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.
