Causes

The most common cause of toothache is tooth decay. Tooth decay is the result of the weakening of the tooth structure due to the action of acids produced by the bacteria present in plaque. Thus, food residues, especially carbohydrates and sugars are the bacteria’s most preferred energy source. The products of their metabolic functions are alcohols and acids that when left for long periods of time on the teeth surface, weakens the enamel structure and produces holes.
Other serious causes of toothache are:

• Abscessed tooth: when dental decay and bacteria reach the nerves of the tooth, the nerve becomes necrotic (dies out). The combination of necrotic nerve tissues and bacteria settles into the surrounding bone producing a very painful abscess.
• Tooth fractures (cracked tooth syndrome).
• Damaged fillings.
• Bruxism: grinding or clenching your teeth wears them off and produces hypersensitivity.
• Gum infection: gum disease or periodontal disease is an inflammatory issue caused by bacteria deposits in the gums. It can produce abscesses and result in severe pain.

Symptoms

According to the source of dental pain, the symptoms will vary, and so will the treatment plan. A toothache can be presented in many ways, and the specific features of the pain will determine the diagnosis and the treatment. Hence, when you consult your dentist, you will be asked to describe the pain. It is important that you be as specific and detailed as you can:

• Is the pain intermittent or constant?
• Is the pain sharp or throbbing?
• What triggers the pain or what makes it worse? Does the pain stay for long or settle quickly?
• What relieves the pain?
• Do you have to take medications to calm the pain down?

When the causes of toothache are severe enough or the pain has been going on for a while, you can also notice swelling around the tooth or in your face, headaches, foul-tasting drainage from the infected tooth or halitosis (bad odour coming from the mouth).

But, what is it that makes toothache so painful?

Teeth are vital organs. Inside every tooth, there is a cavity in which lie nerves and blood vessels which feed the tooth and give mechanical and aesthetic features. When a fracture or a cavity caused by decay reaches the inside of the tooth, it creates an inflammatory response. As the nerve is positioned into a closed chamber surrounded by hard tissues, the pressure produced by this inflammation cannot be released. As a result, you will be feeling what is considered the worst pain of all.

Diagnosis and treatment

Based on a full dental check-up and according to your answers to the above questions, the dentist will be able to make a diagnosis. The dentist will also take a look at your gums, jaws, tongue, throat, sinuses, ears, nose and neck. It is highly probable that the dentist might need to take X-Rays to confirm the diagnosis and set up a treatment plan for you.

There is a wide range of available treatments to relieve toothache, and will depend on the diagnosis:

• Sensitivity management: if the pain is related to sensitive teeth and depending on what is causing the sensitivity, the treatment will go from prescription of sensitive toothpaste to fillings or a more complex restoration.
• Professional hygiene: when the pain is coming from the gums, usually a professional clean should be enough to treat it. In some cases, further periodontal treatment might be necessary.
• Fillings: If a cavity is causing pain but it has not reached the nerve, your dentist will clean the tooth and fill it with the appropriate filling material.
• Root Canal Therapy: If the pain is caused by decay that has reached the nerve of the tooth, you are most likely a candidate for a root canal therapy.
• In more severe cases, such as complex abscesses, fever and/or evident swelling of the jaws is better to control the infection first prior to performing any treatment, so that the dentist avoids spreading the infection to deeper tissues. In such cases, you will be prescribed antibiotics and painkillers and will receive treatment in a further appointment.

Some toothaches coming from around the tooth but not from its inside (nerve), sometimes can resolve on their own or just by improving your oral hygiene at home. Some minor gum inflammation will solve within a few days. You should avoid biting hard foods and eating/drinking extremely cold or hot foods/drinks. If the pain does not solve within two days, or it becomes worse, seek attention from your dentist.

Palliative Care at Home

In some cases, when it gets difficult to attend dental services, you can treat minor dental pain at home. Here are some tips you can put into practice:

• Rinse with warm saltwater: Saltwater can loosen debris between your teeth, act as a disinfectant and reduce inflammation. Stir a ½ teaspoon of salt into a glass of warm water and rinse your mouth thoroughly.
• Cold compress: For swelling and pain hold a cold compress or ice wrapped in a towel to the painful area for 20-minute periods. Repeat every few hours.
• Pain medications: Over-the-counter pain medications can reduce pain and inflammation while you are waiting for your appointment, but they are not a long term solution. NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Nurofen®, Advil®) can be used, or take acetaminophen (Panadol®) if you can’t take NSAIDs. Don’t use NSAID if you are taking medications for blood pressure (BP) or suffer from gastrointestinal diseases, you can take Panadol® instead. Always seek guidance from a healthcare professional before you take any medication.

Natural at Home Treatment

Natural home remedies can be useful, especially when a toothache is caused by teething in children.

• Clove oil: A natural antiseptic that numbs pain and reduces inflammation. Dab a small amount of clove oil on a cotton ball and apply to the painful area. Or add a drop of clove oil to a small glass of water and rinse your mouth thoroughly. Its eugenol content is a natural anaesthetic and can be a temporary remedy for your pain. However, it will not cure the underlying problem, it also tastes bad.
• Peppermint tea: Peppermint’s soothing properties can be applied to the painful area with a cooled down peppermint tea bag. Hold this warm tea bag against the tooth and gum.

Prevention

• Oral hygiene: maintaining excellent oral hygiene is key to keep your mouth and teeth healthy, therefore avoid toothaches.
• Visit your dentist regularly: prevention is better (and cheaper) than cure. Going to regular (once or twice a year) appointments will help you avoid further mouth problems and stay healthy. An appointment for cleaning per year won’t cost you lots and it will be an investment in you and your health.
• Decrease your sugary and acidic foods/drinks intake.
• Although toothaches are not fatal: the proper and timely diagnosis and treatment of a dental or gum infection are crucial to prevent it from spreading to other parts of the face, jaw and skull or even the bloodstream.

References

• Cleveland clinic (2020). Toothache. Retrieved on 22/04/2020 from https://my.clevelandclinic.org/health/diseases/10957-toothache/living-with
• Sanchez, A. F., Romero, E, A. (2001). Toothache. Medicina integral. 37(6( 242-249. Retrieved from https://www.elsevier.es/es-revista-medicina-integral-63-articulo-dolor-dental-10022781