Dental causes
If the pain is more localized in the area of the mouth or the oral cavity, other causes are more likely. In the oral cavity itself, for example, there may be inflammation of the mucous membrane. Especially in young adults, the eruption of whiter teeth may be an option, or bacteria or viruses may have settled in the gums.
Of course, the teeth themselves also have sensitive nerves, which react especially to temperatures and chemical substances (acid contained in food). Normal, healthy teeth are easily able to withstand these stimuli, but once caries has manifested itself and the dentin is exposed, the nerve no longer has a protective covering and transmits the stimulus to the brain in the form of pain. The most common cause of pain in the mouth is pulpitis, an inflammation of the nerves and vessels that lie inside the tooth’s pulp.
The pain caused by this is very intense and sometimes radiates far. Even at night the teeth burn, press and knock painfully. In the beginning it is possible that the pain cannot be attributed to a single tooth.
This is due to the fact that the anatomical structures in which the inflammation in pulpitis takes place are not mobile, i.e. fixed bone and tooth. If an inflammatory reaction occurs in the tissue, the blood flow to the tooth is also reactively increased. Due to the tightness of the tissue, however, it is not possible for the tissue to expand, and so in addition to the inflammatory pain, there is also a pain of pressure and stretching, which can extend over the entire jaw.
After treatment of the pulpits, i.e. removal of the cause of the inflammation, the inflammation either recedes (reversible pulpitis) or it was already too far advanced and continues (irreversible pulpits), resulting in the death of the dental nerve. If this process is very slow, it may well be that the nerve dying off is not even noticed by the patient, since with the loss of the nerve, the ability to perceive pain also disappears. It often happens, however, that a new focus of inflammation, now localized in the bone at the tip of the tooth root, forms later on: apical periodontitis.
In order to treat this, the root canal must be opened and the remaining nerve and vessel remnants must be completely removed. Afterwards, the cavity is disinfected several times and a filling is placed to prevent bacteria from settling there again and causing inflammation. Very similar to the painful character of pulpitis, but fundamentally different in its cause, is the atypical odontalgia, the so-called “phantom tooth pain”.
It is characterized by a long-lasting pain in an area where a tooth has previously been extracted.Even thorough examinations and imaging procedures do not allow the doctor to identify the cause of the pain, so it is assumed that the pain is caused by damage to the nerve fibers in the affected tooth or its immediate surroundings. Patients often complain of an aggravation of the pain in cold weather. It is not advisable to pull the tooth out prematurely, as this does not improve the pain, but in the worst case it may even worsen it.
Pain can also occur in the area of the tongue. A relatively common symptom, especially in older women, is a burning tongue. However, the cause of the burning pain has not yet been clearly identified, probably caused by damage to the thin nerve fibres running through the tongue and the entire oral area.
