6 Conditions That Might Be Causing Your Toothache
A toothache occurs when the nerve in a tooth is irritated, injured, infected, inflamed or exposed. Damage or disease in other oral/facial structures can also cause pain in the teeth, but dental health problems are the most common cause. Identifying what is making the tooth hurt is critical for effective treatment. Here is an overview of the most typical dental causes of toothaches:
1. Toothache from a Tooth Abscess
This is an infection that affects the pulp of the tooth (the soft, living tissue inside the tooth). It may occur if the tooth is cracked or decayed, allowing bacteria access to the pulp. The abscess itself is a pocket of infectious matter that forms at the tip of the tooth just below the root. The pocket is filled with pus which consists of:
- Necrotic (dead) tissue
- Live and dead bacteria along with their waste byproducts
- White blood cells
The nerve in the tooth itself may be inflamed along with tissues in the gums. The result is a throbbing discomfort that may spike occasionally to become excruciating pain. The pain typically gets worse over time. However, the pain may eventually subside once the nerve in the tooth has been completely destroyed by the infection.
An abscess may be identified on an x-ray as a white nodule at the root of a tooth. There may also be redness and a visible pustule on the gums or leaking of foul-tasting material into the mouth. In severe cases, a fever may accompany the abscess. This is a sign that the infection may have entered the bloodstream (a potentially life-threatening condition). Early treatment to remove infected tissue and restore the tooth (root canal) along with antibiotics to kill bacteria can limit pain and speed healing.
2. Toothache from Cavities
As long as the erosion is limited to the enamel layer, a cavity may not cause any pain. However, when the dentin layer of the tooth is exposed, tooth sensitivity may occur. This is because the dentin is more porous than enamel and allows environmental triggers to stimulate the nerve in the pulp. Pain at this stage is usually a sharp twinge but not necessarily ongoing discomfort. Heat, cold, pressure and sugar are often triggers for sensitivity. As the cavity becomes deeper and the pulp is invaded by bacteria, the occasional discomfort evolves into a full-blown toothache. Visual examination may identify some cavities, but x-rays are the gold standard for diagnosis. Filling the cavity or placing a crown is the typical treatment.
3. Toothache from a Damaged Tooth
If a tooth is cracked slightly, bacteria may enter over time and cause the same symptoms as patients experience when the tooth is decayed. The discomfort may take many weeks to develop. However, when a more serious fracture occurs, the pain may be immediate. If the nerve is exposed above the gum line or impinged upon by a broken tooth root, it may cause both persistent pain and shooting pains. With a damaged root, pain may also radiate into the surrounding gum tissue. The pain may be worse during biting or chewing when pressure is placed on the tooth. This type of toothache is often called cracked tooth syndrome. It can occur if a tooth is struck forcefully or cracked from frequent nighttime grinding. Molars that bear the brunt of force during chewing and teeth that have been weakened by large fillings are at the highest risk for fracture.
A crack on the upper portion of the tooth may be easy to spot visually – especially with the use of a bright light shined through the tooth, a bite test or the application of dye. A crack in the tooth root below the gum line is more difficult to detect. Even an x-ray or CAT scan may not find a fracture on the root of a tooth. In that case, an endodontic access (a hole drilled through the crown of the tooth) or a periodontal flap (a flap of gum pulled away from the tooth root) may be required. That way, the tooth root can be examined under magnification. Depending on the severity of the fracture, a filling, crown, inlay or onlay may be adequate treatment. However, a severely damaged tooth may require extraction and replacement with a bridge or a dental implant.
4. Toothache from Impacted Wisdom Tooth
An impacted wisdom tooth is one that is stuck below the gums (soft-tissue impaction) or trapped in the jaw bone (bony impaction). The tooth may actually grow in at an angle so that it presses against the root of the second molar. This can cause pulsating or sharp pain in the affected molar. The area around the wisdom tooth may ache as well. X-rays can easily identify impacted wisdom teeth. Extraction usually resolves the issue if there is no lasting damage to the second molar.
5. Toothache from Uneven or Excessive Pressure
Jaw clenching and tooth grinding (bruxism) as well as bite malocclusion can all place undue pressure on teeth. Over time, this trauma can cause inflammation of the periodontal ligament holding the tooth in place. This inflammation leads to twinges of pain or constant throbbing. Bruxism may be identified by the wear pattern on back teeth. Patients may also exhibit symptoms of TMJ such as jaw pain or headache. Bite malocclusion can be identified visually, with bite impressions and with facial x-rays. Bruxism may be reduced with the use of a mouth guard or splint to limit grinding and relieve some of the pressure of jaw clenching. Bite malocclusion is treated with orthodontics such as braces.
6. Toothache from Gum Disease
Even moderately advanced periodontitis may not cause pain. However, gum disease can increase the risk of toothache from inflammation and infection that spreads from the gum tissue into the tooth. Or, it may contribute to tooth sensitivity through exposure of the tooth root (which also makes the root susceptible to erosion and cavities). Even in cases where periodontitis is not associated with tooth pain, it can cause tooth loss from damage to the periodontal ligament and the bony socket that holds the tooth in place.