Toothache

Most of us have been there: What starts as a dull ache or uncomfortable jolt when you sip your ice tea signals the onset of tooth decay. Soon the pain becomes so unbearable that you can't call the dentist fast enough. The good news is that you can prevent this all-too-common ailment with regular checkups and good oral hygiene.

What causes toothache?

Tooth decay is the most likely cause. Bacteria thrive in your mouth by feeding on food particles left on the teeth. These microscopic agents form a substance called plaque -- an invisible film made up of saliva, food particles, and bacteria -- that clings to the surface of your teeth.

Acids produced by these bacteria can actually eat through tooth enamel -- the hard, white coating on the outside of your teeth -- and create holes (cavities, or in dentist-speak, "dental caries"). The decay can then spread inward to invade the tooth's pulp, which contains its nerves and blood supply.

You may also develop a toothache when you have an abscess, a serious infection marked by pus drainage around the infected tooth. If not treated in time, the infection can spread from the tooth to the supporting jawbones and other parts of the body. The most common cause of an abscess is tooth decay. A deep cavity can penetrate the pulp and cause those cells to die, opening up the area to bacterial infection.

Other causes of toothache include:

  • Gum disease
  • A broken or loose filling
  • A cracked or impacted tooth
  • Food between teeth or under the gum line
  • Grinding your teeth
  • An exposed tooth root
  • Pressure from congested sinuses
  • Injury, such as a blow to the jaw
  • A crown with a crack or hole, leading to an infection underneath it
  • Temporomandibular joint syndrome (TMJ), a disorder marked by pain and tenderness in the joint where your lower jawbone meets your skull.

Some oral cancers can start in the jawbone and mimic dental pain. In very rare cases, pain in the teeth can be a symptom of angina, which is caused by an inadequate blood flow through coronary blood vessels of the heart muscle.

That's why it's always smart to consult your dentist. If there is no underlying dental problem, call your healthcare provider for a checkup.

What are the symptoms of a toothache?

If your toothache is caused by a cavity, you'll probably notice increased sensitivity to sweet, hot, or cold foods as the decay reaches the middle layer of the tooth. When it spreads to the nerve center of the tooth, or pulp, you'll have a toothache. The result may be a dull ache or agonizing, throbbing pain.

If you've recently had dental work -- including a filling, surgery, or routine cleaning -- and your tooth hurts when you bite down or becomes increasingly sensitive over time, report this problem promptly to your dentist. Such symptoms may be the sign that an uneven filling needs adjusting or that there's nerve damage to your tooth.

If you have swelling, stabbing pain when you bite down, a bitter taste in your mouth, swollen glands in your neck, or foul-smelling breath, you may have an abscess. This is a serious condition that should be treated right away.

When should I call the dentist?

As soon as you notice the first symptoms. Left untreated, a toothache can deteriorate and result in a dangerous abscess, leading to tooth loss. Even worse, the infection can spread to the jaw and soft tissues of the head and neck (cellulitis). In rare cases, it can cause so much inflammation that the windpipe swells shut, making it difficult or impossible to breathe.

Since an untreated toothache can turn into a medical emergency fairly quickly, it's important to get dental care right away. If money or lack of insurance is a problem, call the free or low-cost dental clinics and dental schools in your area and make an appointment. Your dentist may be able to arrange a payment plan, and many accept payment by credit card. You may also be able to get healthcare financing through CareCredit.

If your toothache is accompanied by a fever, you have trouble breathing or swallowing, or tooth pain is so severe you can't sleep, call for an emergency appointment. If this occurs on a weekend, go to the emergency room.

What can I do to prevent a toothache?

Since tooth decay is the cause of most toothaches in children and adults, you can take steps to avoid it. Good oral hygiene means brushing at least twice a day with a fluoride-containing toothpaste, flossing each night, and visiting your dentist twice a year for a checkup and a professional cleaning.

In addition, use a toothbrush with soft bristles to avoid damaging your delicate gums. Eat a balanced diet that includes lots of fruits, vegetables, and grains, and limit snacks between meals and sweet or sticky foods and drinks, such as candy or soda. Rinse your mouth out or brush your teeth after eating crackers, cookies or other sticky foods. Replacing your toothbrush every three to four months is another good idea.

It's also crucial to immediately fix any cracks or tiny holes in your teeth, fillings, or crowns that you or your dentist detect. Even a pin-point hole in a crown can allow bacteria to enter, set up camp, and cause an infection that can spread to the jawbone before it's discovered. This is especially important because dental x-rays may not pick up decay behind or underneath a crown until it is well advanced.

How is a toothache treated?

It depends on the cause. If you have a cavity that has not yet reached the pulp, your dentist will drill out the decayed material and then fill the space with tooth-colored filling or silver amalgam. If there is a decayed tooth with an inflamed pulp, your dentist may give you a root canal or extract the tooth. During a root canal, the dentist removes the infected or inflamed pulp, cleans the space, and then seals it to prevent further infection. Afterwards, you'll need to return to your dentist for crown placement over the tooth. If the toothache is caused by an abscess, your dentist may drain the pus and perform either a root canal or a tooth extraction. If you also have cellulitis, your doctor will treat you with a course of antibiotics as well.

In the case of a cracked or fractured tooth, a crown or root canal may be necessary. If you have sensitive teeth due to worn tooth enamel or an exposed tooth root, for example, your dentist may recommend desensitizing toothpaste. This type of toothpaste contains certain compounds that help block pain signals from the tooth surface to the nerve.

What can I do before seeing the dentist?

Although a toothache means a trip to your dentist, you can ease your pain beforehand. Rinse your mouth with warm water to clean it. Then, using dental floss, gently try to remove any food particles or other debris wedged between your teeth, taking care to avoid cutting your gums. (Never use a sharp instrument to dislodge an object stuck between your teeth; this can cause bleeding and worsen your pain. Allow your dentist to remove it.)

If the pain persists, take an over-the-counter pain reliever, such as acetaminophen. You may also try applying an over-the-counter analgesic containing benzocaine directly onto your teeth and gums for temporary pain relief. (However, use benzocaine only as directed by your doctor -- it has been linked to a rare but life-threatening blood disease.)

Avoid putting aspirin or any other painkiller directly against your gums -- it might burn delicate gum tissue. Instead, try a cold compress or ice wrapped in cloth to the outside of the cheek, especially if there's any swelling around the tooth.

References

American Dental Association Dental Emergencies and Injuries. http://www.ada.org/public/manage/emergencies.asp

American Academy of Pediatric Dentistry Emergency Care. http://www.aapd.org/publications/brochures/ecare.asp

Mayo Foundation for Medical Education and Research. Toothache: First Aid. http://www.mayoclinic.com/health/first-aid-toothache/FA00013

American Academy of Family Physicians. Tooth Problems. http://familydoctor.org/511.xml

American Academy of Periodontology. Periodontal (Gum) Diseases http://www.perio.org/consumer/21.html

American Academy of General Dentistry. What is tooth decay, and what causes it? http://www.agd.org/consumer/topics/decay/main.asp

Kreiner, M. et al. Toothache of cardiac origin;13(3):201-7.

Merck Manual Home Edition. Cavities. http://www.merck.com/mmhe/print/sec08/ch114/ch114b.html

University of Illinois Medical Center. Tooth abscess. http://uimc.discoveryhospital.com/main.php?t=enc&id=2301

Mayo Clinic. TMJ disorders. http://www.mayoclinic.com/health/tmj-disorders/DS00355

Merck Manual Home Edition. Cancerous growths. http://www.merck.com/mmhe/sec08/ch113/ch113d.html

American Heart Association. Angina pectoris. http://www.americanheart.org/presenter.jhtml?identifier=4472

Douglass, A.B. et al. Common dental emergencies. American Family Physician. Vol. 67 No. 3.

American Association of Endodontists. FAQs about cracked teeth. http://www.aae.org/patients/faqs/cracksum.htm

American Association of Endodontists. FAQs about root canal treatment. http://www.aae.org/patients/faqs/rootcanals.htm

American Dental Association. Sensitive teeth. http://www.ada.org/public/topics/sensitive.asp

Food and Drug Administration. Public Health Advisory: Benzocaine Sprays marketed under different names, including Hurricaine, Topex, and Cetacaine. February 2006. http://www.fda.gov/CDER/drug/advisory/benzocaine.htm

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