Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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.
"Toothache" usually refers to pain around the teeth or jaws primarily as a result of a dental condition. In most instances, toothaches are caused by tooth problems, such as a dental cavity, a cracked tooth, an exposed tooth root,
or gum disease. However, disorders of the jaw joint (temporo-mandibular joint) can also cause pain that is referred to as "toothache." The severity of a toothache can range from chronic and mild to sharp and excruciating. The pain may be aggravated by chewing or by cold or heat. A thorough oral examination, which includes dental X-rays, can help determine whether the toothache is coming from a tooth or jaw problem and the cause.
Sometimes, a toothache may be caused by a problem not originating from a tooth or the jaw. Pain around the teeth and the jaws can be symptoms of diseases of the heart (such as angina or heart attack), ears (such as inner or external ear infections), and sinuses (air passages of the cheekbones). For example, the pain of angina (inadequate supply of oxygenated
blood to the heart muscle because of narrowing of the arteries to the heart) is usually located in the chest or the arm. However, in some patients with angina, a toothache or jaw pain
is the only symptom of their heart problem. Infections and diseases of the ears and sinuses can
also cause pain around the teeth and jaws. Therefore, evaluations by both dentists and doctors are sometimes necessary to diagnose medical illnesses causing "toothache."
What are dental causes of toothaches?
Common dental causes of toothaches include dental cavities, dental abscess, gum disease, irritation of the tooth root, cracked tooth syndrome, temporomandibular joint (TMJ) disorders, impaction, and eruption.
Dental cavities & dental abscess
The most common cause of a toothache is a dental cavity. Dental cavities (caries) are holes in the two outer layers of a tooth called the enamel and the dentin. The enamel is the outermost white hard surface and the dentin is the yellow layer just beneath the enamel. Both layers serve to protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. Certain bacteria in the mouth convert simple sugars into acid. The acid softens and (along with saliva) dissolves the enamel and dentin, creating cavities. Small, shallow cavities may not cause pain and may be unnoticed by the patient. The larger deeper cavities can be painful and collect food debris. The inner living pulp of the affected tooth can become irritated by bacterial toxins or by foods and liquids that are cold, hot, sour, or sweet, thereby causing toothaches. Severe injury to the pulp can lead to the death of pulp tissue, resulting in tooth infection (dental abscess). A small swelling or "gum blister" may be present near the affected tooth as well. Toothaches from these larger cavities are the most common reason for visits to dentists.
Treatment of a small and shallow cavity usually involves a dental filling. Treatment of a larger cavity involves an onlay or crown. Treatment for a cavity that has penetrated and injured the pulp or for an infected tooth is either a root canal procedure or extraction of the affected tooth. The root canal procedure involves removing the dying pulp tissue (thus avoiding or removing tooth infection) and replacing it with an inert filling material. The procedure is used in an attempt to save the dying tooth from extraction. Once a root canal procedure is done, the tooth is more prone to fracture and will oftentimes require a crown to protect it.
Gum disease
The second most common cause of toothache is gum disease (periodontal disease). Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place. Gum disease is caused by toxins secreted by certain bacteria in "plaque" that accumulate over time along and under the gum line. This plaque is a mixture of food, saliva, and bacteria. An early symptom of gum disease is gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of deep gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth. Gum disease is complicated by such factors as poor oral hygiene, family history of gum disease, smoking, and family history of diabetes.
Treatment of gum disease always involves oral hygiene and removal of bacterial plaque and tartar (hardened plaque). Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "scaling and root planing" and "subgingival curettage." Scaling and root planing is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment, if necessary, may include various types of gum operations. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.
Tooth root sensitivities
Toothache can also be caused by exposed tooth roots. Typically, the roots are the lower two-thirds of the teeth that are normally buried in bone. The bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The condition of exposed roots is called "recession." The exposed roots can become extremely sensitive to cold, hot, and sour foods because they are no longer protected by healthy gum and bone.
Early stages of root exposure can be treated with topical fluoride gels applied by the dentist or with special toothpastes (such as Sensodyne or Denquel) which contain fluorides and other minerals. These minerals are absorbed by the surface layer of the roots to make the roots stronger and less sensitive to the oral environment. Dentists may also apply "bonding agents" to the exposed roots to seal the sensitive areas. If the root exposure causes injury and death of the inner living pulp tissue of the tooth, then a root canal procedure or tooth extraction may be necessary.
Cracked tooth syndrome
"Cracked tooth syndrome" refers to a toothache caused by a broken tooth (tooth fracture) without associated cavity or advanced gum disease. Biting on the area of tooth fracture can cause severe sharp pains. These fractures are usually due to chewing or biting hard objects such as hard candies, pencils, nuts, etc. Your dentist can usually detect the fracture by painting a special dye on the cracked tooth or shining a special light on the tooth. Treatment usually involves protecting the tooth with a full-coverage crown made of gold and/or porcelain. However, if placing a crown does not relieve pain symptoms, a root canal procedure may be necessary.
Temporomandibular joint (TMJ) disorders
Disorders of the temporomandibular joint(s) can cause pain which usually
occurs in or around the ears or lower jaw. The TMJ hinges the lower jaw
(mandible) to the skull and is responsible for the ability to chew or talk. TMJ
disorders can be caused by different types of problems such as injury (such as a
blow to the face), arthritis, or jaw muscle fatigue from habitually clenching or
grinding teeth. Habitual clenching or grinding of teeth, a condition called
"bruxism," can cause pain in the joints, jaw muscles, and the teeth involved.
Bruxism is often due to life "stress," family history of bruxism, and poor bite alignment. Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain and difficulty opening the mouth normally. These muscle spasms are aggravated by chewing or by stress, which cause the patients to clench their teeth and further tighten these muscles. Temporary TMJ pain can also result from recent dental work or by the trauma of extracting impacted wisdom teeth.
Treatment of temporo-mandibular joint pain usually involves oral anti-inflammatory over-the counter (OTC) drugs like ibuprofen (Motrin or Advil) or naproxen (Aleve). Other measures include warm moist compresses to relax the joint areas, stress reduction, and/or eating soft foods that do not require much chewing. If bruxism is diagnosed by a dentist, a bite appliance (night guard)
may be recommended that is worn during the night to protect the teeth. However, this bite appliance is used mainly to protect the teeth and may not help with joint pain. For more serious cases of joint pain, a referral to a TMJ specialist may be necessary to determine further treatment.
Impaction & eruption
Dental pain can come from teeth that are erupting (tooth growing out or "cutting") or are impacted (tooth has failed to emerge into its proper position and remains under gum and/or bone). When a molar (the large teeth at the back of the jaw) tooth erupts, the surrounding gum can become inflamed and swollen. Impacted teeth cause pain when they put pressure onto other teeth or bone and are inflamed and/or infected. Treatment for impacted teeth is usually pain medication, antibiotics (for infections), and surgical removal. This most commonly occurs with impacted molar (wisdom) teeth.
The most common cause of a toothache is a dental cavity.
The second most common cause of toothache is gum disease.
A toothache can be caused by a problem that does not originate from a tooth or the jaw.
REFERENCE:
Davidson, Terence M. "Consultation for Temporal Mandibular Joint Disease (TMJ)." Oct. 10, 2010. University of California, San Diego. <http://health.ucsd.edu/specialties/surgery/davidson/consults/tmj.htm>.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Absecessed tooth is a painful infection at the root of a tooth or between the gum and a tooth, most commonly caused by severe tooth decay. Symptoms of abscessed tooth include fever, painful chewing, sensitivity in the teeth, bitter taste in the mouth, and swollen neck glands.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Temporomandibular joint disorder, or TMJ, is a disorder of the temporomandibular joint(s) that causes signs and symptoms including ear pain, bite problems, headaches, dizziness, clicking sounds in the jaw, tinnitus and/or locked jaws. Behaviors or conditions that can lead to TMJ include teeth grinding or clenching, fingernail biting, habitual gum chewing, trauma to the jaw, stress, and occupational hazards. Treatment for TMJ may include heat, ice, a soft diet, antiinflammatory medications, physical therapy, stress management, occlusal therapy, correction of bite abnormalities, and surgery.
The term oral cancer includes cancer of the mouth (oral cavity) and the back of the mouth (oropharynx). Red and white patches inside the mouth, bleeding, loose teeth, pain upon swallowing, a lump in the neck, earache, and a sore on your lip or in your mouth that won't heal are all symptoms of oral cancer. Treatment for oral cancer depends upon the staging of the disease and usually involves surgery, radiation therapy, or chemotherapy.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Middle ear infection or inflammation (otitis media) is inflammation fo the middle ear. There are two types of otitis media, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Seventy-five percent of children in the U.S. suffer from otitis media at some point. Treatment depends upon the type (chronic or acute).
Mercury is a naturally occurring element found in water, soil, and the air. Mercury is also contained in some fish, some of the products we use in the home, school, or dentist. Information about sources of mercury exposure, potential health effects, symptoms of exposure, fish that may contain mercury, consumer products that contain mercury, and ways to reduce your exposure to mercury is important for the health of you, and your family.
Wisdom teeth are the third set of molars that people get in their late teens or early twenties. Impacted wisdom teeth that only partially erupt allows for an opening for bacteria to enter around the tooth and cause an infection, which results in pain, swelling, jaw stiffness, and general illness. Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic. Recovery from wisdom tooth removal depends upon the difficulty of the extraction.
Gum disease is caused by plaque and may result in tooth loss without proper treatment. Symptoms and signs of gum disease (gingivitis or periodontal disease) include receding gums, bad breath and pocket formation between the teeth and gums. Treatment depends upon the stage of the gum disease, how you responded to earlier treatments, and your overall health.
Bruxism is the medical term for teeth grinding. Bruxism may be caused by stress or anxiety and often happens during sleep. Symptoms and signs include jaw pain, headache, and abnormalities in your teeth. Treatment may involve practicing stress-management techniques, cutting back on caffeine and alcohol, avoiding gum chewing, training oneself not to grind the teeth, and wearing a mouth guard.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Find out more about how orthodontic braces and retainers can provide proper alignment to crooked teeth. Get answers to all your braces questions about care, clear braces, and color bands.
Dental injuries range from a chipped or fractured tooth to a knocked out tooth. Treatment depends upon the severity of the dental injury. Dental injuries may be prevented by aligning protruding front teeth with braces and using face masks and mouthguards while playing sports.
Learn more about what cavities like, their symptoms, treatment and prevention. See how tooth decay, plaque and bacteria contribute to the creation of cavities and how regular brushing and flossing can help.
Gum problems may be caused by improper brushing and flossing, gum disease, canker sores, treatments and hormonal changes. Symptoms of gum problems include red, swollen, sore and bleeding gums. These symptoms can be prevented by brushing twice a day, flossing daily, eating a well-balanced diet, drinking enough water, not smoking, and relaxing.
Oral health problems in children include thumb sucking, tongue thrusting, lip sucking, tooth decay, and early tooth loss. Get tips on how to prevent these problems in your child.
Osteoporosis may be linked to bone loss in the jaw, which in turn, leads to tooth loss. Low bone density may result in ill-fitting dentures, tooth loss, and gum disease. Dental X-rays may be able to distinguish people with osteoporosis from those with normal bone density.
There are certain characteristics that you should look for in whatever toothbrush you choose, regardless of whether it is manual or powered.
Size. The best toothbrush head for you should allow you easy access to all surfaces of your teeth. For most adults, a toothbrush head a half-inch wide and one-inch tall will be the easiest to use and the most effective. Though there are larger toothbrush heads available, you may find that it is difficult to maneuver them to clean certain hard-to-reach areas, such as the sides and backs of your molars. The toothbrush should have a long enough handle so you can comfortably hold it in your hand.
Bristle variety. If you go to the drug store to purchase a manual toothbrush or a replacement head for your electric toothbrush, you will be able to select a toothbrush with soft, medium, or hard nylon bristles. For the vast majority of people, a soft-br...
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