Oral Care

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.