Introduction
Toothache, like any other pain, is always a warning sign that something is wrong with the body. Therefore, one should always search for the cause to find the reason for the toothache and then initiate appropriate therapy.
Causes of toothache
A healthy tooth causes no 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 leading to toothache are often caused by a lack of oral hygiene and dental care. These include :
- Caries
- Periodontitis (inflammation of the periodontium)
- Exposed tooth necks
- Inflammation of the wisdom tooth
- Root Cancer
- Tooth fractures
- Inflammation of the dental pulp
- Alveolitis sicca (exposed tooth socket after tooth removal)
- Sinusitis
Often the toothache is caused by caries. Tooth decay is a disease of the teeth, in which bacteria attack the hard tooth substance through the acid they produce.
Lack of oral hygiene is often the trigger. If the carious defect only occurs in the tooth enamel, there is usually no pain, because the enamel is not connected to the tooth pulp and does not contain nerves. However, if the dentin is already reached, there is no permanent pain at first, but you often feel a pulling pain, mainly while eating sweet food.
The tooth also makes itself felt when eating and drinking hot and cold food. If not treated, caries leads to inflammation of the gums (gingivitis) and further to inflammation of the periodontium. The deeper the caries penetrates, the more intense the pain sensation becomes.
Once the pulp is reached, the pain is almost unbearable. The periodontium also causes pain. The tooth becomes sensitive through percussion.
This means that it hurts when knocking or under stress. An inflammation has formed in the periodontium, which leads to this pain. In most cases, these are teeth where the pulp is not very vital, i.e. alive.
This inflammation can also occur after root canal treatment. 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 cause pulling pain in the teeth in this case. With very cold food, such as ice cream, the pain is normal. However, if unpleasant feelings already occur with cold water, this indicates hypersensitivity.
The necks of the teeth are normally covered with gums. Since there is no longer a protective enamel layer there, but only cement, the cold can get closer to the tooth nerve. Toothache caused by wisdom teeth inflammation is often extremely strong, pulsating and stressful for the person.
If only a slight pain is felt, it is advisable to see a dentist as soon as possible to avoid later consequences and stronger pain. Medications such as paracetamol or ibuprofen can have a soothing effect. However, in the case of severe toothache caused by wisdom tooth inflammation, these painkillers are usually no longer effective, so that only an immediate visit to a specialist can help.
Painkillers, if still effective, are only a temporary solution and do not eliminate the problem of inflammation. Progressive caries, which has progressed deep into the tooth pulp, can cause inflammation of the tooth roots. Toothache at the root can be either inside the root or outside the root.
If the tooth nerve is inflamed, it is called pulpitis. The tooth is particularly sensitive to strong cold and heat and touch. If the inflammation lasts too long, the nerve dies and a root canal treatment must be performed to prevent the pain and further damage.
If the inflammation is advanced, an abscess can form which can spread to the jawbone. This is an encapsulated cavity filled with pus, which causes severe pain. The pain can then usually be localized well.
It has a throbbing effect. Even years after the treatment such inflammations can occur.This is caused by 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 body’s resistance and a new abscess develops.
Often the affected patients complain about a “thick cheek“. If the caries remains untreated, it can spread deeper and deeper into the tooth, up to the point where the pulp is reached. The pulp reacts to the bacteria with an inflammatory reaction.
The resulting swellings put pressure on the nerve fibers because the pulp is trapped and therefore cannot expand. In these cases the viability of the tooth can no longer be maintained. Traumatic tooth damage, for example from a fall, in which a piece of the tooth chipped off, can also be the cause of toothache. Presumed toothache can also be caused by an inflamed maxillary sinus, since the floor of the maxillary sinus is in close contact with the roots of the posterior teeth. Great pain is caused by alveolitis sicca, an exposure of the bone after tooth removal, when the blood clot that forms protectively over the wound has decomposed or has been rinsed out.
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