Toothache Troubles: Managing Dental Pain And Costs

00:11 Eon Engelbrecht E-Radio
Welcome to Save Your Money, Save Your Teeth, the go-to podcast where curiosity meets dentistry straight from the experts. It’s Eon with you, and every week, we’re chatting with Doctor Clifford Yudelman from OptiSmile, taking a deep dive into the world of dental care. And that’s from a consumer’s perspective. So whether you are looking to brighten that smile or protect your wallet, we’ve got you covered with practical advice and the latest insights. So, stick around as we uncover the secrets to maintaining both your dental health and also your finances.
Eon Engelbrecht E-Radio
Doctor Yudelmann, once again, welcome back.
00:51 Dr Clifford Yudelman OptiSmile
Hi, I. Thanks for having me on. I’m really enjoying sharing all this useful information with our listeners. Hopefully, what we’re discussing today will help avoid some problems for some people as well as save money, which is what we’re trying to do here.
01:09 Eon Engelbrecht E-Radio
Before we get into the nitty-gritty stuff. Happy anniversary to you, Doctor Yudelman. To you and your wife. I see you recently had an anniversary. Congratulations.
01:19 Dr Clifford Yudelman OptiSmile
Oh, thank you. Yes, it was our 10th anniversary of rekindling and our first wedding anniversary on Sunday.
01:27 Eon Engelbrecht E-Radio
Amazing.
01:28 Dr Clifford Yudelman OptiSmile
And she was actually my high school sweetheart. We didn’t talk for 37 years after I broke up with her just after matric, and we went our separate ways. I was in Australia, and she popped up on Facebook back in 2014. I was back here three weeks later and the date was 21 April 2014. And four years later, we got engaged. Five years after that, we got married. And that was ten years ago already. So, thank you.
01:56 Eon Engelbrecht E-Radio
That’s amazing. I love that story. I’m a sucker for a nice, romantic story like that. But anyway, moving on now to something less pleasant is that uncomfortable, throbbing, deep, intense pain that you can’t ignore no matter how hard you try. And that’s a toothache. And that’s what we’re talking about today here on the podcast. Doctor Yudelman, what could a sharp, shooting pain in one’s tooth indicate?
02:24 Eon Engelbrecht E-Radio
And what steps should someone take to manage it?
02:28 Dr Clifford Yudelman OptiSmile
So if it’s a sharp shooting pain, like you say, then a nerve is definitely exposed, maybe from a deep cavity or a cracked tooth or a loose filling. The immediate action should be to take over-the-counter painkillers. I usually recommend that people keep away from any leftover codeine tablets or “Stopaine”, those types of things. I like to recommend that people take 400 milligrams of Ibuprofen, which you can buy from behind the counter in the chemist, especially if you don’t have a stomach ulcer or stomach problems. You take those with food, and you can take those three or four times a day, and then in between times, you take two Panadols or Panado, which is 1000 milligrams. So, you’re taking painkillers every few hours, and that will normally control any kind of very severe pain. I recently had shingles and the ER, so I went to the ER. It was so painful, and they recommended all kinds of prescription painkillers, which I refused, and I went home, and I actually did exactly that, the medication that I just recommended.
03:46 Dr Clifford Yudelman OptiSmile
And it even worked for shingles, which is extremely painful. The other thing you should do is you can put a cold compress on the side of the face. If the face is starting to swell, you don’t want to put heat on it, and of course, avoid chewing on the side of the mouth. You should contact a dentist as soon as possible for urgent care to prevent further damage or infection. And you need to be clear when you phone a dentist; hopefully, you have your own dentist. If you’ve been going to a dentist for several years, or you’ve even been to a dentist recently for an examination, the dentist should make an effort to get you on the very same day. If you’re calling around, the priority for the dental practice is not as high. At OptiSmile, we always try to see toothache patients on the same day, but we prioritise our own patients and people that are pre-booked.
04:41 Dr Clifford Yudelman OptiSmile
But because we have seven treatment rooms and a number of dentists, we can often find a gap for someone with a toothache. But it’s not always the case. So that’s another reason why you should listen to our previous podcast about prevention and going in and getting a full checkup to avoid toothaches, because it’s not pleasant.
05:01 Eon Engelbrecht E-Radio
Not at all. What if the pain is more of a dull ache, possibly accompanied by swelling or maybe even a feeling of pressure?
05:09 Dr Clifford Yudelman OptiSmile
If someone makes it through an episode of toothache where they have a sharp pain like we were talking about, which usually, as we said, is indicative of needing a root canal treatment, which we’ve spoken about, or even getting the tooth extracted, if you’re able to get through that stage without seeing a dentist, or sometimes a tooth will die quietly and not give any indication of pain. So, this swelling and this dull ache and the feeling of pressure usually suggests an infection, like a tooth abscess, which requires prompt professional treatment. You can manage the pain with over-the-counter medication like I mentioned, and use saltwater rinses to reduce the bacteria and soothe the inflammation. So, ice packs on the outside and salt water rinses on the inside just a teaspoon of salt in a cup of warm water and you can rinse three or four times a day. And you should get immediate dental care to get antibiotics. This is a case where you would have antibiotics right away and to prevent the spread of the infection. If you keep going, you could wake up with a severe swelling.
06:20 Dr Clifford Yudelman OptiSmile
It could affect your airway and it’s usually much more difficult to treat. This type of thing only gets worse, so you’ve got to act on it. If you don’t have funds or finances, you go to the nearest government, clinical, government hospital or dental school. There’s, in Cape Town, there must be 20 or 30 clinics for underprivileged people or people with no income. And there’s no need to suffer from a dull ache or a swelling or a swollen face. You can normally get treated the same day.
06:54 Eon Engelbrecht E-Radio
So sometimes the tooth hurts when you bite down, but then the pain quickly subsides. Is this also a cause for concern, doctor?
07:01 Dr Clifford Yudelman OptiSmile
So, yeah, so look, this is usually can be caused by a crack or a crack tooth syndrome, or maybe early decay or a loose filling. Even if the pain is fleeting, you should get a checkup as soon as possible to address potential issues early. And you should keep a note, maybe write it down when and how the pain occurs so you can provide detailed information to your dentist for a better diagnosis. We should do, we’ll do a podcast on crack teeth and cracked tooth syndrome, because we do see a lot of this, but basically it’s where you bite on like, say, pizza crust, and you get a sharp pain as you release. And those teeth normally can be treated with an onlay or an inlay. Sometimes a crown, which I don’t usually recommend. I recently had a tooth that was exactly like we just described, and I got an onlay on it.
07:57 Dr Clifford Yudelman OptiSmile
The thin cusp that was cracking, that was giving me the pain on biting was removed and it was replaced with ceramic. And the tooth was absolutely perfect. No root canals or anything like that. If you wait, you’ll end up with a root canal, definitely.
08:14 Eon Engelbrecht E-Radio
Why do some people experience toothaches only when consuming hot or cold foods? Is this a serious issue?
08:22 Dr Clifford Yudelman OptiSmile
So, we spoke about sensitivity recently. So, sensitivity to extremes like hot and cold often results from worn enamel or gum recession, where the dentine is exposed. While it’s not immediately dangerous, it requires a dental examination to prevent further deterioration. We discussed before using desensitising toothpaste and consider changing your brushing technique to protect your enamel and your gums and things like hot water with lemon, and sour candies, and carbonated beverages. These are usually the culprits.
09:02 Eon Engelbrecht E-Radio
Okay, and what about toothaches that seem to come and go, so they appear for a few days, and then they disappear again?
09:09 Dr Clifford Yudelman OptiSmile
Those types of toothaches may indicate a chronic condition, such as a hidden infection or a gum disease. Consistent dental care routine and checkups are essential to monitor and manage things like that. You should tell your dentist about intermittent pain because it can often mean that there are more complex dental health issues.
09:33 Eon Engelbrecht E-Radio
Doctor Yudelman, is it normal to experience toothaches after dental procedures, and when should one contact a dentist about it?
09:41 Dr Clifford Yudelman OptiSmile
If it’s an actual toothache, where your tooth is throbbing or it’s a consistent pain, I would definitely call the dentist right away. At OptiSmile, we give patients our individual numbers. Whichever dentist you’re seeing, we give you our personal number, and we will be available on WhatsApp. We also have after-hours information, and we’re easily contactable. If someone’s had a big procedure, we’ll often check up to see how they’re doing. However, some sensitivity after procedures like fillings and crowns is normal. When patients leave here, we often give them a couple of panados before they leave, and we tell them what to expect.
10:25 Dr Clifford Yudelman OptiSmile
But in most cases, after crowns or fillings, patients leave, the anaesthetic wears off, and there’s no sensitivity at all. Maybe a little bit of tenderness in the gum if we’ve used a wedge, clamp, or something to help shape the filling. But if you’ve got persistent pain or increased sensitivity after several days, that usually means that the bite needs adjustment, or you may need further treatment. If you had a very deep filling or an inlay that was very close to the nerve, it could mean that the nerve didn’t survive the procedure, and you may need a root canal. So I wouldn’t wait. I would contact the dentist if it doesn’t seem right and just get advice directly from your dentist. An early intervention, like polishing a filling to reduce the bite if it’s high, or on an inlay or crown if it’s not biting properly, or maybe there’s a bit of cement still stuck in the gum, early intervention can prevent complications, so definitely follow up on that.
11:31 Eon Engelbrecht E-Radio
Now, I know when you have a toothache, it sometimes feels like the world is ending, and it feels like an emergency. But when does a toothache actually warrant a visit to the emergency room?
11:42 Dr Clifford Yudelman OptiSmile
So that’s a good question because, you know if a patient wakes up with severe swelling or fever, high fever, which means you’ve got a severe infection or difficulty breathing or difficulty swallowing. It can happen from a wisdom tooth. If a patient’s been on and off antibiotics for an infected wisdom tooth, and then the wisdom tooth starts to get infected again with a much more serious germ, you could wake up one day with a slightly swollen face and maybe just not take action on that and then go to sleep and the next day you could literally, your throat could be closing up, you would go straight to the emergency room. There are cases where it’s life-threatening, and even in older people, if you’ve got an elderly parent that’s got a swelling or infection if they’ve got heart problems or diabetes, these things are serious. I wouldn’t phone around and try and get into a dentist. Every emergency room around the world has an oral surgeon on call. Oral surgeons aren’t going to do a filling or a root canal, but they will assess the infection and they will prescribe antibiotics.
12:57 Dr Clifford Yudelman OptiSmile
Sometimes, an antibiotic drip might even be needed. They might put you on other kinds of pain medication. If your airway is getting blocked, they might even put you in the ICU; make sure that you don’t need to be intubated. I would avoid waiting to see if symptoms resolved on their own. I would go straight to the emergency room.
13:16 Eon Engelbrecht E-Radio
Yeah. And how can one manage dental costs while also ensuring serious toothaches are treated?
13:24 Dr Clifford Yudelman OptiSmile
So, look, if someone can’t afford to go to a private clinic like OptiSmile, which by its nature, is the type of thing that we specialise in and where we locate it and the labs that we use, we’re not the cheapest dentist in town. You don’t have to go to a very fancy place for everyday dentistry. If you see a dentist who’s contracted into medical aid, even if you don’t have medical aid, they will charge you medical aid rates, or they should. And you can often ask if you can’t afford treatment and need four or five fillings, maybe they can give you a discount even on expensive treatments. At OptiSmile, if someone needs six teeth fixed in one visit, we will often give a 10 or 15% discount. It still can come to a lot of money, but if you are unemployed or you don’t have the money, you. As I mentioned, you can go to a community health centre or even a university dental clinic.
14:24 Dr Clifford Yudelman OptiSmile
You might wait. There are, in the Western Cape, a number of government clinics. There are also these types of clinics all over South Africa where newly qualified dentists spend a year. It’s called “comserve” community service and you, you’re going to be getting a newly qualified dentist, but it’s better than then having a swollen face. You can get a tooth pulled out for free or almost nothing. They have a sliding scale. But prevention is always key.
14:52 Dr Clifford Yudelman OptiSmile
Regular checkups and maintenance can prevent toothaches, prevent emergencies, and prevent spending higher, you know, leading to higher expenses or higher costs. And listen to some of our previous podcasts about prevention because that is always way better than ending up with a toothache.
15:13 Eon Engelbrecht E-Radio
What would you say is a good approach to ascertain if a dentist is actually understanding of any financial limitations?
15:21 Dr Clifford Yudelman OptiSmile
So, it’s always best to be upfront. Don’t go and pick the fanciest looking dentist on the Internet if you can see that it’s not something you’re going to be able to afford. At OptiSmile, we do charge R2800 for an examination, but we book an hour and a half, and the total value of the treatment that we do in that visit comes to a lot more if we do a 3d scan if we do a ray, we take photographs, we do a full treatment plan, we spend a lot of time. It’s got a much higher value, but it’s still a lot of money. If you’re going to spend R2800 just on an examination at a clinic like ours, there are others like us in Cape Town, and then the clinic charges R1000 rand or R1500 or whatever it is for a filling and you can’t afford that. Don’t go and spend the money on that expensive exam in the first place. Go to a clinic where they’ll have a much quicker look, you know, spend maybe 15 or 20 minutes, say, yep, you need two or three fillings or cavities, and they’ll book you in.
16:29 Dr Clifford Yudelman OptiSmile
If all you can afford is a silver filling, and that’s what they do, it’s better to get it done than to leave the cavity to get worse. And always be transparent. Ask before you get any treatment done. We try not to do any treatment on the first visit. We like to give patients a full written quote and give them time to consider it and to talk to their husband or wife or their bank manager and to make sure that they can afford it. There’s no pressure to start treatment right away unless it is urgent. And even then, we’ll give patients an option unless they have a really extreme toothache and they need a root canal to be started right there, and then we’ll always do what we can to help a patient, even if they’re in front of us and they don’t have the money and some reason they did book in.
17:18 Dr Clifford Yudelman OptiSmile
We always try; we don’t send people away in pain, but that’s not an ideal situation. And there are community health programmes and different clinics. In the Western Cape there’s a clinic called Vision Medical Suite that treats underprivileged and patients with disabilities. And every month, they do theatre where they do general anaesthetics, and underprivileged people can have extractions and so on, especially people with disabilities that need a general anaesthetic. It’s vision or new vision, I can’t remember exactly, but it’s online and it’s not for every type of person. They have certain criteria, but it’s amazing what is available.
18:02 Eon Engelbrecht E-Radio
And finally, any advice for our listeners currently suffering from a toothache?
18:08 Dr Clifford Yudelman OptiSmile
So, I feel very sorry for you. I’m sorry to hear that you have a toothache. Don’t ignore any ongoing dental pain; it can signify a serious underlying health issue. You should explore all your options for dental care. If you’ve got a credit card and it’s not maxed out, it’s better to spend on your teeth than that holiday that you’re saving for. If it means that you will go without food for a month, then rather try and get into one of the clinics I mentioned. Prompt action can often lead to simpler, more cost-effective treatment.
Delaying care usually leads to more extensive and more expensive procedures.
18:52 Eon Engelbrecht E-Radio
That’s toothache for this week. Doctor Yudelman, thank you, as always, for sharing your expertise with us.
19:00 Dr Clifford Yudelman OptiSmile
Thank you very much. I hope we managed to help a lot of people with today’s podcast. You have my sympathy. If you’ve ever had a toothache, or if you’ve got one brewing, go and get it sorted out now. That’s all I can say.
19:16 Eon Engelbrecht E-Radio
Yeah, and don’t wait for your face to swell or breathing difficulties. I think that’s way past the threshold. I think you should definitely get attention in those cases. But thank you, as always, also to our listeners. And remember, while we strive to provide valuable insights, always consult with your own dental professional for advice tailored to your personal health. And then also, don’t forget to subscribe for more enlightening discussions and join us again next week as we continue to explore the fascinating intersection of dental health and financial savvy. Until then, keep smiling and taking great care of your teeth.

Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Doctor Clifford Yudelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting OptiSmile for articles that illuminate the path to optimal oral health. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book directly online at https://optismile.co.za/. OptiSmile, where global expertise meets local care.