Having a toothache can be one of the worst experiences in your life. As per studies, a toothache is the second most severe pain that a human can endure in his life, second only to a heart attack or pain during delivery.

 A toothache often starts as mild discomfort or sensitivity when you take hot or cold foodstuffs that last only a few seconds and disappear soon after the food passes the mouth. Later on, stimulation. The pain starts to linger on for a longer time. When left untreated, this can progress into spontaneous pain without provocation or start as nighttime pains that affect the individual’s sleep. Only a pain killer medication would be able to give him any relief. More often, it can continue to worsen gradually and won’t go away until you visit your dentist to find a solution for your nagging pain.

There can be several possible causes of your toothache, namely

• Dental decay close to or involving the pulp
• Gum infection
• Wear and tear of teeth
• Trauma to teeth
• Erupting wisdom teeth
• Cracked tooth syndrome
• Acute exacerbation of a long standing dental abcess

Each of these causes of toothache is explained below, along with the management options that your dentist will consider.

Causes of toothache and treatment options

1. Caries/Dental Decay

Dental caries or cavities can occur in people of all ages and is a prevalent cause of toothache. You can end up having cavities in your teeth if you do not pay attention to your dental hygiene, i.e., regular brushing, flossing, or not keeping your mouth clean after having sugary foods or drinks.

Tooth decay occurs when acids in the mouth erode the tooth’s hard outer layer (enamel) and expose the dentin, resulting in insensitivity. When left untreated at this stage, the decay slowly progresses towards the pulp, and the symptoms change to mild to moderate or severe pain. You may experience sudden sharp pain or sensitivity in your tooth when you eat anything hot or cold. If not managed properly, the infection can eventually progress into an abscess.

Treatment options

• Root Canal Treatment (RCT): Your dental specialist will perform root canal treatment to treat the pain by precisely removing only the portion of the tooth that causes pain and skillfully save the remaining healthy tooth. During the procedure, the endodontist after giving local anesthesia will painlessly remove the pulp as it contains nerve endings that cause pain and clear any infected material from the tooth. Then the tooth will be skillfully restored from the root tip with sterile materials and the tooth filled to exactly replicate its functional and esthetic state.

• Tooth extraction: Some teeth may become severely decayed if the cavity remains untreated for too long. Only extraction is possible which will leave a gap in between the teeth. This can be treated using a dental implant or a bridge. It is mandatory to replace an extracted tooth unless it is a wisdom tooth.

2. Gum infection

Poor oral hygiene can result in infection of the gums and cause tooth pain. Bacteria can settle down between the teeth, cause gum inflammation (gingivitis), and break down the surrounding gum tissue. If not treated in time, this can progress to advanced periodontal disease resulting in tooth instability and loss. Therefore, as soon as you notice any signs of bleeding, swelling or tenderness in your gums, take steps to consult your dentist.

Treatment options

• Periodontal procedures like scaling and root planing: The deep pockets surrounding the teeth are deep cleaned using special dental instruments such as scalers and curettes to remove tartar and bacterial plaque from both below and above the gumline.
• Flap surgery with or without root canal treatment: In some cases, the deep pockets are not accessible to scaling or root planing and may require a flap surgery to reduce the pockets to prevent bacteria from accumulating there. It also makes it possible for the patient to do regular cleaning by brushing and flossing.

3. Wear and tear of teeth

With age, your natural teeth will undergo some expected wear and tear due to the constant friction from chewing, brushing too hard, and habits like grinding and clenching. If you have a habit of chewing on your fingernails or other rough objects, it also can cause physical abrasion of the teeth and contribute to enamel loss. Acids from foods and beverages like soda and citrus juices work slowly to weaken the teeth enamel.

Worn out teeth can cause yellowish discolouration of the teeth, cause sensitivity on eating certain hot or cold foods, and your teeth surface may appear indented. If your tooth is worn out excessively, you may also experience jaw ache, headache, and difficulty biting and chewing if your teeth.

Treatment options

• Minor wear and tear: Your dentist may suggest different treatment options based on the cause of your problem and the extent of wear and tear. For example, he will recommend using a soft toothbrush with fluoride toothpaste, reducing or eliminating acidic foods and drinks from your diet, and avoiding biting down on hard foods or objects to safeguard the teeth. You will be instructed to wear a mouth guard while sleeping to prevent you from grinding your teeth.
• Excessive wear and tear: However, if you are experiencing severe tooth pain and headaches, you may have excessive wearing of the teeth. Your dentist may suggest correction of the defective teeth with or without root canal treatment. Treatment options include dental bonding to cover the worn-out surfaces, veneers to mask the discoloration and surface deformity, and dental crowns to cover cracked or chipped teeth.

4. Traumatic dental injury

Trauma to teeth can occur due to road traffic accidents, sports injuries or falls resulting in broken or fractured teeth, dislodged teeth or displaced teeth due to external forces. You should seek immediate consultation with an endodontist to save your injured teeth using advanced techniques.

Treatment options

As a first step, your endodontist would do a radiographic assessment to rule out fractures to the jaw and face. The treatment methods include:

• Treating tooth fractures based on the level and extent of the fracture with proper rehabilitation and RCT wherever necessary
• Reattaching the fractured fragment of tooth wherever possible with or without RCT
• Splinting to reposition loose teeth so that the forces applied on the teeth are distributed more evenly and provide additional support to stabilize them
• Reimplanting/replacing lost teeth with crowns or dental implants

5. Erupting/infected wisdom tooth

You may present with pain if your wisdom tooth erupts in the wrong position or gets impacted due to lack of space, causing pain, swelling and soreness at the site and is felt more while chewing, biting or opening the mouth. Since it is difficult to clean the area, it is a prime spot for cavity formation and infection-causing pain and discomfort.

Treatment options

• Medical management: Pain in the jaw can be temporarily managed by application of an ice pack or cold compress. Your dentist may prescribe pain killers to dull the pain.
• Operculectomy with lasers: This is a minor surgery to remove the excess gum tissue covering the partially erupted wisdom tooth. The procedure is done if your wisdom tooth is erupting normally, and it helps to relieve the inflammation and pain at the site.
• Wisdom tooth extraction: Your dentist will advise extraction if the wisdom tooth appears to be wholly or partially impacted.

6. Cracked tooth syndrome

Tiny cracks can appear on the tooth enamel from biting down hard on foods such as nuts, excessive grinding of teeth or due to trauma. If you have pain or discomfort with chewing, then a cracked tooth can be one of the reasons for your pain.

Treatment options

• Proper diagnosis using a dental explorer or dental X-rays
• Rehabilitation according to the level and extent of fracture
• For cracks of least to medium severity, RCT may be required followed by placement of a dental crown
• Extraction wherever necessary

Even after you find relief from your toothache, you mustn’t neglect your dental health. Keep up with your regular brushing and flossing routine, avoid acidic foods and beverages, and never delay seeking a consultation with your dentist for any dental pain issues.

Please remember 90% of dental pains are preventable with timely intervention. A visit to the dentist every six months can save you from this agony. Prevention is better than cure!

Dental Clinic Vyttila, Ernakulam