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Dentin hypersensitivity, or tooth sensitivity, is one of the most commonly reported dental complaints. It causes short spells of sharp, shooting pain emerging from the cervical area of the tooth.
Structure of a Tooth
The central core of the tooth is embedded with soft connective tissue, blood vessels, and numerous nerve endings, making it highly sensitive to even the slightest form of irritation or inflammation.
This delicate nucleus is covered by two calcified layers, namely, the dentin and enamel. The dentin contains numerous microscopic fluid-filled channels called tubules that serve as passages for nerve endings. It is enclosed within a harder shell of enamel, which undergoes a lot of wear and tear over time.
If the protective cover of the pulp is damaged or infected, you will most likely experience increased tooth sensitivity and pain, which can cause difficulties in eating, drinking, talking, and sometimes even breathing.
Does Tooth Sensitivity Cause a Toothache?
When there is a loss of overlying enamel and gingival tissue, the nerves in the dentin become exposed to various types of external stimuli, such as thermal, gaseous, tactile, osmotic, and chemical irritants. The result is tooth pain and sensitivity.
Causes of Toothache
Regular toothache usually results from:
- Tooth decay or cracked tooth
- Tooth infection
- Cavities or dental caries
- Exposed roots
- Jaw joint disorder
- Gum disease
- Loose filling
- Negligent or improper dental care
- Getting something stuck in between teeth
- Severe flossing
- Biting something hard
The following conditions can also cause a toothache: (1)
1. Impacted tooth
The wisdom teeth are a specific set of grinding teeth located at the rear end of the mouth. They typically emerge at a later stage in life (17–25 years).
Wisdom teeth have to push against the existing adult teeth for space. As a result, they may fail to erupt completely and remain partially embedded in the gum, known as tooth impaction.
An impacted wisdom tooth can exert a lot of pressure on the surrounding teeth, gum tissue, and jaw bone, often resulting in pain and swelling.
2. Tooth decay
If your tooth rots to its very pulp, which contains all the nerve endings, you are likely to experience lingering pain and heightened tooth sensitivity to hot or cold stimuli. The condition can get much worse in the absence of treatment and can result in the death of pulp tissue and abscess formation.
3. Cracked tooth syndrome
Biting on a hard object can crack/fracture your tooth. This kind of dental injury can cause intense pain on biting and can make your tooth hypersensitive to hot and cold temperatures.
4. Recession of gingival tissue
Receding gums pull away from the base of the tooth, thereby exposing the dentinal tubules to external irritants. These microscopic canals in the dentinal layer lead to the nerve endings in the dental pulp.
Due to the loss of gingival covering, the dentinal tubules are exposed to external stimuli. This causes the fluid in the dentinal tubules to move, increasing sensitivity.
5. Periodontal abscess/gum abscess
An infection of the gingival tissue can lead to the formation of an abscess on your gumline. This is a severe form of periodontal disease that can lead to receding gums and can trigger a mild degree of pain and tenderness in and around the affected tooth.
Bruxism refers to the compulsive grinding, gnashing, or clenching of the teeth, which can weaken or damage your dental structure if left unchecked. This condition is often characterized by a dull toothache.
7. Sinus infection
A sinus infection can also cause referred pain in the tooth, which may extend to the surrounding jaw. It is typically accompanied by a headache and chest congestion.
8. Dry socket
Surgical removal of a tooth can lead to a dry socket if the extraction site fails to heal adequately.
Ideally, a clot should form within 3–5 days after the extraction to cover the wound, or else the alveolar bone and nerve endings in the empty socket will remain exposed to food and other external irritants. This can give rise to a lot of pain.
9. Health conditions
A toothache can stem from several other underlying health conditions as well, which include:
- Heart attack
- Cluster headache
- Viral infections, such as shingles
- Systemic diseases such as diabetes
- Nerve-related diseases, such as trigeminal neuralgia
- Excessive consumption of alcohol
- Drug abuse, especially the overuse of methamphetamines
- Insufficient intake of vital vitamins such as vitamin B12
Signs and Symptoms of a Toothache
A toothache can manifest in different ways. The intensity of the pain and sensitivity tends to be relatively mild in early-stage gum recession or tooth erosion, but it can be pretty severe in a tooth fracture, cavity, or loss of dental filling.
Here are some of the most commonly reported features of a typical toothache:
- Pain in the lower molar tooth usually feels like it is originating from the ear.
- The affected tooth becomes hypersensitive to foods or beverages that are particularly hot, cold, sweet, or sour. Thus, the pain usually worsens after eating or drinking.
- Touching the affected tooth may aggravate the pain.
- You may experience soreness and pain in the jaw, particularly the area that is near the affected tooth.
- The pain may worsen at night, especially when you are lying down.
- Toothache can feel like a sharp, piercing pain or a deep, dull ache.
- Your tooth may ache consistently or have sporadic outbursts of pain that may occur briefly and then recede.
- Toothaches often have a sudden onset.
- It can be hard to trace the source of the toothache, as sometimes you are unable to specify where it is stemming from, whether from the upper or lower set of teeth.
Medical Treatment for a Toothache
In some cases, dental pain can be resolved with a single therapy, while others may require a combination of different treatments.
Early treatment is key in minimizing the pain and damage caused by dental decay. So, if you notice even the slightest sign of enamel erosion, staining, or cavities, get your teeth evaluated and treated by a professional dentist.
If the tooth decay is still in its initial stage, something as simple as a dental filling can suffice to undo the damage and prevent the condition from worsening. Delayed treatment, on the other hand, can cause tooth decay to spread further and deeper.
To address extensive tooth decay and damage, your dentist may have to resort to more invasive treatment methods, such as a root canal, dental crowning, or even tooth extraction.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and acetaminophen, reduce the localized pain and swelling around the affected tooth.
You can either take oral medications or apply pain-relieving gels to ease the discomfort but make sure to consult your doctor before starting.
Note: Overuse of NSAIDs can have adverse consequences on your general health and must be avoided. Additionally, these pain meds can aggravate liver problems. If you have liver disease, do not use NSAIDs unless advised by your medical doctor.
Diagnosing a Toothache
The underlying cause of a toothache needs to be determined for a dentist to prescribe the appropriate treatment.
To that end, your dentist will:
- Review your medical history.
- Inquire about your symptoms.
- Conduct a visual examination of your teeth.
- Order dental X-rays to assess the internal state of the affected tissues, bones, and teeth.
The following factors can make you more susceptible to toothache and other dental problems:
As the age increases, mineralization in the teeth increases, making the teeth fragile and prone to fracture.
Consistently high glucose levels in the blood can damage the salivary glands and reduce saliva production. A dry mouth provides favorable conditions for bacterial overgrowth and plaque buildup, thus inviting increased tooth decay and gum disease.
3. Periodontal diseases
People with preexisting periodontal disease are naturally prone to toothache, gingival inflammation, and even bleeding gums.
Complications of a Toothache
There are some complications associated with a toothache. They are largely dependent on the cause of the pain.
Cause: Tooth decay (most common)
If tooth decay is the cause of your toothache, the following complications may arise:
- Tooth loss
- Gum/jaw/brain infections
- Reduced appetite and consequent malnutrition followed by significant weight loss in severe cases
Cause: Abscess or some other infection
Infection or abscess may lead to:
- Tooth loss
- Dental infection (if left untreated)
- Cellulitis (when the infection from the abscessed tooth spreads to the facial tissue and causes swelling on your face)
- Brain abscesses (if the infection spreads to the brain tissue)
When to See a Doctor
Although a toothache can generally be treated at home, there are times when you need professional assistance. Consult a doctor if you experience the following:
- Unbearable toothache
- A toothache that persists for more than 2 days.
- Pain in the ears or when opening your mouth
- Bleeding, swollen gums
- Injured tooth
- Difficulty swallowing or eating
Expert Answers (Q&A)
Answered by Dr. Wessam Atteya, BDS, FRACDS (Dentist)
Yes. A toothache can cause fever when it is associated with an infection.
Cold foods/drinks act as noxious stimuli to nerves (including nerve endings in teeth) by causing:
1) Direct nerve irritation (causing the fluids within the tooth microcanals to move and trigger pain)
2) Contraction of the blood vessels next to the nerves (consequently causing the nerves to react by sending pain impulses to the brain)
Make sure you regularly see a dentist to catch any problems early. Ask your dentist to take an X-ray to detect hidden decay. The most important measure is maintaining good oral hygiene/care (brushing and flossing).
Occasionally, whiskey can relieve a toothache due to its partial numbing effect. However, using whiskey for toothache relief may mask a major dental problem that needs attention.
The most effective way is to see a dentist to identify the source of sensitivity and treat it. Many factors can contribute to tooth sensitivity, and they need to be identified.
Yes. When you cannot see a dentist, this can be a good temporary remedy. (2)
It greatly varies according to the cause of the toothache and whether it was managed. For example, if the cause is nerve inflammation, a root canal can relieve the pain immediately.
Going to the dentist only when your tooth hurts is not helpful because by then it is already quite late and a lot of damage is already done. As a result, extensive treatment is needed to resolve the pain. Like any part of your body, constant maintenance is required to avoid long-term damage.