Toothache

What Is a Toothache?

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?

Toothaches occur 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, can be caused by anything that has contact with the tooth. Common causes of tooth pain are the following:

  • Dental cavities/tooth decay
  • Temperature sensitivity -- hot or cold liquids or foods
  • Hot or cold air
  • Teeth grinding or clenching
  • Orthodontic movement -- braces
  • Abscessed tooth
  • Impacted wisdom tooth
  • Pregnancy
  • After a crown, a tooth will sometimes become sensitive after a crown is prepared or cemented.
  • Gingivitis
  • Periodontal disease
  • Gum recession -- exposure of the tooth root that was covered by gum or bone
  • Tooth fracture
  • Acid erosion
  • Damaged or broken fillings or crowns
  • Cold sore or canker sore
Dental Health: Top Problems in Your Mouth

What Symptoms and Signs May Accompany a Toothache?

Toothache and jaw pain are common complaints. It is not unusual for one to feel mild pain from pressure and hot or cold exposure to the tooth. However, if the pain is severe or persists for longer than 15 seconds after the pressure or temperature exposure ceases, then this could be an indication of a more serious problem. If there is severe inflammation of the tooth, the pain can radiate to the cheek, the ear, or the jaw. The signs and symptoms that might lead one to seek care include the following:

  • Pain with chewing
  • Sensitivity to hot or cold air and liquids
  • Bleeding or discharge from around a tooth or gums
  • Swelling around a tooth or swelling of the jaw or cheek
  • 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 one taps 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 can 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, an evaluation by a dentist or doctor is appropriate.

An untreated dental abscess can produce life-threatening health complications.

Toothache Cause

Abscessed Tooth

An abscessed tooth is a dental condition in which the nerve of the tooth, also referred to as the dental pulp, has become infected. The infection usually occurs when a dental cavity (tooth decay) goes untreated and spreads deep within the tooth. The infection can also occur from a broken or cracked tooth where the dental pulp is exposed to the oral environment. The bacteria that cause an abscess can spread down the length of the roots and into the surrounding bone tissue. Dental professionals also consider an infection can also occur between the gum tissues and root of the tooth, which is called a periodontal abscess. Additionally, the dental nerve can be susceptible to injury leading to an infection after a crown or large filling are completed. The greater the amount of decay, the closer the dental treatment gets to the dental nerve, and the more likely the nerve can become compromised. Teeth that are directly subjected to dental trauma (for example, from a fall or from a hit by a projectile such as a baseball) are also prone to infection and should be immediately examined by a dentist.

When Should Someone Seek Medical Care for a Toothache?

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

  • Dental pain is not relieved by over-the-counter medications. Even when it is relieved, a dental evaluation can be beneficial as the pain could be something that can be fixed more easily when treated earlier.
  • 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 to be drained or may require intravenous antibiotics, for example.
Dental Health: Top Problems in Your Mouth

How Do Health Care Professionals Diagnose a Toothache?

A medical history and physical exam will usually indicate the appropriate diagnosis. Sometimes radiographs, often referred to as X-rays, can be used along with other diagnostic aids. Panoramic radiographs and cone beam computed tomography views are used to further evaluate the teeth and bones throughout the mouth and skull. Occasionally, lab evaluation including ECG tracings of the heart will assist the doctor. If the cause is something other than a dental or jaw problem, the doctor may prescribe medications directed at the problem. If the condition is more severe, the doctor may admit the patient to the hospital for further care. The patient may be referred to a dentist for further treatment.

Are There Home Remedies for Toothaches?

  • For toothaches
    • People may use over-the-counter pain medications such as acetaminophen (Tylenol) Aleve or ibuprofen (Advil). Individuals with toothaches should take these medications as directed for temporary relief prior to professional evaluation.
    • Avoid very cold or hot foods because these may make the pain worse.
    • A home remedy for pain relief is to bite on a cotton ball soaked in oil of cloves. Clove oil is available at most drugstores.
    • Garlic contains a chemical called allicin, which acts as a natural antibiotic and can fight a tooth infection. By simply eating more garlic through supplementation or as an ingredient in everyday foods, one can decrease their vulnerability to infection. To help alleviate pain, garlic can be crushed and mixed into a paste with a little bit of salt and applied to the area that is infected. This won't cure the infection but may help with tooth pain and prevent the infection from growing or spreading.
    • Applying medicated relief gel like Orajel to the affected area can provide pain relief in some instances.
  • For jaw pain
    • Aspirin or ibuprofen (Advil, Motrin) may be helpful for problems in the jaw joint (TMJ) in adults.
    • Acetaminophen (Tylenol), not aspirin, should be used for children and teenagers.
    • If pain occurs every time the patient opens his/her mouth widely, the temporomandibular joint (TMJ) may be the source of the pain. Yawning or taking a large bite of food may intensify the pain. To manage this type of pain in the short term, one should avoid hard or chewy foods, apply moist heat to the jaw, and avoid opening wide as much as possible. An appointment with the doctor or dentist will help to determine the cause and direction of treatment.

What Are Treatments for a Toothache?

When someone is experiencing a toothache, they typically can't think of anything besides how to get rid of the pain. It can be a dominating and debilitating experience. The affected person must have a dental evaluation as soon as possible to determine the cause. Sometimes it may just be pain that comes and goes. Other times, the pain is indicative of a serious condition. The dentist will do a clinical exam and may take X-rays or perform other clinical tests to locate the origin of the toothache.

Usually, the best way to stop dental or jaw pain initially is with painkillers. A health care professional may prescribe antibiotics (such as amoxicillin) if there is swelling in the gums or face, or if the patient has fever. A referral to a dentist for follow-up will usually be arranged.

The doctor may try an injection of local anesthetic around the tooth for pain control. The dentist may apply a desensitizing varnish or fluoride treatment to help strengthen the tooth and seal up a part of the tooth that just might be sensitive.

It may be determined that a deep cleaning is necessary -- to remove harmful bacteria and plaque that have become trapped under the gumline. A patient may need feelings if a dentist finds dental decay. Deep decay or a fractured tooth may necessitate a crown or a root canal (cleaning out the nerve of the tooth and sealing the root). If the tooth is too badly decayed or broken, there may be nothing left to do but to extract the tooth. This will provide rapid relief of the tooth pain.

If it has been a while since the last dental visit, the dentist may find multiple factors contributing to the tooth pain. In this situation, the dentist will prioritize dental treatment in order of severity. The dentist will likely recommend procedures that will take care of the pain or infection first, followed by treatment to teeth that are likely to cause pain or infection, and a dental cleaning. The goal will be to provide immediate relief and then work to create an atmosphere of future health.

After most dental procedures, the patient will be able to return to work or school while he or she recovers. If causes other than the teeth or jaw are responsible for the pain, such as TMJ disorders, sinus infection, muscle or nerve problems, management will be according to the specific condition.

Dental Health: Top Problems in Your Mouth

Toothache Follow-up

After leaving the dentist's office, continue to practice good dental care, but be careful not to self-medicate or use numerous over the counter (OTC) oral rinses as they can sometimes exacerbate or prolong problems. Routine and prompt follow-up appointments with the dentist can relieve dental pain faster.

When the patient leaves the emergency department, he or she should take the medications as prescribed and keep their follow-up appointments. If the patient has any concerning signs or symptoms, call the doctor.

Stopping smoking may help improve some dental conditions. If the patient is having trouble quitting, talk to the doctor about assistance.

Is It Possible to Prevent a Toothache?

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

  • Maintain a healthy diet and brush and floss often. Bacteria thrive on refined sugar and starch and need this in order to burrow through the enamel on teeth. One should watch what they eat and be careful about food that sticks to and between the teeth. Regular brushing habits can be key to tooth pain prevention. Brushing after eating or adding foods that can act as a natural toothbrush should be part of one's preventive care routine (end meals with a salad or apple). Brush to remove food particles using a soft toothbrush with fluoride toothpaste as recommended by the American Dental Association. (Xylitol in toothpaste or a mouth rinse will help reduce bacteria.) Floss between teeth daily and brush the gums to encourage healthy gums. Water jets are effective at removing trapped particles, but flossing the teeth does a more thorough job when done carefully.
  • Prevent tooth decay with fluoride and xylitol. 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 tap water is fluoridated. If the water is not fluoridated, the dentist can prescribe fluoride tablets or fluoride supplements for children younger than 10 years of age. Xylitol is a natural product of birch trees and bacteria see it as a food source just like they consume carbohydrates and simple sugars. However, bacteria cannot break down xylitol so it neutralizes bacteria.
  • There are other more modern toothpastes and topical gels that can be placed on the teeth to help fight off acid attack from bacteria and help to remineralize damage caused to the teeth by bacteria. These newer types of products typically contain xylitol, casein phosphopeptide (CPP), amorphous calcium phosphate (ACP), and fluoride.
  • One should arrange to have the teeth cleaned by a dentist or dental hygienist at least twice a year. This has been shown to be effective in preventing both decay and gum disease. Dental X-rays may be needed every year to identify problem areas.
  • One should keep their bridge or dentures clean. The dentist can offer suggestions. Even if one does not have all of their original adult teeth, they can prevent new dental problems if they 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.

What Is the Prognosis for a Toothache?

For most common causes of toothache, the prognosis is good with appropriate dental medicine. Following good dental hygiene, such as brushing with a fluoride toothpaste, flossing, and routine check-ups by the dentist, helps to prevent dental problems.

For conditions other than dental and jaw problems, prompt diagnosis and treatment usually will improve the long-term outcome.

Reviewed on 9/11/2017

REFERENCES:

Cohen, Leonard A. et al. "Toothache Pain: A Comparison of Visits to Physicians, Emergency Departments and Dentists." Journal of the American Dental Association 139.9 September 2008: 1205–1216.

Roblee, Richard. Interdisciplinary Dentofacial Therapy: A Comprehensive Approach to Optimal Patient Care. Chicago, IL: Quintessence Books, 1994: 45-53.

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