Dentistry-Online

Toothache

introduction

Toothache, like any other pain, is always a warning sign that indicates that something wrong in the body is.

Therefore, one should always research the cause in order to find the reason for the toothache and then initiate appropriate therapy.

Causes of toothache

A healthy tooth does not cause pain. Toothache only occurs when the nerves inside the tooth are irritated. Causes for this can be:

Dental diseases and injuries
Situation-related toothache
Toothache after surgery

Dental diseases and injuries

Dental diseases that lead to toothache are often caused by poor oral hygiene and dental care. These include :

Caries
Periodontitis (inflammation of the teeth supporting structures)
Exposed tooth necks
Inflammation of the wisdom tooth
Root inflammation
Tooth fractures
Inflammation of the tooth pulp
Alveolitis sicca (exposed tooth socket after tooth extraction)
Maxillary sinus infection

Caries

The toothache is often caused by tooth decay. Caries is a disease of the teeth in which bacteria attack the hard tissue of the tooth through the acid they produce. Poor oral hygiene is often the trigger. If the carious defect only takes place in the tooth enamel, it is usually no pain present, because the enamel stands with the pulp (pulp) not related and does not contain nerves. But is the dentin already (Dentine), there is no permanent pain at first, but one often feels a pulling pain, mainly when eating sweet food. The tooth is also noticeable with cold and warm dishes and drinks. If left untreated, tooth decay leads to inflammation of the gums (gingivitis) and further to inflammation of the gums.

The deeper the caries penetrates, the more intense the pain sensation becomes. Once the pulp has been reached, the pain becomes almost unbearable.

Periodontal disease

Pain also emanates from the tooth bed, the so-called periodontium. The tooth is going through percussion sensitive. This means that it hurts when it is knocked or under stress. An inflammation has developed in the teeth supporting system, which leads to this pain. Mostly these are teeth in which the pulp is no longer vital, i.e. alive. This inflammation can also occur if the tooth has been treated with a root canal.

Exposed tooth necks

Another reason for toothache can be exposed tooth necks. Exposed tooth necks are usually caused by an inflammation of the gums and a subsequent inflammation of the entire periodontium.

Cold drinks or food often trigger pulling pain in the teeth in this case. If the food is very cold, such as ice cream, it is normal to experience pain. However, if uncomfortable feelings occur even in cool water, this indicates hypersensitivity. The necks of the teeth are usually covered with gums. Since there is no longer a protective layer of enamel there, only cement, the cold can get closer to the tooth nerve.

Read more on the topic: Pain in the tooth neck

Inflammation of the wisdom tooth

Toothache caused by a wisdom tooth infection is often extremely strong, pulsating and stressful for humans.
If only a slight pain is noticeable at first, it is advisable to visit a dentist as soon as possible in order to avoid later consequences and more severe pain. Medicines such as paracetamol or ibuprofen can have a soothing effect. In the case of severe toothache caused by a wisdom tooth infection, however, these painkillers usually no longer work, so that only an immediate visit to the specialist will help. Painkillers, if they are still working, are only a temporary solution and do not eliminate the problem of inflammation.

Read more on the topic:

Wisdom tooth pain
Discomfort on the wisdom tooth

Root inflammation

Progressive tooth decay that has progressed deep into the pulp can cause inflammation of the tooth roots. Toothache at the root can be either inside the root or outside the root. An inflammation of the tooth nerve is called pulpitis. The tooth is particularly sensitive to extreme cold and heat and contact. If the inflammation persists too long, the nerve dies and a root canal treatment must be performed to prevent the pain and further damage.

Read more on the topic: Root inflammation

If the inflammation is advanced, an abscess can form that spreads to the jawbone. This is a pus-filled, encapsulated cavity that causes severe pain. The pain can then usually be localized well. It seems throbbing.

Such inflammations can occur years after treatment. The cause is bacteria that still exist in the root canal after the treatment, despite antibacterial treatment. The body keeps them in check until the process flares up due to a reduction in the immune system and a new abscess occurs. Often those affected complain of a "fat cheek".

Inflammation of the tooth pulp

If the tooth decay is left untreated, it can spread deeper and deeper into the tooth to the point at which the pulp is reached. The pulp reacts to the bacteria with an inflammatory reaction. The resulting swellings exert pressure on the nerve fibers because the pulp is enclosed and therefore cannot expand. In these cases the viability of the tooth can no longer be maintained.

Read more on the topic: Pulpitis on the tooth

Tooth fractures

Tooth damage caused by trauma, for example from a fall in which a piece of the tooth flakes off, can also be the cause of toothache.

Read more on the topic: Broken tooth - what to do?

Maxillary sinus infection

Alleged toothache can also come from an inflamed maxillary sinus, as the floor of the maxillary sinus is in close contact with the roots of the posterior teeth.

Read more on the topic: Maxillary sinus infection

Alveolitis sicca

Alveolitis sicca causes great pain, exposure of the bone after tooth extraction when the blood clot that forms over the wound has decomposed or has been washed out.

Read more on the topic: Alveolitis sicca

Situation-related toothache

It is also possible that the toothache occurs depending on the situation:

Toothache ..

... while chewing
... if you have a cold
... outdoors
... at night
... during pregnancy
... after consuming alcohol
... laying
... with stress (crunching)

Pain with a cold

A cold is a sign that the body has been infected by a pathogen. The immune system is basically already weakened. Therefore, even with a seemingly harmless cold, pain in the dental area can occur. The reason for this is the close relationship between the jaw or teeth and the paranasal sinuses. The paranasal sinuses include the two maxillary sinuses, which are located below the eyes and above the maxillary teeth. Often the maxillary posterior teeth or the canines even protrude into the maxillary sinus, so that changes in the maxillary sinus have a direct effect on the roots of these teeth.

In the case of a cold, on the one hand, the sinuses are filled with nasal secretions and, on the other hand, they are usually inflamed. This means that a certain pressure is built up by the liquid in the caves. The bony structures of the cavities cannot give way, which is why pressure is created when they fill with the secretion. In addition, due to gravity, the secretion flows down to the floor of the maxillary sinus. The roots of the upper jaw teeth protrude there. The fluid can press there on the nerve that pulls into the tooth. There are patients who react very sensitively due to the feeling of pressure and the inflammation in the nasal cavities. If there is pain in the nose or forehead, the pain also radiates to the mouth and jaw. In addition, the poor general condition can lead to the jaw muscles being tense. This affects the temporomandibular joint and teeth.

Read more on the topic: Toothache with a cold

Pain when chewing

Toothache when chewing can have various causes. The chewing load exerts force and the tooth is pressed into its tooth socket.

If the mucous membrane and the gums in the tooth socket are inflamed, pressure is exerted on the inflamed tissue with each chewing process, which is painful. The inflamed tissue in a so-called apical periodontal disease (inflamed root tip) is characterized by the fact that the gums under the root tip are also swollen. The swelling causes the tooth to stand a little higher than normal and thus has a pre-contact. If the patient bites now, he bites first on the affected tooth and this receives more stress. This can damage it, break off. The pain occurs just by bringing the rows of teeth together without applying strong pressure.

Another possible case occurs when the patient receives a filling (or crown) that has not been optimally adapted to the opposing teeth. Then there is also a pre-contact and the tooth has to withstand more pressure than usual, which in most cases it cannot manage. If the toothing is subsequently ground in, the symptoms often disappear quickly, but if the tooth maintains the load, the nerve within the tooth can become inflamed, which entails a root canal treatment.

In the case of dentures, too, pain can occur when chewing if there is a pressure point. The jaw changes steadily with weight and age and with age. This can cause pressure points that lead to pain when chewing and eating with the prostheses. In this case, the affected areas of the prosthesis must be ground out so that the soft tissues heal and no longer cause discomfort when chewing.

Read more on the topic: Toothache when chewing

Pain in the open air

If the teeth pain, especially the molars and jaws, when the outside temperature is cold, an ear infection or inflammation of the parotid gland is a possible cause. Due to the close connection between the ear and the temporomandibular joint, the inflammation can spread from the ear to other structures. At least the pain radiates from the ear to other head areas.

Stress-related crunching pain

Stress releases hormones that, among other things, lead to more blood supply to the gums. Increased pressure can lead to inflammation of the gums and bleeding of the gums.

Read more on the topic: Inflammation of the gums

As compensation, the experiences of one day are processed at night. This usually manifests itself in teeth grinding or clenching. The jaw joint is subjected to very high pressure. The inter-cartilage wears off, causing the bones to rub against each other. In addition, surrounding structures such as the ligaments and temporomandibular joint muscles are put under incorrect strain. This can pinch the main nerve, which causes pain to be referred to the teeth. The close connection between the muscles of the jaw and the head also leads to headaches. The therapy for stress-related toothache lies either in physiotherapy or in making a relaxation splint for the night.

Read more on the topic: Grinding teeth

Pain when lying down

Toothache can subjectively be felt to be much stronger when lying down than when standing.
On the one hand, it is because inflammations caused by the warmth of the bed or a warmer environment are intensified by the better circulation when lying down and can spread more easily. On the other hand, when lying down shortly before or while sleeping, there is no distraction from everyday activities and the person concerned only concentrates on himself. This means that the pain only comes to the surface, as the patient is not distracted.

Furthermore, toothache can occur more frequently when the patient is lying down on the upper teeth if the patient has a cold. An inflammation in the maxillary sinuses or the nose can radiate the pain through the anatomical proximity to the teeth and cause discomfort primarily when lying down, if the patient is already getting poor breath anyway.

Read more on the topic: Toothache while lying down

Pain at night

One reason for increased toothache at night can be a cold. Since you usually spend the night lying down, the head, teeth and gums are well supplied with blood. The blood pressure is then higher when lying down than when standing or sitting during the day. According to the law of gravity, the liquid does not run out of the head. The secretion in the paranasal sinuses presses on the tooth nerves. At night, inflamed gums are supplied with more blood, which leads to stronger pulsating pain in the gum pockets. Wisdom teeth that have not fully erupted and are still covered by gums provide a good niche for bacteria. The gums around the wisdom teeth are usually inflamed, which is why there can be throbbing pain there at night.

If the nerve inside the tooth is inflamed, it will also cause greater discomfort at night because, as described above, the blood flow through the tooth pulp is increased. This creates a higher pressure. However, since the tooth cannot yield, the pressure cannot escape anywhere except through the hole at the tip of the root. This is where the nerves come in and out, which are squeezed by the increased pressure. Grinding and pressing at night can cause the strong forces to break off a tooth or break out a filling, which can lead to spontaneous pain. In addition, the body's own elimination of pain is lowest at night, which means that possible pain was eliminated during the day but reappear at night. Pain pills or globules help through the night, the next day you should then visit a dentist, even if the pain subsides in the morning.

Read more on the topic: Toothache at night

Toothache During Pregnancy

The pain reliever (analgesic) recommended from a conventional medical point of view for toothache during pregnancy and also during breastfeeding is paracetamol.
There is sufficient clinical experience with the use of paracetamol.
However, the intake should be kept as short as possible, not overdosed, not taken in combination with other medications and it is essential to discuss this with the doctor to be treated.
Self-medication is not recommended in any case. Paracetamol is able to cross the placenta barrier. The liver of the fetus can only partially break down the foreign matter. This can lead to liver damage in the unborn child if improperly dosed.
Recent research shows that taking it could later lead to asthma in the child or cause developmental disorders.

Read more on the topic: Toothache During Pregnancy

Aspirin should be avoided during pregnancy as far as possible and, if so, only used under strict indications. In the last three months of pregnancy, however, is completely discouraged. Aspirin crosses the placenta and the ductus botalli at the heart of the unborn child can close. The Ductus Botalli connects the aorta (main artery) with the Truncus pulmonalis (pulmonary artery). Bleeding can occur during use in the last trimester of pregnancy and the newborn is also more susceptible to it.

Pain after drinking alcohol

Toothache after alcohol can have different causes. First, the way in which alcohol is consumed must be considered.
The beverages consumed with the alcohol often cause toothache and not the alcohol itself. Alcohol itself does not damage the tooth enamel, but it does dilate the blood vessels, which under certain circumstances can cause nerve irritation.

Read more about this under: Toothache after consuming alcohol

Toothache after surgery

Toothache may also occur after some dental work.

after drilling
after a filling
after a root canal treatment
under a crown

Pain after drilling

Depending on the depth, drilling on the tooth can irritate the tooth nerve. This often causes pain that persists for some time after treatment. These usually subside by themselves. In rare cases, the pulp is damaged, into which bacteria can now penetrate and trigger inflammation (pulpitis).

Read more on the topic: Toothache after drilling

Pain after filling

Toothache can also occur after a freshly placed filling, regardless of which filling material is used.
This can be due to the fact that the tooth is irritated by the mechanical rotation of the drill every time the caries is removed. This irritation can result in the tooth still causing pain when chewing a few days after the filling is finished.

If the tooth decay is in a very advanced stage ("Caries profunda"), that it reaches close to the pulp with the blood and nerve vessels, it is possible that the tooth hurts after the treatment. In the case of deep fillings, a drug with calcium hydroxide is usually applied underneath the filling so that the tooth can form hard tooth substance on its own, the so-called irritant dentin.

In many cases, however, the tooth decay is so advanced that the removal is done by drilling so close to the pulp that the nerve can be damaged. Then the effect is that after the filling there are more and more pulsating and throbbing pains and chewing is almost impossible. If the nerve becomes inflamed and damaged, it must be removed from the pulp and followed by a root canal treatment in order to preserve the tooth.

The following two weeks are considered to be the critical value after filling. If the tooth is completely symptom-free after two weeks or if there is strong symptom relief, the nerve is in most cases intact and the tooth calms down completely. If severe pain is still present after two weeks, a new visit to the dentist is inevitable so that the cause can be tracked down.

You might also be interested in: Toothache after placing the filling

Pain after a root canal treatment

In the first few days after a root canal treatment, pain is normal because the procedure itself is always associated with a certain degree of irritation to the tooth. The patient will be informed about this before the treatment.

These complaints usually subside completely after one to two weeks. However, if the symptoms last longer and do not subside, a dentist should be visited. There is a possibility that insufficient flushing has not completely removed bacteria and causes pain. The bacteria form antigens and toxins, which can only escape downwards through the closed root filling and thus trigger an inflammatory reaction.

Read more on the topic: Pain after a root filling

Pain under a crown

Complaints from a crowned tooth can have harmless but also serious reasons.

The washing out of the cement is probably the most harmless reason. After a while the cement loosens underneath the crown and a gap is created that is normally covered by the cement. If the crown does not loosen by itself, the patient will only notice something when slight pulling pain occurs. Bacteria and food residues can penetrate into the gap and irritate the ground tooth. If the crown is removed and reattached, the symptoms usually disappear immediately upon insertion.

If the bacteria had the chance to get under the crown over a longer period of time, tooth decay can also have formed, which causes lasting pain. In this case, the crown must be removed and the tooth decay treated before the crown can be reattached.

After grinding a tooth for a crown and attaching it, it is quite possible that the nerve inside the tooth chamber will subsequently become inflamed. If the tooth does not recover from the irritation of grinding, it must be treated with a root canal before the symptoms go away again.

Furthermore, toothache under a crown can also originate from bacteria from an enlarged gingival pocket, which is wrongly perceived by the patient as pain under the crown. In this case, cleaning the bag and putting in an ointment is usually enough to provide lasting relief.

Read more on the topic: Toothache under a crown

Atypical odontalgia

Atypical odontalgia is a neuropathic permanent pain of the teeth. Those affected suffer from long-lasting pain, which usually occurs after a dental treatment, but cannot be traced back to a specific cause.

Find out more about the topic here: The atypical odontalgia

therapy

The therapy for toothache depends on its cause. In the case of caries, the treatment consists of removing the carious tooth material and then filling the defect with a suitable filling material.
If the tooth nerve is already inflamed, you can try to treat the inflammation with a cortisone insert. However, this only makes sense if only a small part of the pulp is involved.

If the entire pulp is affected or even decomposed (gangrene), the tooth on the chewing surface must be drilled open, which causes immediate pain relief, as the pressure can escape. A root canal treatment follows.

After an antibacterial root treatment and a final root filling, the tooth is closed again.

An abscess is opened and provided with a so-called drainage, which ensures that the secretion can drain away.

Overuse pain is cured by eliminating the cause. Painful mucosal injuries either heal on their own or are treated with antiseptics. Symptomatic treatments such as local anesthetics are also used.

After tooth extraction or surgery, pain pills are the method of choice. However, they do not have a healing effect. In the case of alveolitis sicca, a complication after tooth extraction, therapy consists of freshening the wound and tamponade.

In the case of pressure points, it is sufficient to shorten the prosthesis at the corresponding point.

Treatment with high-dose fluoride helps to eliminate toothache on tooth necks.

Read more on the topic: Therapy for toothache

When do you need antibiotics?

A dentist may only prescribe antibiotics under certain conditions. The cause of the pain must be known. Antibiotics should only be taken if dental treatment is insufficient to address the cause of the toothache or problem. This is the case with:

Surgical interventions (before and after)
Maxillary sinus infection
Abscess (pus-filled, encapsulated cavity)
Inflammation of the salivary glands
Severe periodontal disease
Root inflammation with infiltrate

Ibuprofen

The active substance Ibuprofen causes pain relief and anti-inflammatory effects and is a common pain reliever in dentistry. It is available in the form of juice, granules, tablets, or capsules.

The dosage depends on the weight of the patient and the severity of the pain. The maximum amount for an adult weighing around 75 kg is 2400 mg per day. That is 4 times 600 tablets or 6 times 400 tablets within 24 hours. A doctor may order more, but a dose of 2400 mg should be sufficient for toothache.

Particular attention should be paid to weight for children under 12 years of age. As a guideline, the formula 20 to 30 mg ibuprofen per kilogram of body weight applies. The single dose should therefore be a 400 or 600 tablet. Since tablets containing 600 mg ibuprofen require a prescription, you should consult a doctor before taking them. When taking a tablet with 200 mg active ingredient, an immediate improvement can be expected in patients who very rarely or never take a painkiller. However, this low-dose active ingredient does not work in severe pain. It is important not to take a 200 tablet every 2 hours, but rather a 400 tablet every 4 hours, so that the pain is completely eliminated. The maximum dose should not be taken for more than 3 to 4 days in a row.

Read more on the topic: Ibuprofen for toothache

Recommended for pregnant women Paracetamol instead of ibuprofen, but a consultation with the doctor should be made.

Ibuprofen, like paracetamol, can be taken in low doses during pregnancy (600mg / d), but only up to the 28th week. In the last trimester of pregnancy, it should not be taken, as otherwise a vital vessel near the child's heart could become blocked and kidney damage could result. Diclofenac is very effective for toothache, but should not be taken in the last trimester of pregnancy, as it, like other pain relievers, can inhibit labor.

Celecoxib or etoricoxib should not be used due to a lack of experience.

Read more on the topic: Pain relievers for toothache

What can you do yourself against the pain?

What can you do yourself until you have an appointment at the dentist?

Only the dentist can help with toothache of carious origin.
Until then, the pain can be relieved with pain relievers (e.g. diclofenac or ibuprofen, no aspirin, as this drug increases the tendency to bleed).
As a home remedy, cloves were used, which were placed in the carious defect, which is also justified, as clove oil has a calming effect on the pulp.
This home remedy should only be used in an emergency and the dentist should be consulted immediately.

Read more on the topic: Toothache - What To Do?

Home remedies

Basically, it should be noted that you should not only rely on home remedies. Depending on what the cause of the toothache is, no improvement can be expected with herbal remedies or homeopathy. A good remedy is distraction. Chewing or eating something tasty will distract attention from the pain. Also, chewing helps to drown out the passive toothache with an active pain. The pain that one inflicts on oneself is felt less painful than the pain of another.

Therefore, spices such as rosemary, cloves or chamomile are recommended for the pain. Also because of their smell, they have a calming effect and relieve pain. Some mouthwashes themselves also contain bacteria-inhibiting agents such as chlorhexidine, which also has a cooling effect.

Cooling agents are helpful anyway.The cold increases the blood flow, which transports the inflammation away. It is important that the cold cloth or ice pack is not so cold that it freezes the skin.

Stress, exercise and exertion should be avoided in the case of toothache. Resting gives the body a better chance of dealing with the cause. Anti-inflammatory home remedies include salt, propolis, and hydrogen peroxide. All three products, diluted with water, can be used as a rinse solution.

Read more on the topic: Home remedies for toothache

Clove oil for toothache

Clove oil has an antiseptic and antimicrobial effect. So it fights pathogens such as fungi, bacteria and viruses. Thus it relieves tongue coating and bad breath. It indirectly prevents inflammation and tooth decay. Clove oil gets its properties thanks to a certain ingredient, namely eugenol. Eugenol has a pain-relieving and numbing effect, and it also has a disinfecting effect. Since the cause of toothache is usually bacteria or viruses, the oil kills them - but clove oil alone cannot eliminate the cause.

Toothache caused by inflammation of the gums is also combated with eugenol. Eugenol decreases the production of hormones that are responsible for inflammation of the gums. The transmission of pain is slightly inhibited by the influence of eugenol. Clove oil is well tolerated on the oral mucosa, so it can be applied pure to the affected and painful areas. You can also easily chew a clove with the painful tooth. By pressing together, the clove oil is squeezed out of the spice in small portions.

Clove oil should not be used during pregnancy as it contains substances that trigger labor and could endanger both mother and child.

Homeopathy for relief

Homeopathy can help relieve toothache. There are globule preparations for various problems, for example Aconitum helps against pulsating pain such as an acute inflammation of the nerves within the tooth, while Arnica relieves symptoms in cases of swelling and after dental operations. Belladonna is very popular because, in addition to toothache, it can also help with cold symptoms and can also relieve pain primarily at night. Bryonia, Chamomilla and Phosphorus are other globule supplements that can be used to relieve toothache.

In order to find the right one for the individual case, a consultation with the treating dentist is essential. They can recommend the optimal preparation, which supports the actual dental therapy and does not impair it Homeopathy can only have a supportive effect and can never replace dental therapy.

Also read: Homeopathy for toothache

Weekend Pain - What Now?

Suddenly suffering from toothache at the weekend or on public holidays is always an uncomfortable situation, as your own dentist is often closed and you don't know where to go. First of all, it can be helpful to look for the cause yourself.

Is e.g. If a piece of the tooth has broken off, an immediate visit is not urgently necessary. The situation is different when strong, pulsating pain occurs that cannot be alleviated further even with common painkillers or home remedies. This indicates a worse problem that requires immediate inspection.

A dental emergency service is responsible for this at the weekend. A nearby dental clinic has such an emergency service that you can go to, or a dentist is on call and can be reached for such cases. You can find out which options or which dentist / emergency service is responsible for you in the area on the Internet or via the dental emergency hotline.

How can you prevent toothache?

In most cases, well-performed dental care ensures that the pain does not even arise. The thorough removal of plaque is a prerequisite for the bacteria not being able to cause tooth decay or periodontal diseases.

Read more on the topic: Oral hygiene

Summary

Toothache can have different causes. Depending on the type of underlying disease, there are also different therapies. It is especially important to visit the dentist when a toothache occurs so that he can identify the cause and take the appropriate measures.

The basic rule is: The sooner one can be examined, the better the chances of recovery. That is why you should visit the dentist every six months to prevent pain in the first place.