Toothache

The term "toothache" usually refers to pain in the teeth or jaws - primarily as a result of dental conditions. In most cases, toothache is caused by dental problems such as gum inflammation, cracks in the tooth, infection that has affected the root of the tooth. What other causes of toothache are there, what diseases cause it?

What types of toothache are there and what causes them?

Problems with the jaw joint (temporomandibular joint) can also cause toothache. The severity of toothache can range from chronic pain to sharp and excruciating. The pain may be aggravated by chewing or by cold or excessive heat. A thorough examination, including x-rays, can help determine whether the toothache is caused by dental or jaw disease or by other problems.

Sometimes toothache can be caused by problems other than the health of the tooth or jaw. Pain around the teeth and jaws can be a symptom of heart disease (such as angina or heart attack), ear disease (inner or outer ear infection), and sinus disease. For example, pain from angina (insufficient oxygen supply to the heart muscle due to narrowing of the heart arteries) usually radiates to the chest or arms. However, in some patients with angina, toothache or jaw pain is the only symptom of heart problems. Infections, ear disease, and sinus disease can also cause toothache and jaw pain. Therefore, it is important to accurately determine the nature of the disease causing the “toothache.”

Causes of toothache due to dental diseases

Common dental causes of toothache include tooth decay, tooth abscess, gum inflammation, tooth root irritation, cracked tooth, temporomandibular joint syndrome (TMJ).

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Caries and dental abscess

The most common cause of toothache is dental caries. Dental caries are holes in the two outer layers of the tooth, called enamel and dentin. Enamel is the outer white hard surface of the tooth, and dentin is the yellow layer just underneath the enamel. Both layers serve to protect the inner tissue of the tooth, where blood vessels and nerves are located.

Some bacteria in the mouth convert simple sugars into acid. The acid softens and (along with saliva) dissolves enamel and dentin, creating problems in the cavity. Small, shallow cavities in the tooth may not cause pain, and a person may not even notice them. The more deep cavities in the tooth that are affected by bacteria, the greater the likelihood of toothache. Toxins from bacteria or food and liquids can irritate the cavity.

Severe pulp injuries can lead to the death of pulp tissue, resulting in tooth infection (dental abscess). Minor swelling of the gums can also be the cause of toothache. Toothache due to these causes is the most common reason for visiting a dentist.

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Toothache due to fillings

Treatment for shallow, small cavities usually involves fillings. Treatment for larger cavities involves onlays or crowns. Treatment for a cavity that is infected involves cleaning the root canal or removing the affected tooth.

A root canal procedure involves removing the diseased pulp tissue (which avoids tooth extraction) and replacing it with a filling. The procedure is used in an attempt to save the diseased tooth from extraction. If a root canal procedure is not performed, the pulp will become inflamed and the tooth will be very painful.

Toothache due to gum inflammation

The second most common cause of toothache is gum disease (periodontal disease). Gum disease is an inflammation of the soft tissue and simultaneous loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins that certain bacteria release into "plaque" that builds up over time along and around the gum line. This plaque is a mixture of food, saliva, and bacteria.

An early symptom of gum disease is bleeding gums without pain. Pain is a symptom of later stages of gum disease. For example, bone loss around the teeth causes deep pockets around the gums. Bacteria that accumulate in these pockets cause gum infections, swelling, toothache, and further bone destruction. Gum disease can lead to the loss of healthy teeth. Gum disease is complicated by factors such as poor oral hygiene, a family history of gum disease, smoking, and a family history of diabetes.

Treatment of gum diseases

Treatment of gum disease is always associated with oral hygiene and the removal of bacterial plaque and tartar (hardened plaque). Moderate and severe gum disease usually requires thorough cleaning of the teeth and roots of the teeth. The dentist's first task is to remove plaque and tartar, as well as treat the surface of the inflamed gum layer.

Both of these procedures are usually performed under local anesthesia and may be followed by antibiotics to treat the gum infection or abscess. Follow-up treatment may include various types of dental surgery if needed. In advanced stages of gum disease, significant bone loss and loosening of teeth may occur, and tooth extraction may be necessary.

Toothache due to tooth sensitivity

Toothache can be caused by exposed tooth roots. Typically, the roots of the lower two-thirds of the tooth are not visible. Bacterial toxins destroy the bone around the roots and cause the gums and bone to erode, exposing the roots. The condition in which the roots of a tooth are exposed is called "recession." Exposed tooth roots can become extremely sensitive to cold, hot, and acidic foods because the gums and bone are no longer protected.

Early stages of root exposure can be treated with fluoride gels or special toothpastes (such as Sensodyne or Denquel) that contain fluoride and other beneficial substances. These minerals are absorbed by the surface layer of the roots to make the roots stronger and less susceptible to bacterial attack. Dentists may also apply strengthening gels to exposed roots to strengthen the sensitive areas. If bacterial attack causes damage and death of the inner tissue of the tooth, called the pulp, a root canal procedure or tooth extraction may be necessary.

Cracked tooth - pain syndrome

A "cracked tooth" is another cause of toothache that is not related to advanced gum disease. Biting on the fractured tooth can cause severe, sharp pain. These tooth fractures are usually caused by chewing or biting hard objects such as hard candies, pencils, nuts, etc.

A dentist can detect a fracture in the tooth area by applying a special dye to the cracks in the tooth or by shining a special light on the tooth. Treatment usually involves protecting the tooth with a crown made of gold and/or porcelain or metal ceramics. However, if the crown does not relieve the pain, a root canal procedure and filling may be necessary.

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Temporomandibular joint (TMJ) disorders

TMJ disorders can cause pain in, around, or under the ear. The TMJ connects to the skull and is responsible for chewing and speaking. TMJ disorders can be caused by a variety of issues, such as trauma (such as a blow to the face), arthritis, or muscle fatigue from grinding your teeth.

The habitual clenching or grinding of teeth is a condition called bruxism. It can cause joint pain, jaw muscle pain, and toothache. Bruxism (teeth grinding) is often associated with stress, bite alignment, and sometimes the muscles around the temporomandibular joint are used for chewing. This condition can develop into a spasm, causing headaches and neck pain, and making it difficult to open the mouth.

These muscle spasms are aggravated by chewing or stress, which causes the patient to clench the teeth and tighten the muscles further. Temporary TMJ pain can also be a result of recent dental work or trauma following wisdom teeth extraction.

Treatment for TMJ pain typically involves oral over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen. Other treatments include a warm, wet compress to relax the gums, stress reduction, and/or soft foods that don't require much chewing.

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Tooth blockage and fangs

Toothache can occur due to teeth that grow from under another tooth or are subject to some kind of impact (for example, a tooth could not come out in the correct position and remains under the bone of another tooth). Then the teeth can look like fangs.

When a tooth is erupting, the surrounding gums may become inflamed and swollen. Misshapen teeth cause pain when they put pressure on other teeth and become inflamed and/or infected. Dental treatment usually requires pain relief or antibiotic treatment (for infections) as well as surgical removal. This most often occurs with wisdom teeth.

Pulpitis - as a cause of toothache

Reversible pulpitis is the result of inflammation of the pulp, usually due to caries, minor damage to the pulp due to previous extensive treatment or trauma. In this case, the same symptoms are observed as with caries, but unlike caries, the patient cannot indicate the affected tooth. Treatment allows you to identify caries or another cause. Analgesics usually help, but mask the symptoms that can be used to identify the causative tooth.

Irreversible pulpitis causes toothache without an irritant or prolonged pain after irritation. It is usually difficult for patients to determine the causative tooth. A dentist can determine the causative tooth by placing a piece of ice on it and removing the ice immediately when pain occurs. In a healthy tooth, the pain stops immediately. Toothache lasting more than a few seconds indicates irreversible pulpitis. Analgesics are necessary until the tooth is endodontic treated or extracted. Opioids may be prescribed to patients who frequently experience trauma or have not been treated by a dentist. Pressure necrosis is usually a consequence of pulpitis, because the pulp is surrounded by dentin. Usually, the inflamed pulp necroses, which leads to the cessation of pain. This period of asymptomatic treatment can last from several hours to weeks. Subsequently, inflammation in the area of the root apex and / or an infectious process (apical periodontitis) develops. The infectious process usually develops under the influence of the oral microflora. With apical periodontitis, pain occurs when biting and chewing. Usually, the patient can indicate the painful tooth. If the patient has difficulty indicating it, the dentist determines the causative tooth by percussion of the teeth until pain appears. Antibiotics and analgesics are prescribed if treatment is delayed.

Inflammatory diseases of teeth

A periapical abscess may develop as a result of untreated caries or pulpitis. If there is a well-defined (soft) fluctuation with this abscess, it is drained through an incision made at the most pronounced point of fluctuation using a #15 surgical scalpel. External drainage is rarely performed. An inflammatory process that lasts less than 3 days responds better to penicillin, and one that lasts more than 3 days responds better to clindamycin.

Cellulitis can be observed with untreated teeth. Rarely, cavernous sinus thrombosis or Ludwig's angina develops. In these two conditions, there is a threat to life and immediate hospitalization, removal of the causative tooth and parenteral administration of antibiotics to which the microflora is sensitive are required.

Sinusitis may be suspected if many or all molars on one side are painful to percussion or if the patient experiences pain when tilting the head down.

Difficult tooth eruption

Difficult eruption or retention of a tooth, especially 3 molars, can be painful and cause inflammation of the surrounding soft tissues (pericoronitis), which can lead to more serious inflammation. Treatment consists of rinsing with a chlorhexidine solution or hypertonic saline solution (one tablespoon of salt per glass of hot water - no hotter than the coffee or tea that the patient drinks). The salt water is held in the mouth on the sore side until it cools, then spat out and immediately filled with a mouthful of new water. During the day, 3-4 glasses are used for rinsing, which helps to stop the inflammation until the tooth is removed. Antibiotics are prescribed if treatment is postponed.

Less common are acute oral inflammations, including periodontal abscesses, suppurating cysts, allergies, blocked or inflamed salivary glands, and peritonsillar infection. Toothache in children may be accompanied by excessive salivation and fever. Acetaminophen based on the child's weight may help relieve symptoms.

Toothache, as you can now see, can occur not only because of sick teeth, but also for other reasons. To determine them, it is advisable to immediately consult a doctor, so as not to bring yourself to torment.