Dr. Usha Dhavan

Those who have experienced it would vouch for the fact that toothache is one of the worst pains. There could be times when the attack happens out of nowhere and you are crying for relief.

The tooth has 2 parts - the visible part called the crown and the invisible part called the root which is embedded in the jaw bone and covered by the gums.  

Both the crown and the root have 3 layers from inside out. The crown has enamel, dentin, and pulp. The enamel is the mineralized part of the tooth, dentin has fine sensory dentinal tubules, and the pulp receives nerve and blood supply to the tooth through a small orifice at the end of the tooth called the apex.  On the root surface, instead of enamel, there is a softer substance called cementum.  The dentin and the pulp continue through the tooth, but are thinner in the root portion of the tooth.

The mouth has the largest amount of bacteria in the body. These act on the food deposits on the tooth and produce acid which leads to breakdown of the enamel. The only symptom when enamel breakdown happens is food lodgment, and it continues till treatment ensues. Once the breakdown reaches the dentin, sensitivity sets in, and most people go for treatment then. If not, the next layer is the pulp, when there is severe pain.  This acute pulpitis causes pain in spurts and can be unbearable.

On the root surface, if there is periodontal disease and the gum line goes down, then cementum gets worn off (far more easily than enamel) and decay reaches the dentin and pulp (again faster than in the crown).

Whatever the case, the treatment would be the same:

• Dental examination, clinical testing, and x-rays would be diagnostic. Tapping the tooth would reproduce the same pain and that is indicative of acute pulpitis
• Antibiotics and pain killers would be given to control the pain
• Once the infection subsides, root canal therapy is initiated.  Using the decayed portion to gain access to the root, thin instruments called reamers and files are used to clean out the pulp space completely. They are then shaped to accommodate an inert substance called gutta percha which ensures infection does not seep into the tooth again.
• With RCT, the tooth is weakened, and therefore a crown needs to be placed. This could either be a ceramic crown or a full metal crown based on economic and esthetic reasons.

The best way to avoid this is regular visits to a dentist so that decay is identified in the early stages and treated with the minimal cost and maximum natural tooth preservation.

Dental pain is an especially difficult situation to handle on your own. True dental pain usually doesn’t respond to common over the counter pain control options. Let’s go over the different types of dental pain, what you can expect with each, and what you can do temporarily in each case.

Toothache (Severe Constant Throbbing, Hot and Cold Sensitivity)

Dentists call this type of toothache “irreversible pulpitis”. The nerve of the tooth has been traumatized and is in the process of dying. While this lasts you’ll have severe throbbing pain as well as pain from hot and cold. Many times the pain is enough to wake you up at night. I’ve had many patients tell me that it is worse than giving birth or having kidney stones. There are very few things you can do to help with this type of pain because of it’s severity. 800 mg of Ibuprofen every 6 hours will sometimes take the edge off. Anesthetic gels or crushed aspirin tablet around the tooth will be ineffective. The only solutions to this problem are to wait for it to go away, have the tooth extracted, or have a root canal. If you decide to wait it out, you should realize that the tooth will likely become infected at some point in the future.

Toothache (Severe constant pain especially if any pressure is placed on the tooth, No hot and cold sensitivity)

Once the nerve of the tooth has died, the area inside the tooth becomes infected. This infection will often spread out of the tooth and into the bone around the tooth. This is known as a dental abscess. You won’t have any sensitivity to temperature in this case but you can still have severe throbbing pain and pain when you bite or anything touches the tooth. You can use 800 mg of Ibuprofen every 6 hours to take the edge off. Again any anesthetic gel or similar preparation around the tooth will not help. Antibiotics will help in this case to reduce the infection and relieve some of the pain temporarily. The pain will come back at some point in the future. The only permanent options for treatment are to take the tooth out or do a root canal.

Toothache (Pain only when biting)

If you have pain on biting after having fillings done, your bite is usually a little bit high (called a 'high-point') and needs to be adjusted by the dentist. Avoid biting on that area as best you can until you can get it adjusted. If you haven’t had any dental work done recently, this can be the result of a crack developing in the tooth. The best thing to do is avoid chewing on the tooth until you can see the dentist. Most of these teeth end up needing a crown and occasionally need a root canal if the crack goes into the nerve.

Mouth Ulcer

Ulcers in your mouth can mimic the pain from the a toothache. These can develop all on their own or sometimes they are the result of biting your lip or cheek. If you see a roundish white area surrounded by a bright red halo, you likely have an ulcer. Any over-the-couter available anesthetic gel (e.g. Mucopain, Hexigel, Soregel) placed on the ulcer will help numb it and reduce the pain. Most of these will heal on their own within a week.

Sinus Pain

Sinus pain is another one of those situations that can mimic a toothache. The roots of your top molars literally sit right next to your sinuses and any type of sinus pressure from a cold, etc can cause your teeth to ache. You’ll usually feel a minor to moderate constant ache in those areas. One of the best tests of this is to bend your head and upper body down towards your feet and then straighten up suddenly. If this causes additional pain it is usually sinus related. Decongestants like Otrivin will help relieve some of this pain.

TMJ Pain

Lastly, many people develop TMJ pain. The Temporomandibular Joint (TMJ)  is the joint that connects your jaw to your skull. When this joint is injured or damaged, it can lead to a localized pain disorder called Temporomandibular Joint (TMJ) syndrome. Temporomandibular Joint (TMJ) syndrome often responds to home remedies, including ice packs to the joint, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), massage or gentle stretches of the jaw and neck, and stress reduction. The prognosis for TMJ syndrome is generally good as the disorder can usually be managed with self-care and home remedies. If it doesn't respond to any medication, you must see your Dentist for further care.