myself, this is the best I can do over this very limited forum.
I hope that you can locate someone tomorrow and get yourself out of this terrible pain.
Happy Holidays and a Happy New Year,
Dr. Zev Kaufman