Chipped tooth but in Souh America!

have a look at the website of the embassy (Irish or any EU or US). They might have a list of English speaking (or even EU or US educated) dentists.

Having been to Argentina, Chile, Peru and Bolivia I'd def feel confident going to a dentist in Argentina. It's a very European country in a lot of ways. Peru perhaps near a big city but I'd never ever go to a Bolivian dentist unless it was an absolute emergency.

Eh, that's not what that link says at all. In fact what it says is to ask your pharmacist's advice about the safe use of painkillers particularly codeine. It says nothing about going to your pharmacist if you're experiencing dental pain. The most appropriate place to go if you're experiencing oral or perioral pain is the dentist, and that is that, there are no arguments that can be made against that that I will accept.

Big_G wrote: »

Eh, that's not what that link says at all. In fact what it says is to ask your pharmacist's advice about the safe use of painkillers particularly codeine. It says nothing about going to your pharmacist if you're experiencing dental pain. The most appropriate place to go if you're experiencing oral or perioral pain is the dentist, and that is that, there are no arguments that can be made against that that I will accept.

http://www.ipu.ie/more-news/508-ask-your-pharmacist-first.html

The purpose of the commercials is to encourage people to make their local pharmacy their first port of call for their health and increase awareness of the fact that the local pharmacist is the most accessible health professional.

badboyblake wrote: »

Any evidence to back up that statement?

What if you're not near a Dentist/can't get an appointment to see one?

That is totally besides the point. You should not substitute another healthcare professional for a dentist in the case of oral or perioral pain. OBVIOUSLY if there is no dentist you should see another healthcare provider.

Compare the curricula for undergraduate pharmacists, physicians and dentists. Dentists spend 5 years studying the oral and perioral tissues, their diseases and management of those diseases. All we look at all day everyday is the mouth.

I have the utmost respect for my physician colleagues, but I have seen every misdiagnosis in the book from GPs when it comes to diseases of the mouth up to and including a false diagnosis of oral cancer. WOW. And the accompanying wrong treatment plans.

Big_G wrote: »

Well I would like to respectfully disagree with the IPU. Pharmacies are not primary care providers. Pharmacists are not trained in the diagnosis and treatment of oral or perioral pathologies.

Forgive me for trusting the representative body of Irish pharmacists (whose campaign incidentally was fully supported by the IMO, if I recall) over yourself.
To address the OP's issue, as this arose for a friend of mine in South East Asia earlier this year, the answer is simple:

Go to the pharmacist.

They can provide initial pain relief AND advise on where to go to obtain corrective treatment.
The guys in your hostel won't have a clue, and your hotel receptionist or tour guide cannot be relied upon to refer you to the optimal health care provider. But the pharmacist can and will address your needs, if asked.

If the pharmacist is closed, you can bet the dentist is too.

Earlier this year, my mate needed emergency dentistry in Cambodia. He went to the pharmacist, and got some pain relief. The pharmacist was able to refer him to the nearest English speaking European standard dentist and arrange a tuk-tuk to take him directly there.

None of this could have done on his own. There is a genuine risk in many countries, where dental standards are not good, of being treated by a dentist who is poorly trained, under unhygienic conditions.

A pharmacist will send you in the right direction. That's why they should be first port of call.

Big_G wrote: »

That's fair enough, I think that you've misunderstood the message that the IPU were trying to get across, which is that people shouldn't be annoying overworked A+Es and GPs with minor illnesses. This is the one problem that I have with that campaign is that people such as yourself might misunderstand the message.

I haven't misunderstood the IPU's message. It's perfectly clear. A pharmacist is the most easily accessed health professional and should be your first port of call.

Big_G wrote: »

My message is clear if you have dental pain, get thee to a dentist.

Which is not good advice unless you can be sure of a quality standard of dental treatment from that dentist, which is not always possible if you find yourself in a foreign country, where they speak another language and where health and medical standards are not the same as here.

Big_G wrote: »

The advice about seeing a pharmacist for where to attend a dentist is valid. The other thing about dental pain, as anyone who has experienced it will tell you, is that often it is not relieved by over the counter or even prescription analgaesics.
And, by the way, the OP did not say he had any pain, but a broken tooth.

Depends on the pharmacy and the country. I've seen diamorphine handed out without a prescription in Asia. That would do the job for most dental pain, I'd imagine.

Big_G wrote: »

If that is what you feel the message is (I don't), then let me just say I vehemently disagree with that.

Here's what they say:

The purpose of the commercials is to encourage people to make their local pharmacy their first port of call for their health and increase awareness of the fact that the local pharmacist is the most accessible health professional.

And I for one think it's very sensible advice.

Big_G wrote: »

Again true, we are continuously advising people to not travel just for dental treatment. However, and this is admittedly off topic, you were talking about advice that the IPU is giving patients in Ireland, which I am disagreeing with.

Again, I gotta go with the IPU rather than yourself on this one.

Big_G wrote: »

Yes, because diamorphine is an appropriate, non-palliative treatment for dental pain, without any significant side effects. /sarcasm. In fact, dentists use pain as an aid to diagnosis. So if this patient had taken diamorphine, and was in a depressed conscious state, and had decreased symptoms, an appropriate diagnosis may not be possible if he/she decided to attend a dentist. Not to mention an inability by the patient to give informed consent to any treatment. You've said you may not be able to be sure of the quality of dental care, but you can be sure of good care if a pharmacist gives you diamorphine. That makes huge sense.

I was just addressing your suggestion that a pharmacist couldn't alleviate dental pain. Of course they can.
When I last had dental pain abroad, I got given Ponstan by a local pharmacist and that did the trick perfectly.

My how this thread has been dragged off topic by a few know-it-all, know-nothing posts.

For your information, Badboyblake, compound analgesics usually contain two or more drugs, one of which is usually an nsaid and one of which is usually an opioid. Mefenamic acid is an nsaid, and one with weak analgesic properties. In fact some studies have found ibuprofen, which is available over the counter, to be superior.

Here is a study comparing a compound analgesic with ponstan for dental pain: ponstan for dental pain?
here is the definitive league table of analgesics for acute pain: Oxford league table which shows a compound analgesic at number 5. Ahead of many nsaids. In fact it is one that is commonly prescribed in dentistry: solpadol/tylex.

An analysis of the studies you provided:

Dionne and Berthold 2001 - analyses studies which use the oral surgery model of comparing analgesic modalities, therefore irrelevant in the case of irreversible pulpitis, the most severe and difficult dental pain to treat with analgesics. Also mentions compound analgesia should be reserved for cases where the nsaid alone is ineffective.

Canadian collaboration - included only one study on compound analgesics

Hargreaves and Abbott - reads like an opinion piece but says that dental treatment before painkillers is the most appropriate way to treat dental pain, which is what I was saying above. Makes no mention of how effective compound analgesics are, just mentions that codeine has side effects. Big news, nsaids have side effects too.

Mickel et al - a survey study? Really? Poor show. Ask 5 different dentists and you'll get five different opinions. Not great science, really.


BNF 54 - I was unable to access this one. But the search you made was under dental abcess. Not the only form of dental pain, nor the most difficult to obtain pain relief. That is reserved for a hyperaemic pulp/irreversible pulpitis.