I have a toothache, what could be the cause?
Toothache is one of the worst pains any patient can experience. Toothache treatment usually involves a thorough clinical examination and diagnostic tests.
When it comes to causes of toothache, there are multiple possibilities, so the most important part of toothache treatment is to get the diagnosis right – that is, to discover the source of the pain. Among the most common causes of toothache are decay, infection, cracked teeth, grinding, gum recession and gum disease.
A tooth is made up of three layers: the outer hard layer (known as enamel), the second softer layer (known as dentine) and the centre (the nerve and blood vessels of the tooth known as the pulp). When destruction of the tooth structure caused by tooth decay comes close to the pulp of the tooth, toothache can occur.
Common causes of toothache include:
- An infection involving the nerve of the tooth, usually caused by dental decay that has been left to progress towards the nerve.
- An infection involving the ligament and tissues that surround the tooth, usually caused by infrequent or inadequate professional cleans, infrequent flossing or poor oral hygiene.
- Exposure of dentine, the inner part of the tooth, due to factors such as over-brushing, tooth grinding, high acid diet or reflux.
- Food trapping between the teeth, causing irritation or inflammation of the tissue around the teeth.
Tooth decay (dental caries) is usually caused by lack of brushing or flossing and poor oral hygiene. It can also be caused the consumption of too much sugar or acid in food and drinks, resulting in a breakdown of tooth structure. If decay is detected early, it does not usually present as painful. In most cases, dental caries can be diagnosed and treated pain free! When the caries has progressed deeper into the tooth (and gets closer to the nerve) it presents as toothache.
The symptoms of tooth decay include: aching when eating or drinking, sensitivity to cold or hot stimuli, dark spots on the teeth and bad breath. When caries is detected, the dental clinician will most likely take an X-ray to confirm the presence of decay, see how large the cavity is, and check for infection or other pathology. All of these factors, plus further tests and clinical examination, will help determine the best course of treatment for the patient.
Infection occurs when there is decay, an impacted tooth (usually a wisdom tooth) or gum disease. It can sometimes be detected visually (that is, through swelling of the face and/or neck, or by the sighting of an abscess) and also with the presence of pain.
Toothache caused by infection is most commonly described as throbbing or persistent and intense pain. Patients may also have a fever and find that the pain does sometimes dissipate if or when the abscess pops. The other symptoms of infection include pain when eating and drinking, and sensitivity to hot and cold stimuli. If you suspect infection in your mouth, it is important to seek advice from your dentist so that they can prescribe antibiotics (if required) to alleviate your symptoms, and then treat you to prevent further infections.
Cracking can happen to any tooth, but it is most commonly seen in premolars and molars. It is usually a result of grinding or heavy biting, past trauma or large fillings. The symptoms of a cracked tooth include: sharp pain when eating hot, cold or sweet foods and drinks, and sharp pain when biting hard then releasing that pressure.
Grinding, or bruxism, is when the teeth are excessively clenched or ground. It is most commonly caused by stress and occurs subconsciously (when patients are sleeping). Symptoms of bruxism are generalised sensitivity to hot and cold stimuli, generalised toothache, facial pain, stiffness or pain in the jaw/ jaw joint. Dentally it presents with multiple worn or flattened, chipped, broken or loose teeth. A thorough check-up of the teeth and jaw structures will be able to determine if bruxism is the cause of your tooth pain.
Gum recession occurs most commonly from brushing too hard or using a toothbrush that has abrasive bristles. Recession means that the gums have dropped around the teeth and the root surface becomes exposed. As the root surface does not have the same enamel coating as the rest of the crown, patients generally experience sensitivity to cold stimuli. If the root surface is scrubbed with force by the toothbrush, it can start to wear away also, resulting in “abrasion” (a type of wear that occurs from a mechanical force – in this case brushing).
The main symptom of gum recession is sensitivity. Sensitive toothpaste can assist with reducing this sensitivity. If that doesn’t work, your dentist can explain the treatments available to fill or cover up the exposed areas and thus stop further sensitivity.
Gum disease is the inflammation and infection of the gums. It usually occurs due to suboptimal oral hygiene, but there are multiple exacerbating factors that contribute to the disease progression. Symptoms include: red, swollen, bleeding gums; bad breath; and loose teeth. A thorough clean will usually improve the condition of the gum and prevent discomfort/ pain. However, it should be noted that all treatment of gum diseases is ongoing.
Other factors that can cause toothache include:
- Sinusitis – Inflammation of the sinuses which can be in close proximity to the upper teeth
- Neuropathy – Inflammation or damage to the nerves that enter the teeth, which can cause pain, tingling and/or burning sensations
- Cysts – fluid or air-filled sacs in the bone which can be closely related to the teeth and cause pain
- Oral cancer – Cancer of the bone or soft tissues in close approximation to the teeth, causing pain
The best way to proceed when you have a toothache is to book a dental examination to determine the cause of the pain. At Smile Solutions, we will endeavour to find an appointment for you as soon as it suits you and your symptoms. Smile Solutions reception staff will ask you to describe the type of pain and it is very helpful if you can determine the following:
- If the pain is present on biting or chewing (pressure on the tooth)
- If it comes about or worsens when met by hot/cold drinks or food?
- If the pain is intermittent or chronic; sharp or dull
- The tooth or area the pain is coming from
- How long you’ve been experiencing the pain
All of the information you provide our reception staff will help us to prepare for the appointment, the diagnosis and your treatment.
What steps can I take to prevent toothache?
To attempt to prevent toothache, dentists recommend that you brush your teeth twice a day, floss regularly and attend regular dental appointments for cleaning and examinations.
If you are experiencing symptoms of toothache or discomfort, contact Smile Solutions on 13 13 96 to organise an appointment at your earliest convenience. One of our highly trained dentists, specialists or oral health therapists will be happy to assist you.