Toothache - questions and answers
Toothache is pain around the tooth, in the tooth or in the jawbone. It is a signal that there is a problem and that one needs to see the dentist.
The toothache is mostly caused by decay of dental tissues. Other reasons include:
- gum disease
- infection after tooth extraction
- impacted or unerupted teeth
- disturbed position of the teeth
- tooth fracture
Caries destroys dental tissue. When only surface layer (enamel) is affected, everything is pretty painless since the outer layer is not connected to the nervous system. If caries penetrates deeper into the tooth and affects the hard dental tissue (dentin) and a contact with cold, hot and sweet food or drink occurs, the nerves record pain impulse and alarm pain center in our brain. If caries progresses to the soft dental tissue (dental pulp) inside the root canal the pain becomes more intensive. The level of pain can vary and occur periodically or constantly and it can be: mild, blunt, sharp, pulsating, intensive, stabbing, acute and even exhausting.
Gum disease can cause toothache if the following occurs:
- gum disease caused gums to detach from the teeth
- food and bacteria are collected in the space between the gums and the teeth
- a periodontal pocket appeared in that space
- if the pocket becomes deep and leads to inflammation, it will progress along the tooth and destroy dental tissue.
- Such a process will most certainly lead to painful states, which can be serious and long-term
- diseased gums will be swollen and infected which can make chewing painful
- temporary relief can occur if it comes to pocket burst but it will only be short-term if not properly treated
The pocket must be opened, drained and treated with antibiotics, and such procedure can only be done by a dentist.
Three-way or trigeminal nerve is a big nerve of the face and the jaw. All teeth i.e. nerves coming through the tooth root are connected to it. That is the reason we can feel the pain in the upper jaw although the source of pain is in the lower jaw. Such opposite feeling of pain is mostly happening when the cause of pain is caries inside the tooth. If the caries is on the outer side of the tooth, it is very easy to determine the tooth, which causes the pain syndrome. Examination at the dentist's will clearly define which tooth must be repaired in order to get rid of the toothache.
The outer layer of the tooth (enamel) is not connected to the nervous system, but hard dental tissue (dentin) below it is. When dentin is exposed to external influence, it will react to hot, cold and sweet food or drinks. The level of pain can be weak and will disappear shortly after the consumption.
Caries must not be the only culprit for decay of the outer layer of the tooth and exposure of dentin. There are also other causes like:
- abrasion or wear - decay of enamel on the edges where the tooth is connected to the gums which can be caused by excessive and hard brushing.
- erosion- this happens when gastric acid enters the oral cavity and erodes the enamel (a special problem with bulimia)
- deteriorating or grinding - it especially applies to patients who clench or grind their teeth when sleeping
When caries enters the root canal it will lead to pulp inflammation, the pain will be temporary, and the tooth becomes sensitive to hot and cold beverages or food. Further development of caries increases the pain which can lead to constant pulsating pain. Pain can also occur temporary, and can become worse when laying because of the increased flow of blood to the brain.
Periodontal pocket is the most common culprit for a strong pulsating toothache, regardless if it is in it's initial stadium or if it is fully developed.
- such pain mostly indicates that pulp deteriorated because of bacteria penetration
- pulsating pain can last for hours on end
- deteriorated soft tissue of the dental pulp decays and produces gases, which will cause a strong reaction to hot and cold
- the pocket can be deepen to the top of the root and form a cyst, and the gums will be swollen
- body temperature can rise and one can feel exhausted
The only solution in this case is to open the tooth, remove the deteriorated dental pulp, and the tooth is left open in order for the secretion to come out. Relief of the pain will start immediately although the tooth will remain sensitive and sore, and the area around the root will stay infected. An antibiotic therapy is needed and after endodontic therapy the tooth is filled or a new crown is placed if necessary.
The combination of these symptoms indicates that the burst of periodontal pocket occurred, and the bad breath and rotten taste in the mouth are present because of the purulent discharge drainage. Toothache will be relieved because of the reduced pressure in the pocket, but will remain present and chewing will be painful. A visit to the dentist's to start antibiotic treatment is necessary as soon as possible.
After the tooth extraction the jaw remains with a hole where the root once was. Gum is not sewn after the tooth extraction and the wound is left open. If food penetrates the wound, there is a possibility of infection before the gum heals, and the toothache which can appear can be even stronger than before tooth extraction. The pain is constant and stabbing and hard to be put under control with any kind of pain killers. Going to the dentist is the best solution.
After filling the tooth it can be sensitive the next few weeks, and as a rule it happens when caries has attacked the tooth so deep that it has almost approached the dental pulp. Dentin, placed below enamel, is very sensitive, although we call it hard dental tissue. The sensitivity will reduce when the filling is maximally connected to the rest of the dental crown.
In a regular position teeth are arranged so that there is a small space between them allowing us to brush our teeth from all sides. Food often stays in those places, and a problem can be caused if:
- the food sticks between the teeth i.e. in the gums while chewing
- remaining food will cause gum irritation, which will lead to swelling, redness and gum ache
- if it develops into an inflammation it can spread to the rest of the jaw and cause toothache and pain when chewing.
In order to avoid such development one should regularly brush the teeth and use dental floss or silk in order to keep oral hygiene. If there is a problem, and the patient cannot remove it himself/herself, he/she should visit the dentist as soon as possible.
It is often the case that wisdom teeth do not have enough space in the jaw to develop completely and erupt. Their eruption can be very painful for the patient, and there are several reasons.
- Partial eruption of wisdom teeth - they will most probably have some gum over them. The food will enter under the gum during consumption. It will most probably lead to gum inflammation, which can be very painful for the patient.
- Impacted wisdom teeth - they can cause pain by pressuring the nerves surrounding them or neighboring wisdom teeth on it's way during eruption.
Sinuses can lower in the bone and can be very near the top of the tooth root at some places in the upper jaw. The main three-way or trigeminal nerve going through the face connects all jaw, teeth and face nerves. When we get a cold our sinuses often get a cold too and the infection can therefore be transmitted to the tooth root if the sinuses are near. This of course is not a problem with teeth and they do not have to be treated because the toothache will disappear as the sinuses get better.
Different accidents can seriously damage out teeth, and especially teeth in the frontal region can be affected. The pain will vary depending on the type and level of teeth impairment.
- If a great part of the tooth is broken and dental pulp and blood vessels get exposed, the pain will become very strong and uncomfortable. In this case it will be necessary to treat the root canal and dental pulp as well as corresponding restoration of the dental crown.
- If the tooth is not broken but stuck into the jawbone, this can lead to dental pulp impairment as well as blood vessels around the top of the tooth root. Such tooth will be sensitive even to the smallest pressure (chewing) and can lead to wobbliness and movement of the teeth. The dentist will accurately follow behavior of the teeth in order to determine the level of impairment and determine the best therapy according to it.
It can sometimes happen that a tooth has a crack not visible to the naked eye. It mostly happens with teeth that were testored with a filling. If the crack progressed up to the inner part of the tooth, where the pulp is, the tooth will react to cold and hot. If such a crack happens, the mostly has to be extracted.
A big three-way or trigeminal nerve is going through the face. All the nerves from the face and the jawbone, as well as the teeth are connected through it. It can happen we feel the pain in the nerve and therefore our whole face hurts, and not a single tooth. It is very hard to determine the source of pain in such a state, but, luckily, this a very rare state.
Painkillers are used to relieve the toothache. Aspirins or ibuprofen are mostly used, and there are painkillers for which you need a doctor's receipt. If you use them on selfinitiative you must comply with the instructions or consult with your doctor.
Wisdom teeth are the last teeth to grow. Some patients get them earlier and some later in life. The eruption can be painful, and with most patients they cannot develop full since there is not enough space in the jaw.
- Ice - can be used in several ways. The first option is to cool the tooth with a cold compresses directly on the cheek. The relief will be immediate but short-term. The other option is to rub an ice-cube on the palm between the thumb and index finger. Using this method for 5-7 minutes will cool the pain center in the brain and we will feel relief in 5-10 minutes for a longer period than in the first method. This method is scientifically proven with effectiveness greater than 90%.
- Clove - you can buy clove oil in each better equipped drugstore. Follow the instructions for use and be careful to put the oil only on the aching tooth, and not the gums. Be careful about the quantity and do not swallow it since it can lead to poisoning. Clove oil will not cure the toothache, but will only temporarily relieve the nerve.
- Salt - a teaspoon of salt melted in warm water can also be helpful. Gurgling will relieve the pain and disinfect the oral cavity if necessary. The solution must not be swallowed but must be spitted out.
- Black tea - a teabag of black tea must only be wetted in warm water and placed on the aching tooth. Black tea will reduce intensity of pain and relieve the nerve.
- Sage - sage tea will help in relieving the toothache. Gurgling or a teabag on the tooth will both be effective. If you gurgle it you can swallow or spit out the tea, according to your wish.
If the patient is not sure of the cause of the pain he/she should first brush the teeth, use dental floss and mouthwash. It can be possible that the pain is caused by the food left between the teeth and a detailed brushing could relieve the toothache.