WHILE tooth pain is common, it should not simply be ignored.
An aching tooth can be a warning that something is affecting the tooth, gums or surrounding tissues.
A toothache can begin as a mild twinge when drinking something cold and develop into a persistent, throbbing pain that makes eating, sleeping and concentrating difficult.
One of the most common causes is tooth decay. When bacteria in dental plaque break down sugars and produce acids, they can gradually destroy tooth enamel and the underlying layers. As decay moves deeper toward the sensitive inner portion of the tooth, pain may develop, particularly when eating sweet, hot or cold foods.
Another frequent cause is inflammation or infection of the dental pulp. The pulp contains nerves and blood vessels inside the tooth. Deep decay, a crack or repeated dental procedures can allow this tissue to become inflamed. The resulting pain may be severe, spontaneous or persistent and can sometimes become worse when lying down.
A dental abscess is another important cause of tooth pain. An abscess is a collection of pus associated with a bacterial infection. It can cause intense pain, swelling, tenderness and sometimes fever or a bad taste in the mouth. Facial swelling or difficulty swallowing or breathing requires urgent medical attention.
Tooth pain can also result from a cracked or damaged tooth. A crack may allow pressure or temperature changes to irritate the tissues inside the tooth. Some people experience a sharp pain when biting down or releasing their bite. Cracks can be difficult to see without a dental examination.
Sometimes the source of pain is not the tooth itself. Gum disease can cause tenderness, swelling and bleeding around the teeth. In advanced cases, infection and damage to the tissues supporting the teeth can produce discomfort and looseness.
People who grind or clench their teeth, particularly during sleep, may also experience tooth sensitivity or aching. Repeated pressure can strain the structures supporting the teeth and contribute to wear, cracks and jaw discomfort.
Dental sensitivity is another possible explanation. Receding gums, worn enamel and exposed areas of the tooth can allow hot, cold, sweet or acidic foods to stimulate sensitive areas. Brief sensitivity is different from pain that persists after the trigger has disappeared.
Pain can occasionally be referred from another part of the body. Sinus problems, for example, can sometimes cause pressure or aching in the upper teeth because their roots are close to the sinus cavities.
The appropriate treatment depends entirely on the cause. A dentist may examine the tooth, gums and bite and, when necessary, take dental X-rays. Treatment can range from fluoride care and fillings to treatment of an infected pulp, extraction or management of gum disease.
Painkillers may provide temporary relief, but they do not remove the underlying cause.
A toothache is therefore more than an inconvenience. Persistent, severe or recurring tooth pain deserves professional attention, particularly when accompanied by swelling, fever or difficulty swallowing.
Early treatment can prevent a relatively small dental problem from becoming a more complicated—and potentially more painful—one.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
