Toothaches are well known to be one of the most miserable types of pain that one can experience. On quite a few occasions, I’ve had female patients tell me that the pain they have with a toothache is worse than anything they went through with childbirth. So what causes toothaches, and what can you do to help minimize discomfort if you experience a toothache?
Common Types of Toothaches
The most common types of toothaches are caused by an irritation to the living tissue on the inside of the tooth, which is known as the pulp. This irritation is usually caused by a deep cavity, but can also be caused by a severe fracture of a tooth. Because the pulp is encased by the hard tooth, the pulp can’t swell like other tissue in the body can. Pulpal inflammation causes an increase in pressure within the tooth, which also causes an increase in pain. If the inflammation continues, it will eventually compress and cut off circulation to the blood vessels that feed the tooth. This ultimately causes the tooth to die and become abscessed/infected. It is at this point that a patient might notice swelling of their gums or even their face.
At the dental office, we characterize these types of toothaches in three ways: reversible pulpitis, irreversible pulpitis, and dental abscess.
Reversible pulpitis is where a tooth has been traumatized (as by a blow to the face) or has a moderately deep cavity. A patient with reversible pulpitis may experience very short bursts & 15 seconds of intense pain. However, this pain only occurs when the tooth is stimulated by exposure to certain hot or cold foods or to biting pressure. A tooth with reversible pulpitis can be expected to return to normal and have no further pain if the irritant is removed (i.e. has a filling or avoids further trauma to the tooth)\
A tooth with irreversible pulpitis is one with a very deep cavity or one that has suffered a worse trauma. Someone with this problem will experience longer bouts of pain with the tooth. The pain may still be caused by certain hot or cold foods or biting pressure, but can also occur spontaneously. Patients often report that these teeth keep them up at night. Only two treatments will work to solve this toothache: a root canal or tooth removal.
Abscessed teeth are essentially the next stage in progression from irreversible pulpitis. This is where theb tooth completely dies. It usually is not as sensitive at this point to hot or cold foods, but can be very sensitive to biting pressure. An abscessed tooth can also have swelling in the gums below it or even in the face beside it (although swelling is not always evident).
Like in irreversible pulpitis, the only treatments to make the tooth feel better are a root canal or tooth removal. It is very important to treat abscessed teeth quickly, as facial swelling can spread rapidly and can cause difficulty in breathing.
A root canal basically removes the pulp tissue from the inside of the tooth. It allows a person to keep their tooth, but it will no longer be painful.
Toothaches Can Have Other Causes
There are a few other types of toothaches that people can experience. People with severe gum (periodontal) disease can have a gum infection, often characterized by loose teeth and/or pus along the gum line. People who are experiencing migraine headaches, sinus headaches, or ear aches often feel like their teeth hurt. Furthermore, people who severely clinch or grind their teeth can experience temporary toothaches.
So What Can You Do to Help with Discomfort If You Experience A Toothache?
Over-the-counter pain relievers such as ibuprofen or tylenol can help. However, never place and hold aspirin or other pain relievers directly against the gum or cheek, as this can cause chemical burns on the tissue. Warm salt water rinses (swishing and spitting) can also help relieve some discomfort. If you feel like the pain is coming from the gums, you may find it helpful to use a very small amount of topical anesthetic (like Orajel) in the area. Finally, placing a cold compress on your face beside the sore tooth can often help relieve discomfort.
When Should I See A Dentist?
If your pain lasts longer than a day or two, it is a good idea to make a visit to the dentist. You should go see the dentist immediately if you notice swelling around the tooth or in the face. At our office, we always make time for emergency patients because we know how uncomfortable toothaches are. And for our existing patients, we also have an emergency number where someone from the office can be reached after hours or on weekends.
If you are having tooth pain, please contact our office to see how we can help you.