Toothache

Toothache or tooth pain is caused when the nerve root of a tooth is irritated. Dental (tooth) infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction (tooth is pulled out). Pain sometimes originates from other areas and radiates to the jaw, thus appearing to be tooth pain. The most common areas include the jaw joint (temporomandibular joint or TMJ), ear pain, and even occasional heart problems.

• Bacteria growing inside your mouth can contribute to gum disease, plaque, and dental decay. These problems can become painful. The cause and prevention of dental disease has been well investigated.

• You can prevent the majority of dental problems through flossing, brushing with fluoride toothpaste, and having your teeth professionally cleaned twice a year. The dentist may apply sealants and fluoride, which are especially important in children.

Toothache Causes

Toothache occurs from inflammation of the central portion of the tooth called pulp. The pulp contains nerve endings that are very sensitive to pain. Inflammation to the pulp or pulpitis may be caused by dental cavities, trauma, and infection. Referred pain from the jaw may cause you to have symptoms of toothache.

Toothache Symptoms

Toothache and jaw pain are common complaints. There may be severe pain to pressure, or to hot or cold stimuli. The pain may persist for longer than 15 seconds after the stimulus is removed. As the area of inflammation increases, the pain becomes more severe. It may radiate to the cheek, the ear, or the jaw. Other signs and symptoms that may lead you to seek care include the following:

• Pain with chewing

• Hot or cold sensitivity

• Bleeding or discharge from around a tooth or gums

• Swelling around a tooth or swelling of your jaw

• Injury or trauma to the area

• These signs and symptoms may sometimes be associated with dental decay or gum disease (periodontal disease). Dental decay or an area of redness around the tooth's gum line may point to the source of pain. If you tap an infected tooth, it may make the pain more intense. This sign may point to the problem tooth even if the tooth appears normal.

• A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear or throat pain, or an injury to the temporomandibular joint (TMJ) that attaches the jaw to the skull may be confused with toothache. Pain from a deeper structure (called referred pain) may be passed along the nerve and be felt in the jaw or tooth. In order to pinpoint the source of the pain and get relief, call your dentist or doctor.

When to Seek Medical Care

 

 You should call your doctor or dentist for advice for the following concerns:

• Dental pain may not be relieved by over-the-counter medications.

• You may experience severe pain after a tooth is pulled. This may occur on the second or third day after tooth extraction. This is a result of the tooth socket being exposed to air. The condition is known as "dry socket syndrome." If you develop this condition, you should see a dentist within 24 hours.

• Pain may be associated with swelling of the gums or face, or you may have discharge around a tooth. Fever is an important sign of infection in dental disease. Simple dental decay (caries) does not cause fever. These signs may signify an infection surrounding the tooth, the gum, or the jaw bone (mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended to be done inside the tooth (endodontic drainage), a "root canal" is performed.

• Broken or knocked-out teeth may occur from an injury. Unless associated with more severe injuries, your dentist should be contacted as soon as possible. Swallowed teeth and permanent tooth loss are considered dental emergencies. Tooth loss due to injury (traumatic loss) is cared for differently in children who have lost their primary teeth than for older children and adults with injury to their secondary teeth.

• Pain may be present at the angle of your jaw. If every time you open your mouth widely you have pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big. Your dentist may be able to suggest solutions to this problem.

• Wisdom teeth can cause pain. As wisdom teeth (molars) are coming out, they cause inflammation of the gum around the erupted crown. The gum overlying the crown may become infected. The tooth most commonly involved is the lower third molar. The pain may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot be closed properly. In severe cases, pain in the throat and the floor of the mouth may make it difficult to swallow.

Any history of trauma, chest pain or history of heart disease, or rashes may suggest causes of pain other than purely dental origin. These symptoms with toothache or jaw pain indicate that you should visit your doctor or a hospital's Emergency Department.

• High fever or chills: This may indicate a more widespread infection that might require more than antibiotics by mouth.

• Recent head or face injury: If you experience headache, lightheadedness, nausea, vomiting, or other symptoms that concern you after an injury to your face or mouth, you may have a more serious injury in addition to your dental injury.

• A facial rash associated with a toothache: This condition may improve with medication. The doctor should be able to decide what is appropriate.

• Any jaw pain occurring with chest pain: Although jaw pain is most commonly caused by dental disease, it is sometimes referred pain from other areas. People with heart disease, especially people who have had stents placed, people with diabetes, or those who have had heart surgery may have jaw pain as a symptom of heart attack (myocardial infarction) or angina (ischemia). If your jaw or tooth pain is associated with lightheadedness, sweating, or shortness of breath, you should see a doctor.

• Trouble swallowing or excessive pain or bleeding from gums: If you have a history of a weakened immune system, diabetes, or steroid use, you are more susceptible to infections. Infections can often be more severe and extensive or caused by unusual organisms. Dental and gum infections in people with these conditions may require more aggressive treatment. An abscess may need draining or IV antibiotics, for example.

• For toothaches
  
  • Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil) may be used. Take these as directed on the package and around the clock on a schedule while you arrange a dental appointment.

• Avoid very cold or hot foods because this may make the pain worse.

• Relief may be obtained from biting on a cotton ball soaked in oil of cloves. Oil of cloves is available at most drug stores.

Prevention

 

 

 

Most people can avoid severe dental problems with regular dental care. Have your dentist's telephone number easily available in case of an emergency.

• Maintain a healthy diet. Bacteria thrive on refined sugar and starch and need this in order to burrow through the enamel on your teeth. Watch what you eat and be careful about food that sticks to and between your teeth. Brush your teeth after eating or add foods in your diet with some roughage that may act as a natural toothbrush. End your meal with a salad or apple.

• Establish a good program of cleaning your teeth to remove the food particles. Brush your teeth after eating. Use a soft toothbrush with fluoride toothpaste as recommended by the American Dental Association. Floss between teeth daily and brush your gums to encourage healthy gums. Water jets are effective at removing trapped particles, but flossing your teeth does a more thorough job when done carefully.

• Prevent tooth decay with fluoride. Fluoride is effective in preventing tooth decay in children. Fluoride is a natural element and is found in many water supplies and vegetables. Check and see if your tap water is fluoridated. If your water is not fluoridated, your dentist can prescribe fluoride tablets or fluoride supplements for children younger than 10 years.

• Arrange to have your teeth cleaned by a dentist or dental hygienist twice a year. This has been shown to be effective in preventing both decay and gum disease. Dental x-rays may be needed every 3-5 years to identify problem areas.

• Keep your bridge or dentures clean. Your dentist can offer suggestions. Even if you do not have all of your original adult teeth, you can prevent new dental problems if you try these preventive tips.

• Wear a protective dental guard or headgear while playing sports to help prevent injury.

• Do not smoke. Tobacco smoking may make some dental conditions worse.