Many of our chronic dental painters / narcotic entrepreneurs have horrible teeth, no doubt about it. While their "horrible pain and can't afford a dentist" will probably be treated without suspicion initially, the subsequent 6 or 7 visits a month for 10/10 pain smack of insincerity and scamming behavior. Most dental pain is treated with antibiotics and pain medication. The more visits, the less likely it is that percocet will be on the discharge menu. After a few of these visits, the savvy patient starts adding allergies; first ibuprofen, then tramadol. Then tylenol, which would then eliminate percocet as a choice. Clever seekers will say they have no trouble with the oxydocone, but that effectively shoots them in the foot since we never, ever give out plain oxy's in the ER.
When the patient is diagnosed with abcess, sometimes they get IV antibiotics. Mostly they leave with a script for penicillin and pain meds. Some doctors will write notations on the script numbering the penicillin "1 of 2". When only script #2 is presented at the pharmacy (the pain med) this prompts a call from the pharmacist asking what the 1st script was, because the patient can only afford one of them. Definitely needs antibiotics, they are told; maybe they should buy that instead of cigarettes. The patient usually just goes away, to try and play us another day.
Why not just combine the antibiotic AND the pain med? Percocillin! Everybody is happy!