Doctor's Notes on Toothache
A toothache is pain that is felt inside or around a tooth. There are many causes of toothache. Toothache can be caused by decay or abscess of a tooth, fracture (breaking) of a tooth, gum infection (called periodontitis), repeated tooth grinding, or damage to a previous filling or dental work.
The pain of a toothache may be throbbing, sharp, or dull. The pain may occur constantly or may only occur when there is pressure on the tooth, such as when eating. Symptoms that can be associated with toothache depend on the cause of the pain and may include redness and swelling of the gums and tissues around the tooth, fever, jaw pain, headache, or drainage of pus from the painful area. Toothache caused by trauma may be accompanied by breaking or chipping of the affected tooth.
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.
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
- After a crown, a tooth will sometimes become sensitive after a crown is prepared or cemented.
- 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
Some studies show that people with gum disease are more likely to have heart disease than those with healthy gums. Researchers aren't sure why that is; gum disease isn't proven to cause other diseases. But it makes sense to take care of your mouth like you do the rest of your body.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.