Dr. Donna S. Bautista, DDS, completed her undergraduate studies at the University of California, San Diego with a bachelor of arts in biochemistry and cell biology. During her time at UC San Diego, she was involved in basic research including studying processes related to DNA transcription in the field of molecular biology. Upon graduation, she went on to attend dental school at the University of California, San Francisco. In addition to her formal dental training, she provided dental care for underserved communities in the Bay Area through clinics and health fairs. She also worked toward mentoring high school students interested in the field of dentistry.
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.
A toothache is pain that occurs in or around a tooth. The pain usually comes from within a tooth or the surrounding gum and bone structures. The pain can be from more than one tooth. Toothache pain is usually felt as a constant or intermittent ache that does not go away. A toothache can be stimulated by temperature changes such as exposure to cold drinks or pressure on the tooth while chewing. In other instances, a tooth can arise spontaneously without any stimulation.
It's hard to ignore a bothersome aching tooth while eating or going about one's day. While a toothache is bothersome, it is a way for the offending tooth or area to make one aware that it needs some attention and care.
What causes a toothache?
Toothaches are usually caused by injury or trauma to the tooth. Injury is commonly a result of dental decay (or "cavity"). A cavity is usually felt when it gets larger and deeper into the layers of tooth structure. The hard outer layer of tooth is called enamel, and the softer layer beneath enamel is called dentin. Dentin is sensitive with tiny microscopic tubes that run from the very center of the tooth. The center of the tooth is called the pulp chamber and contains the pulp. The pulp is comprised of blood vessels and nerves. If decay gets past enamel into the dentin, the cavity can sometimes cause discomfort. A deeper cavity that approaches the center of the tooth will likely cause pain since there is more damage to the tooth and there is less tooth structure to insulate and protect the pulp. Localized infection between the gum and tooth (periodontal abscess) can cause toothache. A traumatic physical blow to a tooth can induce a toothache as well.
Other causes of toothache include the following:
Abscessed tooth: This is an infection that originates from within the tooth and spreads to the root and the surrounding bone.
Damaged or fractured tooth: Fracture of a tooth can expose the sensitive dentin or even the pulp. Sometimes fractures are not obvious even though the fracture line can run deep into the tooth, causing pain every time one puts pressure on it with biting or chewing. This is called "cracked tooth syndrome."
Dental work: After a deep or large filling or crown is done, the tooth can feel more sensitive. Dental work, although necessary, can sometimes irritate the nerve. Over time, the sensitivity can resolve if the tooth is healthy enough.
Teeth clenching or grinding: This habit is called bruxism and is oftentimes done unconsciously. Unfortunately, bruxism causes damage to teeth and sometimes irritates the nerves to the point where teeth become sensitive.
Gum infection or gum disease: The gum, gum ligament, and bone that surround and anchor the teeth are collectively called the "periodontium." Pain is usually felt during the later stages of gum disease (or "periodontitis") where there is advanced loss of bone that surrounds the teeth. Because of bone loss, a gum abscess (infection) can form in the space that develops between the tooth and the gum, causing pain.
Exposed root surfaces: When the roots of teeth are no longer covered with the protective bone and gum, these surfaces can be sensitive to stimuli such as brushing the teeth or temperature changes.
Sinusitis: Because the roots of the upper molars are very close to the maxillary sinus cavities, inflammation from the sinus cavities can cause these molars to be sensitive and feel like a toothache.
Third molars ("wisdom teeth"): Third molars are the very last permanent teeth to appear in the mouth. More often than not, there is not enough space for these molars in the mouth. As a result, third molars become fully or partially trapped (impacted) within the jawbone and below the gum. Because of poor accessibility, it is difficult to properly clean partially exposed third molars; therefore, these areas are susceptible to problems. Problems with third molars can cause dull to severe pain from pressure of eruption, gum infection, or dental decay.
When a cavity advances deep into the tooth, it may produce increased sensitivity to foods that are cold, hot, or sweet. But not all cavities will cause a toothache. If they are small or progressing slowly, they may only be detected by a dentist before they cause pain.