An Overview of Toothaches

Toothache Overview

A toothache or tooth pain is caused when the nerve in the root of a tooth is irritated. Dental (tooth) infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction (tooth is pulled out). Pain sometimes originates from other areas and radiates to the jaw, thus appearing to be tooth pain. The most common areas include the jaw joint (temporomandibular joint or TMJ), ear pain, and even occasional heart problems.

• Bacteria growing inside your mouth can contribute to gum disease, plaque, and dental decay. These problems can become painful. The cause and prevention of dental disease has been well investigated.
• You can prevent the majority of dental problems by flossing, brushing with fluoride toothpaste, and having your teeth professionally cleaned twice a year. The dentist may apply sealants and fluoride, which are especially important for children’s teeth.

Toothache Causes

Toothache occurs from inflammation of the central portion of the tooth called pulp. The pulp contains nerve endings that are very sensitive to pain. Inflammation to the pulp or pulpitis may be caused by dental cavities, trauma, and infection. Referred pain from the jaw may cause you to have symptoms of a toothache.

Toothache Symptoms

Toothache and jaw pain are common complaints. There may be severe pain to pressure, or to hot or cold stimuli. The pain may persist for longer than 15 seconds after the stimulus is removed. As the area of inflammation increases, the pain becomes more severe. It may radiate to the cheek, the ear, or the jaw. Other signs and symptoms that may lead you to seek care include the following:

• Pain with chewing
• Hot or cold sensitivity
• Bleeding or discharge from around a tooth or gums
• Swelling around a tooth or swelling of your jaw
• Injury or trauma to the area

These signs and symptoms may sometimes be associated with dental decay or gum disease (periodontal disease). Dental decay or an area of redness around the tooth’s gum line may point to the source of pain. If you tap an infected tooth, it may make the pain more intense. This sign may point to the problem tooth even if the tooth appears normal.

A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear or throat pain, or an injury to the temporomandibular joint (TMJ) that attaches the jaw to the skull may be confused with toothache. Pain from a deeper structure (called referred pain) may be passed along the nerve and be felt in the jaw or tooth. In order to pinpoint the source of the pain and get relief, call your dentist or doctor.

When to Seek Medical Care for a Toothache

You should call your doctor or dentist about a toothache when:

• Pain is not relieved by over-the-counter drugs.
• You experience severe pain after a tooth is pulled. This may occur on the second or third day after tooth extraction. This is a result of the tooth socket being exposed to air. The condition is known as “dry socket syndrome.” If you develop this condition, you should see a dentist within 24 hours.
• Pain is associated with swelling of the gums or face, or you have discharge around a tooth. Fever is an important sign of infection in dental disease. Simple dental decay (caries) does not cause fever. These signs may signify an infection surrounding the tooth, the gum, or the jaw bone (mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended to be done inside the tooth (endodontic drainage), a “root canal” is performed.
• Broken or knocked-out teeth occur from an injury. Unless associated with more severe injuries, your dentist should be contacted as soon as possible. Swallowed teeth and permanent tooth loss are considered dental emergencies. Tooth loss due to injury (traumatic loss) is cared for differently in children who have lost their primary teeth than in older children and adults with injury to their secondary — or permanent –teeth.
• Pain is present at the angle of your jaw. If every time you open your mouth widely you have pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big. Your dentist may be able to suggest solutions to this problem.
• Wisdom teeth are causing pain. As wisdom teeth (third molars) are coming out, they cause inflammation of the gum around the erupted crown. The gum overlying the crown may become infected. The tooth most commonly involved is the lower third molar. The pain may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot be closed properly. In severe cases, pain in the throat and the floor of the mouth may make it difficult to swallow.

Any history of trauma, chest pain, or heart disease, or rashes may suggest causes of pain other than purely dental origin. These symptoms with toothache or jaw pain indicate that you should visit your doctor or a hospital’s emergency department.

• High fever or chills: This may indicate a more widespread infection that might require more than antibiotics by mouth.
• Recent head or face injury: If you experience headache, lightheadedness, nausea, vomiting, or other symptoms that concern you after an injury to your face or mouth, you may have a more serious injury in addition to your dental injury.
• A facial rash associated with a toothache: This condition may improve with medication. The doctor should be able to decide what is appropriate.
• Any jaw pain occurring with chest pain: Although jaw pain is most commonly caused by dental disease, it is sometimes referred pain from other areas. People with heart disease, especially people who have had stents placed, people with diabetes, or those who have had heart surgery may have jaw pain as a symptom of heart attack or angina. If your jaw or tooth pain is associated with lightheadedness, sweating, or shortness of breath, you should see a doctor.
• Trouble swallowing or excessive pain or bleeding from gums: If you have a history of a weakened immune system, diabetes, or steroid use, you are more susceptible to infections. Infections can often be more severe and extensive or caused by unusual organisms. Dental and gum infections in people with these conditions may require more aggressive treatment. An abscess may need draining or IV antibiotics, for example.

Exams and Tests for Toothaches

A medical history and physical exam will usually indicate the appropriate diagnosis for a toothache. Sometimes X-rays called Panorex views (panoramic X-rays of the teeth and jaw) are taken. Occasionally lab evaluation including ECG tracings of the heart will assist the doctor. If the cause is something other than a dental or jaw problem, the doctor may prescribe drugs directed at the problem. If the condition is more severe, the doctor may admit you to the hospital for further care. You may be referred to a dentist for further treatment.

Treating a Toothache at Home

• Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil) may be used. Take these as directed on the package and around the clock on a schedule while you arrange a dental appointment.
• Avoid very cold or hot foods because this may make the pain worse.
• Relief may be obtained from biting on a cotton ball soaked in oil of cloves. Oil of cloves is available at most drug stores.
For jaw pain:
• Aspirin may be helpful for problems in the joint of the jaw in adults.
• Acetaminophen (not aspirin) should be used for children and teenagers.
• If pain occurs every time you open your mouth widely, the temporomandibular joint (TMJ) may be the source of the pain. Yawning or taking a large bite of food may intensify the pain. An appointment with your doctor or dentist will help to determine the cause.
In most cases, toothaches or jaw pain can be cared for with pain medications and antibiotics. A referral to a dentist for follow-up will usually be arranged. In some cases, the doctor may try an injection around the tooth for pain control. If there is swelling in the gums or face, or you have fever, antibiotics may be prescribed.
• At the dentist’s office, fillings, pulling teeth, or other procedures may be performed as required. A tooth extraction will be the most likely procedure with a primary (baby) tooth. On permanent teeth if the problem is severe, root canals (sealing off the root of the tooth) and crown procedures are generally performed.
• An antibiotic will usually be prescribed if a fever or swelling of the jaw is present. Such procedures are generally done in stages, with pain and infection being cared for immediately, and reconstructive procedures being performed at a later time (weeks to months). You will be able to return to work or school while you recover. Dentists and oral surgeons may plan additional procedures at the most appropriate time.
• If causes other than the teeth or jaw are responsible for the pain, management will depend on the condition.

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