Toothache

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Toothache
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What is a toothache?
"Toothache" usually refers to pain around the teeth or jaws. In most instances, toothaches are caused by tooth or jaw problems, such as a dental cavity, a cracked tooth, an exposed tooth root, gum disease, disease of the jaw joint (temporo- mandibular joint), or spasms of the muscles used for chewing. The severity of a toothache can range from chronic and mild to sharp and excruciating. The pain may be aggravated by chewing or by cold or heat. A thorough oral examination, which includes dental X-rays, can help determine the cause, whether the toothache is coming from a tooth or jaw problem.

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 diseases of the heart (such as angina or heart attack), ears (such as inner or external ear infections), and sinuses (air passages of the cheek bones). For example, 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 are the only symptoms of their heart problem. Infections and diseases of the ears and sinuses can also cause pain around the teeth and jaws. Therefore, evaluations by both dentists and doctors are sometimes necessary to diagnose medical illnesses causing "toothache."

What are dental causes of toothache?

Common dental causes of toothache include dental cavities, dental abscess, gum disease, irritation of the tooth root, cracked tooth syndrome, temporomandibular disease, impaction, and eruption.

Dental Cavities

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. Certain bacteria in the mouth convert simple sugars into acid. The acid softens and (along with saliva) dissolves the enamel and dentin, creating cavities. Small shallow cavities may not cause pain and may be unnoticed by the patient. The larger deeper cavities can collect food debris. The inner living pulp of the affected tooth can become irritated by bacterial toxins or by foods that are cold, hot, sour, or sweet-causing toothache. Toothache from these larger cavities is the most common reason for visits to dentists.

Treatment of a small and shallow cavity usually involves a dental filling. Treatment of a larger cavity involves an onlay or crown. Treatment of a cavity that has penetrated and injured the pulp requires either a root canal procedure or extraction of the affected tooth. Injury to the pulp can lead to death of pulp tissue, resulting in tooth infection (dental abscess). The treatment of an infected tooth is either removal of the tooth or a root canal procedure. The root canal procedure involves removing the dying pulp tissue (thus avoiding or removing tooth infection) and replacing it with an inert material. The procedure is used in an attempt to save the dying tooth from extraction.

Gum Disease

The second most common cause of toothache is gum disease. Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds the teeth and holds them in place. Gum disease is caused by toxins secreted by bacteria in "plaque" that accumulate over time along the gum line. This plaque is a mixture of food, saliva, and bacteria. Early symptoms of gum disease include gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of 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.

Treatment of early gum disease involves oral hygiene and removal of bacterial plaque. Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "root planing" and "subgingival curettage." Root planing is the removal of plaque and tartar (hardened plaque) 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 may include various types of gum surgeries. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.

Tooth Root Sensitivities

Chronic gum disease also contributes to toothache due to root sensitivities. The roots are the lower 2/3 of the teeth that are normally buried in bone. The bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The exposed roots can become sensitive to cold, hot, and sour foods because they are no longer protected by healthy gum and bone. The sensitivities may be so severe that the patient avoids any cold or sour foods.

Early stages of root exposure can be treated with topical fluoride gels applied by the dentist or with special toothpastes (such as Sensodyne or Denquel) which contain fluorides and other minerals. These minerals are absorbed by the surface layer of the roots to make the roots stronger and less sensitive to the oral environment. If the root exposure causes injury and death of the inner living pulp tissue of the tooth, then a root canal procedure or tooth extraction may be necessary.

Cracked Tooth Syndrome

"Cracked Tooth Syndrome" refers to toothache caused by a broken tooth (tooth fracture) without 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. Sometimes, the fracture can be seen by painting a special dye on the cracked tooth. Treatment usually involves protecting the tooth with a full-coverage gold or porcelain-fused-to-metal crown. However, if placing a crown does not relieve pain symptoms, a root canal procedure may be necessary.

Temporo-Mandibular Joint (TMJ) Syndrome

Diseases of the temporo-mandibular joint(s) can cause pain, usually in front of one or both ears. The TMJ hinges the lower jaw (mandible) to the skull. Pain in the temporo-mandibular joint(s) can be caused by acute trauma (such as a blow to the face), inflammatory or degenerative arthritis, or by the mandible being pushed back towards the ears whenever the patient chews or swallows. Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain and difficulty opening mouth normally. These muscle spasms are aggravated by chewing or by life "stress," which cause the patients to clench their teeth and further tighten these muscles. Temporary muscle spasms can also be caused by dental injections that are used to deliver local anesthetic for dental work or by the trauma of extracting impacted wisdom teeth.

Treatment of temporo-mandibular joint pain usually involves oral anti-inflammatory drugs like ibuprofen (Motrin) or naproxen (Naprosyn). Other measures include warm moist compresses to relax the joint areas, regular aerobic exercise to reduce stress, eating soft foods that do not require much chewing, and/or repositioning the mandible forward with a TMJ dental splint.

Repositioning the mandible forward with a splint relieves pressure on the nerves and blood vessels of the TMJ, and relieves pain. The splint changes the position of how the upper and lower teeth meet. To maintain this new position, the TMJ splint needs to be worn all the time, including mealtimes, indefinitely. In patients who do not wish to wear the splint indefinitely, alternative measures to maintain the new position include placing full-coverage crowns on all of the back teeth (bicuspids and molars) or by using dental braces.

Impaction & Eruption

Impacted (teeth pressing together) or erupting (tooth growing out or "cutting") molar teeth (the large teeth in the back of the jaw) can cause pain. As the molar teeth erupt, the nearby tissues can become inflamed and swollen. Impacted teeth can require pain medication, antibiotics, and surgical removal. This most commonly occurs with impacted molar (wisdom) teeth.
Toothache At A Glance

* 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.

"Toothache" usually refers to pain around the teeth or jaws. In most instances, toothaches are caused by tooth or jaw problems, such as a dental cavity, a cracked tooth, an exposed tooth root, gum disease, disease of the jaw joint (temporo- mandibular joint), or spasms of the muscles used for chewing. A toothache can also be caused by a problem that does not originate from a tooth or the jaw, like diseases of the heart (angina or heart attack), ear infections, and sinus infections. A thorough oral examination, which includes dental X-rays, can help determine the cause.