What is a toothache?
A toothache is pain that occurs in or around a tooth. The pain originates from within a tooth or the surrounding gum and bone structures. One usually feels toothache pain as a constant or intermittent ache that does not go away. Temperature changes, such as exposure to cold drinks or pressure on the tooth while chewing, can stimulate a toothache. In other instances, tooth pain can arise spontaneously without any stimulation. Odontalgia is another name for a toothache.
It's hard to ignore an aching tooth while eating or going about one's day. Persistent pain urges us to find out how to get rid of a toothache. While bothersome, it is a way for the painful tooth or area to signal that one should seek some attention and care from a dentist before things get worse.
What causes a toothache?
Injury or trauma to the tooth or area usually cause toothaches. Injury is commonly a result of tooth decay (or cavity). People usually feel cavities when they get larger and deeper into the layers of tooth structure. Enamel is the hard, outer layer of tooth, and dentin is the softer layer beneath the enamel. Dentin is the tooth's sensitive layer with tiny microscopic tubes that originate from the very center of the tooth. The pulp chamber (the center of the tooth) 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 sore tooth, as well.
Other causes of toothache include the following:
- Abscessed tooth: This infection 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 tooth pain every time one puts pressure on it with biting or chewing (called "cracked tooth syndrome").
- Dental work: After getting a filling or crown, the tooth can feel more sensitive. This is especially the case if the removal of tooth decay was large or deep. 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 and at night. Unfortunately, bruxism causes damage to teeth and sometimes irritates the nerves to the point where teeth become sensitive.
- Gum infection or gum disease: The periodontium consists of the gum, gum ligament, and bone that surround and anchor the teeth. Early stages of gum problems usually involve inflamed gum, called gingivitis. The gum is usually red, swollen and will bleed easily. A gum problem can progress to include the jawbone surrounding teeth and represents the later stages of gum disease (or "periodontitis") where there is advanced loss of bone around 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 protective bone and gum no longer cover the roots of teeth, 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, also called wisdom teeth, 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.
Toothache Symptoms and Causes
The symptoms of toothache include sharp pain or dull pain in or around a tooth. The most common cause of a toothache is a dental cavity as a result of tooth decay.
- Dental cavities and toothache can be prevented by proper oral hygiene.
- Another common cause of toothache is gum disease.
- Toothache can also be a result of an injury or an abscess of the tooth.
- Toothache symptoms can be caused by a problem that does not originate from a tooth or the jaw.
Symptoms of toothache can be mimicked by sinus infection, shingles, and other diseases.
What are toothache symptoms and signs?
Signs and symptoms that can might indicate a tooth problem are
- pain with biting or chewing,
- teeth hypersensitivity to changes in temperature,
- cheek or gums swelling near tooth,
- discharge or bleeding of gums,
- constant throbbing within a tooth.
A toothache can present as a dull or sharp pain that may arise spontaneously on its own or by stimulation.
Additional symptoms may include
How do health care professionals diagnose a toothache?
The dentist performs a series of diagnostic tests along with dental X-rays to determine the origin of a toothache. These tests try to mimic what may be causing the pain, such as cold stimuli, biting or chewing pressure, and finger pressure on the gums. The response to a cold stimuli test can help in determining whether a tooth is vital (nerve is intact within tooth) or suffering from pulpitis (inflammation of the pulp). Determining duration and acuity of pain from cold stimuli can help diagnose and determine treatment.
Sometimes, the cause of a toothache may come from somewhere different from where pain is actually felt (called "referred pain"). For these situations, diagnostic tests performed by the dentist are particularly important in accurately detecting the problem.
What is the treatment for a toothache?
Toothache treatment depends on the cause of the pain and how much damage is present. In general, the best way to stop a toothache is for the dentist to remove any present infection or decay and repair the damage to protect exposed, sensitive areas. For a shallow cavity on a tooth, a dentist removes the decay and seals the tooth with a filling. If the cavity is very deep and gets into the pulp, the dentist performs "root canal treatment" because the pulp has been exposed and infected with bacteria. This procedure essentially removes all the vital contents of the tooth (nerves and blood vessels) and seals the inner aspects of the tooth (root canal system) with an inert filling material. An abscessed tooth that has very localized infection usually needs root canal treatment with antibiotic therapy. If the infection has become widespread, one may need antibiotic therapy and additional steps to properly drain the infection. Dentists often prescribe pain medications to manage the pain. Sometimes extraction of the tooth may be the only option for treatment if the tooth or surrounding gum and bone are too damaged.
For a periodontal abscess, a dentist performs a simple drainage procedure under local anesthesia. Additionally, a dentist thoroughly cleans the affected gum pocket to remove any tartar buildup and debris. Once cleaned, the pocket is irrigated with an antimicrobial rinse containing chlorhexidine. Sometimes, antibiotics are locally administered into the pocket to further aid in healing. Depending on the extent of the abscess, a dentist may prescribe oral antibiotics. Additionally, for the short-term, a dentist may prescribe chlorhexidine oral rinse as a mouthwash to aid in healing. The area should be kept clean with gentle tooth brushing and warm water rinses. A follow-up visit is recommended to make sure the infection has completely resolved and develop a plan to properly maintain the area.
For tooth fractures or cracked tooth syndrome situations, dental crown placement is the usual treatment. A crown will replace missing tooth structure and/or it will help protect the weakened tooth from further breakdown and sensitivity.
Are home remedies effective for a toothache?
Generally, home remedies are only effective as a temporary measure to calm severe tooth pain and are not intended to cure the problem. How does one try to get instant relief without the aid of a dental professional? Oral pain medication will be a key step. Over-the-counter pain medicines such as ibuprofen (Advil) or naproxen (Aleve) are nonsteroidal anti-inflammatory drugs and are best taken on a schedule to provide pain relief. Acetaminophen (Tylenol) is an alternative painkiller. In some cases, alternating doses of ibuprofen and acetaminophen is effective.
The essential oil, clove oil, is a toothache remedy that is actually an ingredient in some sedative dental filling materials. It is a natural home remedy that has a numbing effect and can provide instant relief. Clove oil (eugenol) can be found at the pharmacy. Small amounts of clove oil should be used to the affected area. Dilute a few drops in a teaspoon of olive oil to avoid burning the mouth tissue. Before application of the diluted clove oil, rinse the mouth thoroughly with warm salt water or warm water to clear any debris from the affected area. Then, place a small cotton ball soaked with a few drops of the diluted clove oil on the tooth or gum area. Allow a few minutes after application for the numbing effect to take place. Other products that contain benzocaine (including Orajel or Anbesol) can temporarily numb the affected tooth or gums and provide pain relief as well. If clove oil is not available, plain olive oil can also provide some relief by coating a painful area.
To help a toothache until treatment can be found, one should avoid chewing on the affected tooth/area and minimize extreme temperatures of hot and cold. Keeping the area clean and free of food debris may help as well. Warm salt water or plain warm water rinses can help soothe the affected area and keep the mouth clean. If swelling of the surrounding gums or tissues is present, immediate treatment with a dentist or physician is advised to avoid the spread of infection. Home remedies may temporarily alleviate pain but do not to treat infection.
Above all, proper diagnosis and timely treatment by a dentist is strongly advised to effectively treat a toothache.
How is a toothache treated during pregnancy?
Dentists can safely perform treatment during pregnancy as long as a few guidelines are followed.
Generally, if dental work is required to treat a toothache, the recommended time for treatment is during the second trimester of pregnancy. However, if there is a risk of infection or severe pain, dental treatment may need to be performed at any point during a pregnancy. The obstetrician is consulted on what would be the safest option to avoid any possible complications during dental treatment.
If a dental X-ray is needed, a lead apron is always used for every patient. For a pregnant patient, this is particularly important in protecting the unborn child.
Careful consideration should be made to ensure that any medications that are used are safe during pregnancy. This applies to local anesthetics administered during dental treatment and antibiotics (such as amoxicillin [Amoxil, Trimox, Moxatag, Larotid]) taken before or after treatment. Over-the-counter drugs such as aspirin, ibuprofen, or naproxen are avoided as these are not considered safe during pregnancy. Acetaminophen is considered safe for pain management.
What is the prognosis for a toothache?
For the most part, the prognosis is good for a toothache. In this era of modern dental care, dentists can quickly identify the problem and treat it effectively. The outcome is best when toothache is treated as early as possible to avoid further damage or risk of spreading infection.
Is it possible to prevent a toothache?
Conscientious efforts to practice good oral hygiene go a long way in preventing dental problems. Toothbrushing with fluoride toothpaste and use of dental floss are essential to good dental care at home. Furthermore, regular maintenance visits with a dentist can serve to keep things in check. Small cavities can be found before turning into larger cavities or an abscessed tooth. Gum problems, including periodontal abscess, can be addressed before advancing to a more diseased state.
To keep teeth strong, avoid the habit of chewing on ice or very hard foods that can cause tooth fractures. Using our teeth as a tool to open a bag of potato chips or cracking open a nutshell increase the chances of a tooth fracture as well. Minimize high sugar content foods or beverages to decrease the risk of dental decay. Be mindful of acidity in beverages as this can be a source of sensitivity and cavities for teeth.
Medically Reviewed on 7/10/2018
Cohen, Stephen and Richard C. Burns. Pathways of the Pulp, 2nd Ed. The C.V. Mosby Company, 1980.