Any pain originating in or around a tooth is referred to as dental pain.
Toothache or dental pain (from inside the tooth) often occurs due to infection and inflammation of the dental pulp, mostly as a result of dental caries (tooth decay).
The pain around a tooth arises from damage to the supporting structures of the tooth like the gums, the tissues, and the bony structures.
From outwards, the tooth is made up of three layers-
Enamel– It is the hardest structure in the body and offers protection to deep layers of tooth. It has no vital cells and cannot be repaired once it is lost
Dentine – Similar in composition to bone, it contains tiny nerve endings from the pulp. The dentine is protected by the enamel on the crown (visible portion) of the tooth, and by a thin layer called cementum, in the root
Pulp– It contains tiny nerves and blood vessels which provide nutrients to the dentine and is responsible for the vitality of the tooth
Symptoms
Dental caries is usually a slow and progressive condition. There are no symptoms in the initial stages, but when the enamel, dentine, and pulp are damaged, sensitivity and symptoms start.
Food lodgement– Depending on how the initial destruction of tooth layers occur, sometimes a cavity (hole) is created, where food may get stuck.
Short, sharp pain– At first, there is sensitivity to cold and sweet items (which acts as stimuli) that stops as soon as the stimulus is removed. This is called reversible pulpitis.
Prolonged pain– When the infection goes deeper, sensitivity and pain occur when hot food and drinks are consumed. This pain does not disappear when the stimulus is removed and signifies irreversible pulpitis. The pain persists and increases at night especially while lying down.
Spontaneous throbbing pain– There is severe pain on the affected tooth while chewing, which indicates pus formation (abscess) at the end of the root. The affected tooth is sometimes elevated from the socket and feels shaky.
Swelling of the jaw– Sometimes the pus at the end of the root may spread quickly into surrounding spaces and form a visible extra-oral swelling. There is severe pain, difficulty in opening the mouth, and swollen lymph glands. Untreated space infections can result in complication. Thus, it requires medical attention.
Difficulty in swallowing and opening the mouth– In young people, often the last teeth in the lower jaw do not erupt on time because of a lack of space. Impacted wisdom tooth may cause localised swelling and infection. There may be swelling inside and outside the mouth, with the patient unable to open it more than a centimetre or two. There is pain upon swallowing food, and a sore throat.
Causes
Dental caries– The most common cause of dental pain is decay or caries. This is due to the destruction and demineralization of the hard tissues (enamel and dentine) of the tooth by the action of bacteria. There is a wide variety of bacteria colonising the mouth, mostly inactive. A suitable environment, like a diet with high sugar content, causes bacteria to produce acid and attack the enamel of the tooth. Once the enamel is destroyed, caries progresses rapidly towards the dentine and the pulp in the absence of treatment.
Gums– Poor brushing habits can cause the gums around the tooth to move down or get loose and create pockets. This provides a good environment for bacteria to thrive and food to get lodged inside. Infection keeps progressing towards the tip of the root, and the tooth starts to shake and become painful. This condition occurs very commonly in chronic illnesses like diabetes.
Abrasion (loss due to mechanical action)– Sometimes, sensitivity and dental pain may occur due to wearing away of the enamel, or movement of the gums away from the crown of the tooth, and subsequent exposure of the cementum (root) of the tooth. Aggressive or faulty brushing techniques can cause this condition.
Food can also get stuck between the teeth, especially when they are irregularly arranged. This will lead to decay of the teeth and subsequent pain.
Trauma to the tooth during sports or any accident can result in its fracture. Depending on where the fracture line lies on the tooth, the intensity of the pain may increase.
Diagnosis
The following measures will be taken by your dentist in order to diagnose dental pain:
- A brief history of the pain will be taken followed by a full-mouth examination. Often, individuals with dental pain misunderstand the location of the pain
- The dentist will inspect the teeth. Any cavity will be air-dried and checked under bright light
- If decay is spotted, a cold or hot stimulus may be placed on the tooth, and the elicited response be noted
- The identified tooth and adjacent teeth will be gently tapped with a metal probe (instrument) or mouth mirror to check if there is any infection beyond the root
- A fine probe will be used to check the entire perimeter of the tooth where the gums are attached to check the health of the gums
- If there is pus and swelling inside the mouth, the lymph nodes below the lower jaw will be examined for any enlargement
Once the carious tooth is identified, an intra-oral X-ray will be taken by your dentist. It is a small image which shows only two or three teeth and is a very useful guide to detect the extent of damage, and to determine the treatment.
Your dentist may suggest OPG (orthopantomogram) in case of any fracture and multiple dental caries.
Treatment
- Simple sensitivity due to reversible pulpitis can be corrected by proper brushing and cleansing and avoiding sugary foods.
- Cavitation of the tooth causing reversible pulpitis will always require a restoration (filling). It may be restored with a temporary filling, observed for a few days and then be permanently filled by your dentist.
- Irreversible pulpitis and abscess (pus) cause damage to the pulp. These situations have to be managed with root canal treatment as directed by your dentist. The pulp and its necrosed (dead) tissue are removed, the canal is cleaned with medicated solutions and finally a restoration is placed from the tip of the root till the outer surface. A metal crown may also be needed in some cases.
- If the carious tooth is severely damaged, or if the infection has spread to the surrounding tissues, the tooth will be removed by your dentist.
Your dentist may prescribe NSAIDs that can reduce dental pain.
Dental caries is the most common chronic condition in the world. It can lead to loss of teeth and associated problems like difficulty in chewing, aesthetic issues, and requires high cost of replacement.
Decay of teeth can be prevented by regular dental check-ups, proper brushing, flossing, and by following a healthy diet.
