A toothache or tooth pain is most often caused when the nerve to a tooth is irritated, but there are numerous other reasons for a person to experience tooth pain. Risk factors for toothache include dental infection, gum disease, plaque, dental decay, injury, cracked teeth, poorly placed fillings or crowns, failing or leaking fillings or crowns, loss of a tooth (including tooth extractions), temporomandibular joint (TMJ) disorders, and obstructive sleep apnea. There are instances, however, where pain originating from outside the mouth radiates to the mouth, thus giving the impression that the pain is of tooth origin. This often happens when there is a problem with the jaw joint (temporomandibular joint or TMJ), ears, nerves, sinuses, or muscles. Occasionally, heart problems can give a sensation of tooth pain. Pregnancy can also be a risk for tooth problems that lead to pain. Due to fluctuating hormone levels during pregnancy, pregnancy gingivitis and tooth decay can occur.
One can prevent the majority of dental problems through basic oral hygiene home care — flossing and brushing. There are many different products, such as xylitol- and fluoride-containing rinses and toothpaste, and having teeth professionally cleaned on a regular schedule. The dentist may apply sealants, varnishes, and fluoride, which are especially important in children but can also be valuable to adults and the elderly, too.
What causes a toothache?
Injury or trauma to the tooth or area usually cause toothaches. Injury is commonly a result of tooth decay (or cavity). People usually feel cavities when they get larger and deeper into the layers of tooth structure. Enamel is the hard, outer layer of tooth, and dentin is the softer layer beneath the enamel. Dentin is the tooth’s sensitive layer with tiny microscopic tubes that originate from the very center of the tooth. The pulp chamber (the center of the tooth) contains the pulp. The pulp is comprised of blood vessels and nerves. If decay gets past enamel into the dentin, the cavity can sometimes cause discomfort. A deeper cavity that approaches the center of the tooth will likely cause pain since there is more damage to the tooth and there is less tooth structure to insulate and protect the pulp. Localized infection between the gum and tooth (periodontal abscess) can cause toothache. A traumatic physical blow to a tooth can induce a sore tooth, as well.
Other causes of toothache include the following:
- Abscessed tooth: This infection originates from within the tooth and spreads to the root and the surrounding bone.
- Damaged or fractured tooth: Fracture of a tooth can expose the sensitive dentin or even the pulp. Sometimes fractures are not obvious even though the fracture line can run deep into the tooth, causing tooth pain every time one puts pressure on it with biting or chewing (called “cracked tooth syndrome”).
- Dental work: After getting a filling or crown, the tooth can feel more sensitive. This is especially the case if the removal of tooth decay was large or deep. Dental work, although necessary, can sometimes irritate the nerve. Over time, the sensitivity can resolve if the tooth is healthy enough.
- Teeth clenching or grinding: This habit is called bruxism and is oftentimes done unconsciously and at night. Unfortunately, bruxism causes damage to teeth and sometimes irritates the nerves to the point where teeth become sensitive.
- Gum infection or gum disease: The periodontium consists of the gum, gum ligament, and bone that surround and anchor the teeth. Early stages of gum problems usually involve inflamed gum, called gingivitis. The gum is usually red, swollen and will bleed easily. A gum problem can progress to include the jawbone surrounding teeth and represents the later stages of gum disease (or “periodontitis”) where there is advanced loss of bone around the teeth. Because of bone loss, a gum abscess (infection) can form in the space that develops between the tooth and the gum, causing pain.
- Exposed root surfaces: When the protective bone and gum no longer cover the roots of teeth, these surfaces can be sensitive to stimuli such as brushing the teeth or temperature changes.
- Sinusitis: Because the roots of the upper molars are very close to the maxillary sinus cavities, inflammation from the sinus cavities can cause these molars to be sensitive and feel like a toothache.
- Third molars (“wisdom teeth”): Third molars, also called wisdom teeth, are the very last permanent teeth to appear in the mouth. More often than not, there is not enough space for these molars in the mouth. As a result, third molars become fully or partially trapped (impacted) within the jawbone and below the gum. Because of poor accessibility, it is difficult to properly clean partially exposed third molars; therefore, these areas are susceptible to problems. Problems with third molars can cause dull to severe pain from pressure of eruption, gum infection, or dental decay.
Once your dentist has diagnosed the cause of your toothache, he will explain to you what is involved in fixing the problem.
Depending on your underlying diagnosis, your dentist may recommend or prescribe various medications.
For pain relief, your dentist may recommend taking Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID). For severe pain, your doctor may prescribe an opioid. Local nerve block injections may also be given for severe pain or during a dental procedure.
If you have an abscess, pulpitis, gingivitis, or periodontitis your doctor may prescribe an antibiotic, like amoxicillin. Antibiotics will also be prescribed for bacterial sinusitis.
Oral Rinses and Topical Fluoride
Chlorhexidine oral rinses may be administered by your dentist to treat gingivitis. Fluoride rinses or topical fluoride treatments may also be given by your dentist to prevent or treat tooth decay.
For tooth sensitivity, in addition to brushing your teeth with a special toothpaste made for teeth sensitivity, such as Sensodyne, your dentist may apply fluoride to your teeth (especially the parts of your teeth that meet the gum).
If you have sleep-related bruxism, your dentist may recommend wearing a mouth guard at nighttime.
Keep in mind, while a mouth guard will protect your teeth from damage, it won’t decrease the number of bruxism episodes. This is why addressing your underlying bruxism triggers—stress or drinking alcohol or caffeine at night—will also be an essential part of your treatment plan.
Sometimes, various dental procedures are warranted to treat your diagnosis. For instance, for tooth decay and cavity formation, the primary treatment is restorative therapy, which entails removal of the decay by drilling, followed by filling of the removed area with a strong material (called a filling)?
For irreversible pulpitis, your dentist will need to perform a root canal. For an abscess, incision and drainage of the infected pocket is the primary therapy.
Lastly, for a cracked tooth, treatment depends on the location and direction of the crack, as well as the extent of the damage.
For instance, for a fractured cusp, your dentist may simply place a new filling or crown over the cracked tooth to protect it. Likewise, for a cracked tooth that does not extend below the gum line, your dentist may perform a root canal and place a crown to prevent the crack from spreading further.
For more serious cracks, like a crack that extends below the gum line or for a fractured root with an associated infection, tooth extraction may be necessary.
The key to good oral health is preventing problems before they arise. For example, to prevent cracked teeth, it’s important to wear a mouth guard during contact sports and to avoid biting hard candies or ice.
To prevent cavities, gum disease, and tooth sensitivity, try following these preventive strategies:
- Brush your teeth gently twice daily using soft-bristle toothbrush and a fluoridated toothpaste
- Floss daily
- Drink fluoridated water
- Undergo regular professional dental cleanings
- Replace your toothbrush every three to four months or sooner
- Avoid smoking
- Eat a regular, balanced diet rich in fruits, vegetables, protein, and fatty fish and minimize ingestion of sugar-rich foods or drinks