Toothache; Causes, Symptoms, Diagnosis, Treatment

Toothache 








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Toothache also is known as dental pain is a pain in the teeth and/or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. Common causes include inflammation of the pulp, usually in response to tooth decay, dental trauma, or other factors, dentin hypersensitivity (short, sharp pain, usually associated with exposed root surfaces), apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the root apex), dental abscesses (localized collections of pus, such as apical abscess, pericoronal abscess, and periodontal abscess), alveolar osteitis (“dry socket”, a possible complication of tooth extraction, with loss of the blood clot and exposure of bone), acute necrotizing ulcerative gingivitis (a gum infection, also called “trench mouth”), temporomandibular disorder and others.

A toothache is the most common cause of oral pain []. Although fractured teeth and exposed dentin may produce dentin hypersensitivity and cause dental pain [], untreated dental decay has been reported as the most important reason for a toothache which can impact routine daily activities such as eating, studying, concentrating on delicate tasks, and so on []. Several investigations that studied the impact of dental and facial pain emphasized that tooth and mouth diseases directly influence the quality of life in a community [].

A wide range of toothache prevalence has been reported from 5% to 88% []. Dental pain has been confirmed as a public health problem []. A recent investigation of children and adolescents revealed that overall, about one-tenth of patients complaining of pain suffered from a toothache [].

Causes of Toothache/ Dental Pain

  • Infection
  • Gum disease
  • Grinding teeth (bruxism)
  • Tooth trauma
  • An abnormal bite
  • Tooth eruption (in babies and school-age children)
  • A toothache in or around a tooth or several teeth caused by different factors can lead to crippling pain.
  • Gum inflammation
  • Gum disease
  • Tooth decay
  • Damaged tooth filling
  • Abscessed tooth
  • Infected gums
  • Tooth fracture
  • Even teeth grinding
  • Severe, persistent gum pains;
  • Pain when you open your mouth wide;
  • Migraines and fevers caused by mouth pains;
  • Consistent bad tasting fluids draining from your gum.
  • Toothaches are sometimes sharp, dull, intermittent or persistent. To feel the pain in some instances, you have to press against the tooth or gum.

TMJ/TMD (Temporomandibular Joint Disorder), sinus or ear infections, and tension in the facial muscles can cause discomfort that resembles a toothache, but often these health problems are accompanied by a headache.

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Pain around the teeth and the jaws can be symptoms of heart disease such as angina. If your dentist suspects a medical illness could be the cause of your toothache, he or she may refer you to a physician

Symptoms of Toothache/ Dental Pain

Because the symptoms of a toothache may resemble other medical conditions or dental problems, it can be difficult to diagnose the cause without a complete evaluation by your dentist. If you notice pus near the source of the pain, your tooth may have become abscessed, causing the surrounding bone to become infected. Or the pus could indicate gum disease, which is usually characterized by inflammation of the soft tissue, bleeding gums and abnormal loss of bone surrounding the teeth.

Contact your dentist immediately if you have any of the following symptoms:

  • Fever
  • Difficulty breathing or swallowing
  • Swelling around the tooth area
  • Pain when you bite
  • A foul-tasting discharge
  • Continuous lasting pain

While tooth decay is often the primary cause of a toothache, it’s important for you to have a complete oral examination to determine the cause. Other causes of a toothache can include the following.

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ParameterDentin hypersensitivity:Reversible pulpitis:Irreversible pulpitisPulp necrosisApical periodontitisPeriodontal abscessPericoronitisMyofascial painMaxillary sinusitis
SitePoorly localizedPoorly localizedVariable; localized or diffuseNo painWell localizedUsually well localizedWell localized, associated with a partially impacted toothDiffuse, often over many musclesBack teeth top jaw
OnsetGradualVariableVariableFrom the pain of reversible pulpitis to no pain in daysGradual typically follows weeks of thermal pain in the toothSudden, no episode of thermal sensitivitySuddenVery slow; weeks to monthsSudden
CharacterSharp, quickly reversibleSharp, shootingDull, continuous pain. Can also be sharpNo painDull, continuous throbbing painDull, continuous throbbing painSharp, with continuous dullDull, achingDull, aching, occasional thermal sensitivity in back top teeth
RadiationDoes not cross the midlineDoes not cross the midlineDoes not cross the midlineN/ADoes not cross the midlineLittle, well localizedModerate, into jaw/neckExtensive, neck/templeModerate, into other facial sinus areas
Associated symptomsThe patient may complain of receding gums and/or toothbrush abrasion cavitiesCan follow restorative dental work or traumaFollows period of pain that does not lingerFollows the period of spontaneous painThe tooth may feel raised in the socketMay follow the report of something getting “stuck” in gumTooth eruption (“cutting”) or impacted toothTension headaches, neck pain, periods of stress or episode of mouth open for long periodSymptoms of URTI
Time patternHypersensitivity as long as the stimulus is applied; often worse in cold weatherPain as long as the stimulus is appliedLingering pain to hot or cold or spontaneous painThe absence of pain following days or weeks of intense, well-localized painPain on biting following constant dull, aching pain developmentDull ache with an acute increase in pain when the tooth is moved, minimal thermal sensitivityConstant dull ache without the stimulusSpontaneous, worse with eating, chewing, or movement of jawSpontaneous, worse when head is tipped forward
Exacerbating and relieving factorsExacerbating: thermal, particularly coldExacerbating: thermal, sweetSimple analgesics have little effectProlonged heat may elicit painSame as irreversible pulpitis, or no response to cold, lingering pain to hot, pain with biting or lying downTapping tooth makes worse, the cleansing area may improve painThe cleansing area can improve painRest or ice makes pain better, movement and chewing make it worseTilting head forward, jarring movements (jumping) make pain worse
SeverityLess severe than pulpitisSevere, for short periodsVariable; pain dissipates until periapical tissue affectedSevereSevereSevereMild to severeMild to moderateMild to severe
Effect on sleepNoneNone usuallyDisrupts sleepNoneDisrupts sleepVariable, can disrupt sleepIf moderate to severe will disruptUnusualUnusual

Treatment of Toothache/ Dental Pain

Acetaminophen

An over-the-counter medicine like acetaminophen is useful in treating toothaches, and it’s the most common medications given after dental treatment, according to the American Dental Association. The National Institutes of Health notes that acetaminophen is an analgesic and changes the way your body perceives pain, which is what makes an ache tolerable.

NSAIDs

Toothaches are often accompanied by inflammation, swelling, and redness of the gums, or irritation to other parts of the mouth.

These symptoms may benefit from taking an anti-inflammatory, such as naproxen or ibuprofen, Etoricoxib as a single dosage with metronidazole and PPI (or any of the other nonsteroidal anti-inflammatory drugs (NSAIDs). You should only take one of these medications if you know for certain that you have no allergies to the ingredients, and you should always ensure you take an NSAID with food to avoid irritation to the stomach.

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Holding an ice pack or a package of frozen peas to the outside of your face can be surprisingly helpful. The cold helps numb the pain. Apply the ice for a few minutes at a time and then take a break.

Topical Medication

Products such as benzocaine applied directly to the tooth can also provide you with some short-term relief from pain. Your dentist may recommend Colgate Orabase 20% Benzocaine for this purpose, as it contains 20% Benzocaine to provide clinically proven pain relief for mouth irritations.

Ice Packs

Avoid Hard Foods

Toothaches are frequently caused either by a broken tooth or a dental cavity, so until you are sure of the reason for your pain, it’s best to take precautions. While you’re waiting for and directly after toothache treatment, sticking to soft foods will help you to avoid further damage to brittle or sensitive teeth.

Keep it Clean

It is essential to maintain good dental hygiene even when you have a toothache. If it’s too painful to perform your regular daily brushing and flossing, try a product such as Colgate Peroxyl Mouth Sore Rinse. The bubbling action cleans and alleviates discomfort to promote healing. It’s not always convenient to get the treatment you require at the time you need it, but these options will help reduce the pain enough to see you through until you can get professional help.

Home remedies for a toothache

Cloves

Cloves contain a chemical called eugenol. Eugenol is an anesthetic chemical, means it numbs the nerves and stops the sensation of pain. Eugenol also has antiseptic properties that help kill germs. You can also use Clove oil to treat the pain. Just dab a small cotton ball and rub the oil on the tooth which has pain. You can use the clove or clove oil remedy up to 3 times a day, NOT MORE THAN THAT. Eugenol can be poisonous if consumed in high amounts.

Asafoetida (Hing)

For this, you will need a tablespoon of orange juice as well. Just mix a pinch of Asafoetida in the orange juice and dab a cotton ball in the mix. Place this cotton ball on the painful teeth or the jaw for 5 to 10 minutes. This remedy works immediately in reducing pain and hence it is very popular.

Ice Cube

Massage the jaws near the painful teeth for 3 to 4 times in a day with an Ice cube. A 5-minute massage with Ice cube can significantly lower the inflammation and pain.

Salt mouthwash

A toothache caused by mild infection or injury will be reduced by time. To fasten this process, mix 1 tablespoon of salt in a cup of lukewarm water. Now take a gulp of this water in your mouth and squish it over the painful area. Repeat this 2-3 three times and the pain will be eased off.

Garlic

Garlic has antibiotic properties and the ability to fight various types of infection. If your toothache is due to some type of infection, and cure the pain. You can simply chew a clove of Garlic or you can mash the garlic clove to make a paste and apply the paste on the tooth. Garlic has Elicin, a chemical which is a potent antibiotic. Remember to use fresh garlic or freshly made garlic paste.

Instant Relief from Toothache

A mouth rinse with alcohol (Hard drinks like whiskey or vodka) provides instant relief from a toothache. Alcohol numbs the nerve fibers in the jaws immediately and prevents the sensation of pain.

Should you go see a Dentist?

Yes, you should see a doctor, if the pain lasts more than a day. If the pain is not resolved and persistent, you should visit a Dentist. Upon inspection and diagnosis of the problem, a dentist may advise you to go for many Orthodontal procedures such as tooth extraction, root canal surgery or if the tooth has a cavity; get a filling done.

The longer you avoid to visit the doctor, the worse pain will get.

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If a toothache isn’t treated properly, the dental pulp can eventually become infected. This can lead to serious dental problems with severe and throbbing pain.

Allopathic treatment for a toothache

The treatment for a toothache will depend on the reason for the pain. Your dentist will observe your teeth, jaws and may carry out an X-ray to try to rectify the cause of pain. Some of the commonly practiced medicines and procedures are listed below:

Hydrogen Peroxide

Dip a Q-tip in the Hydrogen peroxide and apply it to the affected tooth. This will clean the area around and help in numbing the pain for some time. Keep the hydrogen peroxide for 2-3 minutes in the mouth, then rinse it off with clean water. Do not swallow it

Painkillers

You can take painkillers such as Acetaminophen or Ibuprofen orally to control tooth pain. If the patient is an adult then aspirin can be given to him. Aspirin is not advised to children to reduce the tooth pain.

Dental Filling

A dentist will clean the decayed area (cavity) and fill it with a filling substance.
In some cases, the filling gets loose due to wear-and-tear over time, Then the dentist will remove old filling and replace it with a new one.

Root Canal

Root canal treatment is administered when the dental pulp is severely infected and damaged. It is a serious surgical procedure. Depending on your teeth condition, root canal treatment can take up to 2-5 sessions with a dentist if. In this procedure, a dentist will completely remove the infected dental pulp then fill the teeth with a special type of filling. The doctor will also seal the treated tooth with a dental crown and cap to prevent future infections.

Dental Implants

Many times the decay occurs on a critical area of teeth and it becomes difficult to treat it by above-discussed methods. Then the doctor will have to remove the affected teeth. The doctor will fix a dental implant to replace the removed tooth.

Preventing toothache

The best way to prevent getting a toothache and many other dental problems; is to keep your gums and teeth as healthy as possible. To maintain good health of teeth and gums, you should follow these steps:

Brush twice

Use a toothpaste that contains fluoride to brush your teeth twice every day. The best times to brush, as usual; are before breakfast in the morning and before going to bed at night. Gently brush your gums and tongue as well.

Dental Floss

Sometimes, the bristles of a toothbrush are not capable of cleaning the teeth thoroughly. Just use a thin dental floss to remove dirt from in-between the teeth. If you feel like it, use a freshening mouthwash.

Control Sugar intake

Avoid the consumption of sugary foods and drinks. Sugar residues on teeth and gums can encourage the growth of bacteria and trigger the infection.

Avoid Tobacco

Chewing of Smoking tobacco can cause tooth decay and oral cancer. Tobacco can worsen many dental problems.

Examine Regularly

Visit your Dentist at regular intervals to get your teeth tested. Well, the gap between check-ups can vary, depending on the health and condition of your teeth. Go for check up at every 6 months, and prevent decay or other dental problems.

Referances

Toothache

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