Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

TOOTHACHE



Toothache facts
  • The most common cause of a toothache is a dental cavity.
  • The second most common cause of toothache is gum disease.
  • A toothache can be caused by a problem that does not originate from a tooth or the jaw.
  • During pregnancy, the ideal time for non-emergency dental treatment is during the second trimester or if possible, after delivery.
  • Over-the-counter medications such as ibuprofen (Motrin or Advil) can be effective pain relief when taken on a schedule.
What is a toothache?
·         A toothache refers to pain around the teeth or jaws primarily as a result of a dental condition. In most instances, toothaches are caused by tooth problems, such as a dental cavity, a cracked tooth, an exposed tooth root, or gum disease. However, disorders of the jaw joint (temporomandibular joint) can also cause pain that is referred to as "toothache." Moreover, sinus infection can mimic a toothache.
·         The severity of a toothache can range from chronic and mild to sharp and excruciating. The pain may be aggravated by chewing or temperature (cold or heat). A thorough oral examination, which includes dental X-rays, can help determine the cause of the pain and whether it is coming from a tooth or other non-dental problem.

What are dental causes of toothaches and how are they treated?
·         Common dental causes of toothaches include dental cavities, dental abscess, gum disease, irritation of the tooth root, cracked tooth syndrome, temporomandibular joint (TMJ) disorders, impaction, and eruption.

Dental cavities and dental abscesses

The most common cause of a toothache is a dental cavity. Dental cavities (caries) are holes in the two outer layers of a tooth called the enamel and the dentin. The enamel is the outermost white hard surface and the dentin is the yellow layer just beneath the enamel. Both layers serve to protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. Bacteria in the mouth convert sugar into acid. The acid softens and dissolves the enamel and dentin, creating cavities.
Small, shallow cavities may not cause pain and may go unnoticed. The larger deeper cavities can be painful and collect food debris. The inner living pulp of the affected tooth can become irritated by bacterial toxins or by foods and liquids that are cold, hot, sour, or sweet, thereby causing severe toothaches. Severe injury to the pulp can lead to the death of pulp tissue, resulting in a tooth infection (dental abscess). Deeper cavities can also lead to a small swelling or a "gum blister" which forms near the affected tooth. Toothaches from these larger cavities are the most common reason for visits to dentists.
Treatment for cavities depends on the severity. For a small and shallow cavity, treatment usually involves a dental filling. For a larger cavity, a filling may be insufficient, resulting in the need for an onlay or crown. For a cavity that has penetrated and injured the pulp or for an infected tooth, a root canal procedure of the affected tooth is typically required. In a few instances, an extraction may be unavoidable depending on the size of the infection. The root canal procedure involves removing the dying pulp tissue (thus avoiding or removing the tooth infection) and replacing it with an inert filling material. The procedure is used in an attempt to save the dying tooth from extraction. Once a root canal procedure is completed, the tooth is more prone to fracture and will oftentimes require a crown to protect it.
Sometimes, a dental abscess can be the cause of rapid swelling in the mouth that could potentially spread to nearby parts of the face such as the sinuses, the floor of the mouth, or the bloodstream. This rapid swelling is caused by the spread of infection and can be an emergency if the spreading cannot be controlled and results in a compromised airway or more serious condition. Treatment at a hospital emergency room may be necessary.

Gum disease

The second most common cause of toothache is gum disease (periodontal disease). Gum disease refers to infection of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins secreted by oral bacteria in "plaque" that accumulates over time along and under the gum line. This plaque is a mixture of food, saliva, and bacteria. An early sign of gum disease is gum bleeding. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth. Gum disease is complicated by such factors as poor oral hygiene, family history of gum disease, smoking, and family history of diabetes.
Treatment of gum disease always involves meticulous oral hygiene by an individual as well as removal of bacterial plaque and tartar (hardened, calcified plaque) by a dental professional. Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "scaling and root planing" and "subgingival curettage." Scaling and root planing is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment, if necessary, may include various types of gum operations. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary. Frequent visits to the dentist are recommended for periodontal maintenance (dental cleanings) and monitoring of the teeth and gums.

Tooth root sensitivities

Toothache can also be caused by exposed tooth roots. Typically, the roots are the lower two-thirds of the teeth that are normally buried in bone. Roots can be exposed by aggressive tooth brushing, irregular tooth positioning, or gum disease. During gum disease, bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The condition of exposed roots is called "recession." The exposed roots can become extremely sensitive to cold, hot, and sour foods because they are no longer protected by healthy gum and bone. Acidic drinks can also further aggravate the tooth and contribute to further breakdown of the exposed roots. This is referred to as "acid erosion."
Early stages of root exposure can be treated with topical fluoride gels applied by the dentist or with over-the-counter special toothpastes (such as Sensodyne) which contain fluorides and other minerals. These minerals are absorbed by the surface layer of the roots to make the roots resistant and less sensitive to the oral environment. Dentists may also apply "bonding agents" or bond a filling to the exposed roots to seal the sensitive areas and provide relief. Additionally, soft toothbrushes are always recommended for teeth to avoid unnecessary wear on enamel and root surfaces.

Cracked tooth syndrome

"Cracked tooth syndrome" refers to a toothache caused by a broken tooth (tooth fracture) without an associated cavity or advanced gum disease. Biting on the area of tooth fracture can cause severe sharp pains. These fractures are usually due to chewing or biting hard objects such as hard candies, pencils, nuts, etc. Your dentist can usually detect the fracture by painting a special dye on the cracked tooth or shining a special light on the tooth. Treatment usually involves protecting the tooth with a full-coverage crown made of gold and/or porcelain. However, if placing a crown does not relieve pain symptoms, a root canal procedure may be needed. In some cases, the crack is too deep and the tooth cannot be saved. In this case, the tooth is extracted.

Temporalmandibular joint (TMJ) disorders

Disorders of the temporomandibular joint(s) can cause pain which usually occurs in or around the ears or lower jaw. The TMJ hinges the lower jaw (mandible) to the skull and is responsible for the ability to chew or talk. TMJ disorders can be caused by different types of problems such as injury (such as a blow to the face), arthritis, or jaw muscle fatigue from habitually clenching or grinding teeth. Habitual clenching or grinding of teeth, a condition called "bruxism," can cause pain in the joints, jaw muscles, and the teeth involved. People who clench or grind their teeth may wake with a toothache, headache or earache. There may be soreness around the facial muscles and tenderness at the jaw joints. The action of clenching or grinding can cause cracks, fractures, and wear on the teeth. This exposes the underlying layer of dentin and causes teeth to become sensitive to temperature changes and pressure. Additionally, clenching or grinding damages the existing dental restorations and may cause teeth to loosen.
Bruxism is often due to life stress, family history of bruxism, and poor bite alignment. Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain and difficulty opening the mouth normally. These muscle spasms are aggravated by chewing or by stress, which cause the patients to clench their teeth and further tighten these muscles. Temporary TMJ pain can also result from recent dental work or by the trauma of extracting impacted wisdom teeth.
Treatment of temporomandibular joint pain usually involves oral anti-inflammatory over-the counter (OTC) drugs like ibuprofen (Motrin or Advil) or naproxen (Aleve). Other measures include warm moist compresses to relax the joint areas, stress reduction, and/or eating soft foods that do not require much chewing. If bruxism is diagnosed by a dentist, a bite appliance (night guard) may be recommended that is worn during the night to protect the teeth. However, this bite appliance is used mainly to protect the teeth and may not help with joint pain. For more serious cases of joint pain, a referral to a TMJ specialist may be necessary to determine further treatment.

Impaction and eruption

Dental pain can come from teeth that are growing out ("erupting" or "cutting") or are impacted (tooth has failed to emerge into its proper position and remains under gum and/or bone). When a molar (the largest teeth at the back of the jaw) tooth erupts, the surrounding gum can become inflamed and swollen. Impacted teeth cause pain when they put pressure onto other teeth, bone, and gum. It is further aggravated by infection. Treatment for impacted teeth includes pain medication, antibiotics (for infections), and surgical removal. This most commonly occurs with impacted third molar (wisdom) teeth.

What are non-dental causes of toothaches?

Sometimes, a toothache may be caused by a problem not originating from a tooth or the jaw. Pain around the teeth and the jaws can be symptoms of problems in other areas of the body including the heart, ears, and sinuses.
The pain of angina (inadequate supply of oxygenated blood to the heart muscle because of narrowing of the arteries to the heart) is usually located in the chest or the arm. However, in some patients with angina, a toothache or jaw pain is the only symptom of their heart problem.
Infections and diseases of the ears and sinuses can also cause pain around the teeth and jaws. Due to the proximity of the ears and sinuses to the teeth, pain related to these structures can feel as if it originates from teeth. For example, the maxillary sinuses are located just above the roots of the upper posterior teeth. A sinus infection near these upper teeth can be mistaken for a tooth problem. Because infections and diseases outside of the mouth can be the cause of such pain that is described as a "toothache," evaluations by both dentists and doctors are sometimes necessary to diagnose medical illnesses.

How is toothache during pregnancy managed?

For pregnant patients, toothaches can be a nuisance and cause discomfort. While the pregnancy can cause some additional complications, dental procedures can be performed effectively and safely with the proper precautions. Initially, a thorough exam is performed around the face and in the mouth to determine the source of the pain. Should an X-ray be necessary, lead shields are used to cover the abdomen and thyroid to prevent radiation exposure to the mother and unborn child. An X-ray is important in assessing the extent of damage that might be present in the mouth and help determine the treatment.
Dental treatment for a severe toothache or large cavities should be performed to reduce the risk of infection and eliminate the source of the pain. The ideal time for treatment is during the second trimester of pregnancy. However, in some instances, emergency dental treatment such as a root canal or a tooth extraction may be necessary and would need to be performed immediately despite the stage of the pregnancy. The pregnant patient's obstetrician may need to be consulted as well to determine what is best for the patient and baby in emergency situations.
Medications used during dental work include anesthetics and antibiotics. Anesthetic is necessary to make the procedure comfortable and stress-free and antibiotics may be necessary to treat an infection. Certain anesthetics (such as lidocaine) and antibiotics (such as penicillin and clindamycin) fall under the FDA's Category B medications and thus, are classified as safe during pregnancy. To manage dental pain, acetaminophen (Tylenol) is recommended for pain relief. Avoid medications such as ibuprofen or aspirin as these are generally not considered safe during pregnancy.

Are home remedies effective for toothaches?
If a visit to the dentist is not immediately available, there are a few remedies that may help to ease a toothache in the meantime. Avoid chewing in the area of pain and minimize exposure of cold or hot food or drinks to the area. Over-the-counter medications such as ibuprofen (Motrin or Advil) can be effective when taken regularly. Other pain relievers such as acetaminophen (Tylenol) and aspirin may also help. Rinsing the mouth out with warm water and thoroughly brushing and flossing could help remove food debris that is adding to the irritation. Oral pain relief products containing benzocaine (Orajel and Anbesol) can provide temporary relief to a tooth or the gum area. It is important to note that if there is any kind of swelling that is rapidly growing, a visit to an emergency room may be necessary as this kind of dental problem cannot wait.

Can toothaches be prevented?
The prevention of most causes of a toothache starts with a conscious effort to practice good oral home care and have regularly scheduled visits with a dental professional. Catching a small cavity or gum infection early can head off bigger problems such as an abscessed tooth or advanced gum disease. Additionally, avoid unnecessarily chewing on hard foods that could cause tooth fractures, such as ice and hard candies. When exposing teeth to acidic beverages such as soda, orange juice, and sports drinks, using a straw may help minimize sensitive teeth. Conscientious habits for the sake of dental health are a big step in preventing the unexpected toothache.

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