Toothache - Causes and how to get rid of it

Toothache is a common problem. In this article we explain the possible causes of toothache and how to get rid of it.

1) The parts of the tooth: where does it hurt?

To understand toothache, it is essential to know the structure of a tooth. Each tooth has a visible part (the crown) and another inserted into the bone (the root). In turn, each tooth is made up of several layers:

  • a) Enamel: this is the outermost and hardest layer of the tooth. It is an insensitive tissue that does not have living cells and is extremely resistant.
  • b) Dentin: it is an important element of the tooth since it contains living cells. Dentin also contains microscopic channels called dentinal tubules, through which sensations are transmitted to the nerve or pulp.
  • c) Cementum: it is the layer that covers the root of the tooth. It is a substance similar to dentin, but much finer. Attached to this cement are the fibers and ligaments that anchor the tooth to the bone.
  • d) The dental pulp: it is the nerve of the tooth. It provides blood flow, nutrients and sensitivity to the tooth.

The sensation of tooth pain is caused by some thermal, mechanical or chemical stimulus that reaches the dental pulp or the periodontal ligament. This stimulus will cause a more or less intense pain depending on its origin.

2) Can all teeth hurt?

It is important to know that all teeth can hurt. An adult mouth is made up of 8 incisors, 4 canines, 8 premolars, and 12 molars. It is true that the last two usually have two or three roots compared to the rest that have one, so it is not uncommon for them to cause more problems.

3) Causes and treatments of toothache

The causes of tooth pain can be diverse, so the treatments too.

3A) Pulpitis: the main reason for tooth pain

Pulpitis is an inflammation of the dental pulp or nerve. This produces pain when faced with stimuli such as cold or heat, although in some cases it can trigger continuous pain. We distinguish between reversible pulpitis, when the pain disappears in a short time, and irreversible, when the nerve involvement is total and definitive.

3Aa) Treatment of pulpitis

If the pulpitis is reversible, treatment will consist of removing the cause of the inflammation. This usually happens by performing a filling or restoration with composite, although other types of interventions may be necessary. If the nerve is damaged and the pulpitis is irreversible, the solution will consist of performing a root canal or tooth extraction.

3B) Tooth decay - A common cause of toothache

Dental caries is an infectious disease caused by bacteria that exist in the mouth. When we consume sugary products or hydrates, these bacteria produce acids capable of destroying tooth enamel during their metabolism. Once the caries penetrate the enamel, its advance is unstoppable since the dentin is much weaker.

3Ba) How to get rid of toothache caused by cavities

If caries is the element that triggers the pain, the treatment will include a filling, an inlay and/or a root canal depending on the severity and depth.

3C) Tooth abscess

An abscess is an infection around the root of the tooth, another common cause of dental pain. When bacteria enter the dental pulp, pus can accumulate inside the tissues which, if not drained and treated in time, can lead to the death of the tooth and damage to surrounding tissues.

3Ca) Treatment for dental abscess

The treatment of a dental abscess may involve the consumption of antibiotics as in any infection. In the indicated cases, a drainage of pus from the area will be performed afterwards. It may also require additional treatment to eliminate the cause of this abscess, either with a deep cleaning of the gums if it is of periodontal origin or a root canal treatment if it is of dental origin.

3D) Fractures or dental fissures/cracks

Fissures or fractures can be another cause of toothache. The difference between the two is that in fractures there is a detachment of the broken part while in fissures there is "only" cracking. These do not have to be always painful since it will depend on how deep this lesion occurs.

3Da) How to relieve tooth pain from a fracture or crack

If a fracture affects only the crown of the tooth, it could be treated with a reconstruction and/or endodontics. If the fracture also affects the root, the treatment will require extraction of the tooh.

3E) Tooth sensitivity: another cause of toothache

Dental sensitivity is defined as pain or discomfort of the teeth due to contact, a change in temperature or due to the chemical nature of the substance we are eating or drinking. The discomfort lasts for a moment and then disappears until the next stimulus. This occurs when the dentin loses its protective covering, or if the gums recede leaving part of the root exposed, and hot and cold or acidic or sticky foods reach the nerves and cells inside the tooth.

3Ea) How to relieve tooth sensitivity

In general, the use of desensitizing toothpastes and fluoride gel can help in this task, but in more serious cases it may be necessary to perform a crown, a filling, an inlay, a root canal or even a gingival graft to reduce the root exposure.

3F) Periodontal disease

Periodontal disease affects different structures that surround teeth. It is caused by bacteria that accumulate in tartar and dental plaque, which sticks around the teeth and if not removed, they get between the tooth and the gum. These bacteria create toxins that damage and develop an infectious inflammatory process, which involves the destruction of the tissues that support the teeth, such as the periodontal ligament and bone.

3Fa) How to treat periodontal disease

It will be necessary to carry out the specific treatment indicated for each stage of disease progression. It can include everything from periodontal prophylaxis, scaling and root planing or even a periodontal surgery.

3G) Tooth eruption and toothache

Tooth eruption is the process by which the teeth break through the gums until they become visible in the mouth. This process occurs twice in life: the eruption of baby teeth and that of permanent teeth. This process can generate some discomfort of greater or lesser intensity, but if it involves pain, it is usually because the tooth does not have enough space to come out or it is doing it in the wrong direction and damaging other tissues or teeth. 

3Ga) Wisdom tooth eruption and pericoronitis

Wisdom teeth are especially prone to problems. These usually appear between the ages of 17 and 24 and, in many cases, erupt in a malposition due to lack of space in the jaw. This can lead to pericoronitis, an inflammation and/or infection of the gum which can cause pain, bad breath, a bad taste in the mouth and even fever.

3Gb) How to relieve tooth eruption pain

If the tooth is emerging correctly but is causing discomfort, you can try to relieve the pain by applying local cold to the area or taking painkillers. If the pain is caused because the tooth is erupting incorrectly due to lack of space, its extraction may be necessary.

3H) Dry socket

The socket is exposed after a dental extraction, forming a blood clot that protects the nerve endings of the empty dental cavity during healing. Sometimes, this clot may not form or break due to genetic factors, tobacco use, food remains in the alveolus, etc., which produces a very painful process called alveolitis.

3Ha) How to treat dry socket

The main treatment is symptomatic with painkillers and/or antibiotics. It is also important to remove food debris by irrigating the area with saline solution. Socket curettage may be indicated to decontaminate the bone surface and cause bleeding for a new clot to form. In addition, the use of plasma rich in growth factors (PRFG) can help regenerate the area.

3I) Occlusal overload

Occlusal overload occurs when one or more teeth receive more load than the rest. If this is not corrected, the teeth can crack and/or fracture and the surrounding tissues such as the gums and the periodontal ligament can be damaged. This produces mobility of the tooth and pain, especially with pressure on the affected teeth.

3Ia) Treatment of occlusal overload

Depending on the origin, it may need one or several interventions, but almost all of them will require an occlusal adjustment to release that excess contact. This is done through small abrasions on the surface of the tooth until the pressure is released.

3J) Dental resorptions

Dental or root resorptions are defects in a tooth that can affect the enamel, dentin, cementum and pulp. These defects are usually caused by trauma, orthodontic treatment, cysts, impacted teeth, systemic, idiopathic or genetic diseases.

3Ja) How to treat root resorption

Depending on the area affected by the resorption, it can have different treatments such as endodontics, fillings, inlays or tooth extraction in very advanced cases, 

3K) Referred toothache from TMJ

The temporomandibular joint (TMJ) is what connects the jaw to the skull and allows us to speak and chew. Sometimes there is a dysfunction in this joint either due to bruxism, congenital anomalies or a bad way of biting. This can trigger a number of symptoms including jaw pain.

3Ka) How to treat temporomandibular dysfunction

Depending on the diagnosis and the severity of the dysfunction, they are treated with physiotherapy, dry needling, drug therapy, botulinum toxin, discharge splint, and surgery in the most severe cases.

3L) Trigeminal neuralgia

The trigeminal nerve is responsible for transmitting sensations from the face to the brain. Neuralgia is a chronic problem in that nerve and can cause episodes of stabbing pain or a burning sensation triggered by simply touching the face. These episodes can last several days and normally affect only one side of the face, and may refer to several areas of the face, including the teeth.

3A) How to treat trigeminal neuralgia

The most common initial treatment is medication. The most commonly used drug is an anticonvulsant, although other drugs such as tricyclic antidepressants are also used. The medication serves to prevent trigeminal neuralgia, but not to stop the pain, since the effect of the drug begins half an hour after taking it, when, normally, the peak of the pain has already passed. If the medication fails or causes side effects in the patient, surgery will be considered to decompress the nerve or to limit or suppress the transmission of the stimulus.

4) Home remedies for toothache

We recommend visiting the dentist for proper diagnosis and treatment, but there are some home remedies that can help you. Among the most common is applying local cold in case of inflammation, rinsing with salt water if there is an infection or extreme cleaning and flossing in the event that there is something between the teeth that could be damaging them. Of course, medication can also play a big role, but always adjusted to the diagnosis.

5) The dentist will help you with your tooth pain

If you suffer from any persistent toothache, it is advisable to visit the dentist, so that they can determine the cause of the discomfort and possible treatments. Generally these pains are warnings that something is not right in our mouth, so it should be solved as soon as possible.

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