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Toothache (cont.)

When to Seek Medical Care

One should call the doctor or dentist for advice for the following concerns:

  • Dental pain is not relieved by over-the-counter medications.
  • If one experiences severe pain more than two days after a tooth is pulled, it is possible that the tooth socket is not healing properly. A condition known as "dry socket syndrome" may have occurred and the patient should see a dentist immediately.
  • Pain may be associated with swelling of the gums or face, or the patient may have discharge around a tooth. A fever is another sign of infection in dental disease. These signs may indicate an infection surrounding the tooth, the gum, or the jaw bone (maxilla or 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 unfortunately are common. Unless associated with more severe injuries, the dentist should be contacted as soon as possible. The sooner a patient seeks treatment, risk of infection is decreased and teeth have a higher chance of being saved. It is particularly important that children who have damaged their primary teeth (baby teeth) be treated right away in that such injuries can affect secondary teeth (adult teeth).
  • Pain may be present at the angle of the jaw. If opening the mouth causes 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. The dentist may be able to suggest solutions to this problem.
  • Wisdom teeth can cause pain. As wisdom teeth (molars) come out, inflammation of the gum around the erupted crown often occurs. This can then lead to gum infection. The pain usually occurs in the lower third molar and may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot close 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, heart disease, or rashes may suggest causes of pain other than purely dental. What appears to be a toothache could be a symptom of a much more severe underlying issue. The following symptoms in conjunction with toothache or jaw pain indicate that the patient should visit the doctor or a hospital's emergency department.

  • High fever or chills: This indicates a more widespread infection that may require medication stronger than oral antibiotics.
  • Recent head or face injury: If the patient experiences headaches, lightheadedness, nausea, vomiting, or other symptoms after an injury to the face or mouth, the patient may have a more serious injury in addition to the dental injury.
  • A facial rash: This could be an indication of a growing infection related to a tooth. 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 a heart attack (myocardial infarction) or angina (ischemia). If the jaw or tooth pain is associated with lightheadedness, sweating, or shortness of breath, the patient should see a doctor immediately.
  • Trouble swallowing or excessive pain or bleeding from gums: If the patient has a history of a weakened immune system, diabetes, or steroid use, they 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.
Medically Reviewed by a Doctor on 6/10/2014

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