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Dental Pain

Dental Pain

There are several sources of dental pain.  The most common of which is the toothache.  A toothache is most commonly caused by tooth decay but there are several other causes.  These can include gum disease, trauma or injury, dry socket (infection after an extraction), impacted teeth, tooth wear, sinus infection, the bite being off, neuralgia and a cracked tooth.

Decay causes pain after the cavity spreads from the outer layer of the tooth (known as enamel which has no nerve supply) into the underlying dentine which has a nerve supply.  Here, the nerves detect pain in response to hot, cold or sweet food or drinks.  As the cavity progresses deeper the pain usually becomes more intense.  The pain can be occasional to persistent and continuous.  The pain may be present only when provoked by pressure, hot, cold or sweets or it may occur in more severe cases spontaneously.  The pain may be mild, dull, aching or gnawing to throbbing, sharp, intense, severe and even excruciating.

It is important to note that cavities do not always cause a toothache and often a cavity can reach the nerve of the tooth without pain as a warning that something is wrong.

When the decay has spread to the nerve of the tooth, the nerve will die.  Often an abscess will develop, causing severe throbbing pain that can last for hours.  The dead tissue inside the tooth can form gasses that react strongly to hot foods and drinks.  Treatment for this is to drain any pus out of the tooth and do a root canal and crown.  The crown is done to restore the tooth since after a root canal, the tooth is left in a weakened state.  The alternative is to extract the tooth.

Dentine can be exposed not just by decay.  Dentine can be exposed by trauma, attrition, erosion or abrasion.

  • Trauma.  Accidents can cause damage to teeth and the intensity of the pain will depend on the nature and degree of the damage.  When a large piece of tooth has broken off, the nerve endings and sometimes the nerve itself is exposed. Treatment may range from a simple filling, to root canal treatment with a crown, to possible extraction.  If the bone supporting the tooth or the root is fractured, the tooth has a more questionable prognosis.
  • Attrition.  This is the wearing down of teeth by grinding.  Some wear is normal with time but this can be accelerated by bruxism which is the abnormal grinding to teeth.
  • Erosion.  This is caused by stomach acids regurgitating into the mouth dissolving the enamel and dentine.  This is often seen in bulimics and patients who have reflux disease.
  • Abrasion.  This is the wearing away of enamel at the gum line where it is the thinnest by brushing too vigorously, thus exposing the dentine at the gum line.
  • Abraction.  When people grind their teeth, the force put on the part of the tooth above the gum line known as the crown causes the crown to bend slightly on the root.  This causes the enamel and dentine to breakdown at the gum line leaving a lesion that looks very similar to the one caused by abrasion.

In its early stages, sensitivity can be controlled by over the counter or prescription toothpastes or by having a desensitizing treatment or even a filling at the dentist’s office.

Gum disease can cause a toothache by causing the gum to lose its attachment to the tooth and the gum can also become loose around the tooth.  Food and bacteria can accumulate in this space between the tooth and gum.  As this space gets deeper around the tooth, a periodontal pocket begins to develop,  As the process continues, the infected pocket develops an abscess below the gum line.  The pain can be mild or severe and the area is usually swollen to some extent.  Relief can occur when the abscess bursts and drains but without treatment it will re-occur.

Food getting wedged between the teeth can cause pain.  Normally there is a firm contact between all of the teeth.  This prevents food from getting packed between the teeth when chewing takes place.  If there are small spaces that develop, food can be forced into these spaces between the teeth and then up into the gum.  This acts as an irritant to the gum and the gum then becomes inflamed, swollen and painful.  This inflammation can spread to other areas around the tooth causing the tooth to become painful on chewing.

Using floss, interdental brushes and toothpicks can help keep the area clean but the underlying problem should be corrected by a dentist.

Cracks in teeth can be very hard to find and can cause a great deal of discomfort.  Hairline fractures often develop in teeth especially those with large fillings.  Many can be superficial and may never cause a problem.  Others can be much deeper, putting the tooth at risk for fracture or for the crack spreading into the pulp chamber where the nerve lies.

Signs of a fracture range from nonexistent to severe pain on chewing or to hot and cold.

Treatment depends on how deeply the crack has spread and may involve placing a crown with or without a root canal to extraction if the problem is serious enough.

Sometimes it can be very difficult to tell which tooth is causing dental pain.  Sensation to all teeth is supplied by one major nerve called the trigeminal nerve.  Different branches of this nerve supply the upper and the lower teeth.  Pain may be felt arising from an upper tooth where the cause of the pain may be a lower tooth or visa versa.  This is called referred pain.  A careful exam by the dentist will locate which tooth is causing the problem.

At times, what may be felt as being a toothache may not be caused by a tooth at all.  Above the upper teeth there are air spaces or sinuses in the bone supporting those teeth.  Sometimes the roots of the upper teeth come very close to those spaces.  If the sinuses become infected, the inflammation caused by the infection can make one feel that the pain is coming from the teeth.  When the sinus problem is treated, the toothache will go away.

A condition called trigeminal neuralgia which causes facial pain of varying intensity can also be confused with a toothache.  Treating a tooth here just as with a person with a sinus problem will not make the pain go away.

After a filling is placed, a tooth can be sensitive for a week or more.  This is especially true if the decay was very deep and close to the nerve.  The dentine near the nerve is very sensitive and it needs time to lay down a protective layer of dentine between the nerve and the filling.  This will insulate against temperature changes and reduce sensitivity.  Sometimes adjusting a new filling can help with any sensitivity that may occur after a filling is placed.

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