Toothache

Definition

A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection.

Description

A toothache may feel like a sharp pain or a dull ache. The tooth may be sensitive to pressure, heat, cold, or sweets. In cases of severe pain, identifying the problem tooth is often difficult. Any patient with a toothache should see a dentist for diagnosis and treatment. Most toothaches get worse if left untreated.

Demographics

Toothaches are common. Yet people have fewer cavities on average in the early 2000s than they did in the nineteenth or twentieth century, in part because in the late 1900s many towns added fluoride to the drinking water and many dentists began prescribing fluoride tablets as a preventative measure. Fewer cavities and better tooth health have reduced the number of toothaches.

Causes and symptoms

Toothaches may result from any of a number of causes:

tooth decay (dental caries)
inflammation of the tooth pulp (pulpitis)
abscesses
gum disease, including periodontitis
loose or broken filling
cracked or impacted tooth
exposed tooth root
food wedged between teeth or trapped below the gum line
tooth nerve irritated by clenching or grinding of teeth (bruxism)
pressure from congested sinuses
traumatic injury

When to call the doctor

If the toothache lasts for more than 24 hours an appointment with the dentist should be made. If there is fever , swelling, intense pain, or bleeding in addition to the toothache the dentist should be seen right away.

Diagnosis

Diagnosis includes identifying the location of the toothache, as well as the cause. The dentist begins by asking the patient specific questions about the toothache, including the types of foods that make the pain worse, whether the tooth is sensitive to temperature or biting, and whether the pain is worse at night. The dentist then examines the patient's mouth for signs of swelling, redness, and obvious tooth damage. The presence of pus indicates an abscess or gum disease. The dentist may flush the sore area with warm water to dislodge any food particles and to test for sensitivity to heat. The dentist may then dry the area with gauze to determine sensitivity to touch and pressure. The dentist may probe tooth crevices and the edges of fillings with a sharp instrument, looking for areas of tooth decay. Finally, the dentist may take x rays, looking for evidence of decay between teeth, a cracked or impacted tooth, or a disorder of the underlying bone.

Treatment

Treatment depends on the underlying cause of the toothache. If the pain is due to tooth decay, the dentist will remove the decayed area and restore the tooth with a filling of silver amalgam or composite resin. Loose or broken fillings are removed, new decay cleaned out, and a new filling is placed. If the pulp of the tooth is damaged, root canal therapy is needed. The dentist or a specialist called an endodontist removes the decayed pulp, fills the space left behind with a soothing paste, and covers the tooth with a crown to protect and seal it. If the damage cannot be treated by these methods, or if the tooth is impacted, the tooth must be extracted. If the dentist finds an infection, antibiotics are given to treat it.

Toothaches should always be professionally treated by a dentist. Some methods of self-treatment, however, may help manage the pain until professional care is available:

rinsing with warm salt water
using dental floss to remove any food particles
taking acetaminophen (Tylenol) or ibuprofen (Advil) to relieve pain (Aspirin is not recommended for children because of the risk of Reye's syndrome.)
applying a cold compress against the outside of the cheek
using clove oil ( Syzygium aromaticum ) to numb the gums (The oil may be rubbed directly on the sore area or used to soak a small piece of cotton and applied to the sore tooth. Clove oil should not be put on the tongue because it often burns or stings.)

Alternative treatment

Toothaches caused by infection or tooth decay must be treated by a dentist. Several alternative therapies may be helpful for pain relief until dental treatment is available. Clove oil ( Syzygium aromaticum ) may be rubbed on sensitive gums to numb them or added to a small cotton pellet that is then placed into or over a hole in the tooth. The herb corydalis ( Corydalis yanhusuo ) may also help relieve toothache pain. Pain also may be reduced by using acupressure, acupuncture, or reiki.

Prognosis

Prompt dental treatment provides a positive outcome for toothache. In the absence of active infection, fillings, root canal treatments, or extractions may be performed with minimal discomfort to the patient. When a toothache is left untreated, a severe infection may develop and spread to the sinuses or jawbone, and eventually cause blood poisoning.

Prevention

Maintaining proper oral hygiene is the key to preventing toothaches. The best way to prevent tooth decay is to brush at least twice a day, preferably after every meal and snack. Flossing once a day also helps prevent gum disease by removing food particles and bacteria at and below the gum line, as well as between teeth. Children should visit the dentist at least every six months for oral examinations and professional cleaning. Dentists often recommend that children see the dentist for the first time before they are one year old. Parents should help young children brush their teeth. Fluoride is also very helpful in preventing tooth decay. If the town's water is not fluoridated, the parent should ask the dentist for fluoride supplements.

Parental concerns

Toothaches are most often caused by cavities. If not treated promptly an infection could begin or spread. If infection spreads to the blood, serious complications can result.

KEY TERMS

Abscess —A localized collection of pus in the skin or other body tissue caused by infection.

Bruxism —Habitual clenching and grinding of the teeth, especially during sleep.

Cavity —A hole or weak spot in the tooth surface caused by decay.

Dental caries —A disease of the teeth in which microorganisms convert sugar in the mouth to an acid that erodes the tooth. Commonly called a cavity.

Enamel —The hard, outermost surface of a tooth.

Endodontist —A dentist who specializes in diagnosing and treating diseases of the pulp and other inner structures of the tooth.

Impacted tooth —Any tooth that is prevented from reaching its normal position in the mouth by another tooth, bone, or soft tissue.

Periodontitis —Inflammation of the periodontium, the tissues that support and anchor the teeth. Without treatment it can destroy the structures supporting the teeth, including bone.

Pulp —The soft, innermost layer of a tooth that contains its blood vessels and nerves.

Pulpitis —Inflammation of the pulp of a tooth that involves the blood vessels and nerves.

Resources

BOOKS

Bagley, Katie. Brush Well: A Look at Dental Care. Decatur, IL: Capstone Press Inc., 2001.

Diamond, Richard. Dental First Aid for Families. Ravensdale, WA: Idyll Arbor Inc., 2000.

Keller, Laurie. Open Wide: Tooth School Inside. New York: Henry Holt & Co., 2003.

McDonald, Ralph E., et al. Dentistry for the Child and Adolescent. St. Louis, MO: Mosby, 2004.

PERIODICALS

Goldstein, Laura. "Two Ways to Soothe Sensitive Teeth." Prevention 52, i.11 (November 2000): 161.

ORGANIZATIONS

American Dental Association. 211 East Chicago Ave. Chicago, IL 60611–2678. Web site: http://www.ada.org.

WEB SITES

"Understanding a Toothache." Available online at http://www.floss.com/understanding_a_toothache.htm (accessed October 15, 2004).

Tish Davidson, A.M. Bethany Thivierge