A toothache is defined as pain originating from or around a tooth. While it can be a significant indicator of a cavity, dental pain is not always caused by decay. The presence of discomfort simply signals that something is irritating the sensitive structures inside or surrounding the tooth. Because numerous issues can affect the teeth, ranging from simple sensitivity to complex infections, a professional diagnosis is the only way to determine the precise cause. Ignoring a toothache is never advised, as the underlying problem will likely worsen over time.
Common Symptoms of Tooth Decay
Tooth decay, also known as dental caries, is initiated by oral bacteria that feed on sugars and starches, producing acids as a byproduct. These acids begin to dissolve the minerals from the tooth’s hard outer layer, the enamel. Initially, decay might appear as a small white spot on the enamel and often causes no pain.
As the acid erosion continues, it creates a hole, allowing bacteria and acid to penetrate the softer, porous layer beneath the enamel called dentin. Dentin contains microscopic tubules that lead directly to the pulp, the innermost part of the tooth that houses the nerves and blood vessels. Once the decay reaches the dentin, the tooth becomes highly sensitive, often experiencing sharp pain when exposed to hot, cold, or sweet foods and drinks.
If the decay is left untreated, the bacterial infection progresses deeper into the pulp chamber, causing the tissues to become irritated and swollen. Since the pulp is encased in the hard walls of the tooth, swelling compresses the nerves. This results in a severe, persistent, and often throbbing toothache. This stage can also lead to a visible hole, discoloration, or pain when biting down.
Other Sources of Dental Pain
Pain in the mouth often mimics a cavity but can originate from structures like the gums or jawbone. Gum disease, including gingivitis and the more advanced periodontitis, involves inflammation and infection of the gum tissue and bone supporting the teeth. This condition can cause a dull, chronic ache around the base of the teeth rather than sharp, localized tooth pain.
Dentin can become exposed and sensitive even without bacterial acid erosion. Aggressive brushing or gum recession can wear away the enamel or expose the root surface, which lacks the protective enamel layer. This sensitivity results in a brief, sharp pain when the tooth is touched by cold air or liquids, a condition distinct from the prolonged pain of deep decay.
Referred pain is another common cause, where the discomfort is felt in the tooth but originates elsewhere in the head or neck. For example, pressure from a sinus infection can affect the roots of the upper back teeth, making them feel painful. Similarly, issues with the temporomandibular joint (TMJ) or clenching and grinding the teeth (bruxism) can cause jaw and muscle pain that radiates into the teeth.
Immediate Steps for Temporary Relief
While waiting for a dental appointment, several temporary measures can help manage the discomfort. Rinsing the mouth with warm salt water can help soothe the area, as the solution acts as a mild disinfectant and can reduce inflammation. Mix about half a teaspoon of table salt into a glass of warm water and gently swish the solution around the painful area before spitting it out.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be effective for reducing both pain and inflammation. Always follow the dosage instructions on the package. Applying a cold compress to the outside of the cheek near the painful spot also helps; the cold temperature constricts blood vessels, which reduces swelling and temporarily numbs the pain. Avoiding extremely hot or cold foods and drinks, as well as hard or sticky items, can prevent irritating the already sensitive tooth.
Recognizing a Dental Emergency
Certain symptoms accompanying a toothache signal a severe problem that requires immediate professional attention. The most serious warning sign is significant facial or jaw swelling that may extend into the neck, as this often indicates a spreading infection or abscess. A fever accompanying the tooth pain is another indicator that the infection has progressed.
Pain that is so severe it cannot be controlled by over-the-counter medication, or a toothache that awakens you from sleep, should be treated with urgency. Other emergency signs include uncontrolled bleeding from the mouth, pain following significant trauma like a knocked-out or severely fractured tooth, or difficulty breathing or swallowing.