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Medical Author:

Donna Bautista, DDS

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

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.

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In this Article

• Toothache facts
• What is a toothache?
• What are dental causes of toothaches and how are they treated?
• Dental cavities and dental abscesses
• Gum disease
• Tooth root sensitivities
• Cracked tooth syndrome
• Temporalmandibular joint (TMJ) disorders
• Impaction and eruption
• What are non-dental causes of toothaches?
• How is toothache during pregnancy managed?
• Are home remedies effective for toothaches?
• Can toothaches be prevented?
• Patient Comments: Toothache - Treatments
• Patient Comments: Toothache - Describe Your Experience
• Find a local Doctor in your town
• Toothache Index

The second most common cause of toothache is gum disease (periodontal disease). Gum disease refers to infection 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 oral bacteria in "plaque" that accumulates over time along and under the gum line. This plaque is a mixture of food, saliva, and bacteria. An early sign of gum disease is gum bleeding. 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 meticulous oral hygiene by an individual as well as removal of bacterial plaque and tartar (hardened, calcified plaque) by a dental professional. 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. Frequent visits to the dentist are recommended for periodontal maintenance (dental cleanings) and monitoring of the teeth and gums.