Brief overview
- Causes: e.g. Caries, tooth root inflammation, gum inflammation, periodontitis, abscess, tooth eruption, tooth fracture, fillings, crowns and temporaries that have fallen out, barotrauma (painful tooth cavities due to pressure differences), heart attack, angina pectoris, sinusitis, shingles (herpes zoster), headaches and migraines, trigeminal neuralgia, ear infections, jaw cysts, inflammation caused by medication (bisphosphonates) and radiation to the jawbone, sensitive teeth.
- When to see a doctor? Always consult a doctor if you have toothache. Self-treatment only as a first aid measure.
- Treatment: depending on the cause, e.g. caries treatment, root canal treatment, cleaning of the gum pockets, painkillers, treatment of other underlying illnesses (heart attack, sinusitis, etc.).
- Home remedies for toothache: Emergency measures if a visit to the dentist is not possible: Biting a clove, rubbing the painful area with clove oil, placing a damp cloth or towel with an ice pack on the cheek, tea made from peppermint, St. John’s wort, lemon balm, quendel and valerian, mouth rinses with sage tea, highly concentrated, lukewarm salt water rinse.
Toothache: causes
In the majority of cases, toothache is caused directly by the teeth. However, sometimes it is also caused by health problems or illnesses that affect other parts of the body.
Toothache due to dental problems
The following triggers are particularly likely (usually as a result of poor oral hygiene):
- Caries (tooth decay): The tooth surface is covered with a thin biofilm (plaque) that is colonized by bacteria (mainly Streptococcus mutans). These bacteria break down sugar molecules from food residues into acid, which attacks the tooth enamel. If the plaque is not removed regularly, the enamel is slowly destroyed – a cavity develops. Food residues and bacteria can then penetrate the tooth, possibly reaching the pulp and causing painful irritation. The affected tooth is particularly sensitive to sweet, sour, cold and heat.
- Abscess: Tooth root inflammation can spread to the surrounding tissue and jawbone and form pus accumulations (abscesses). Typical signs of this are pronounced, warm swellings and persistent toothache.
- Inflammation of the gums (gingivitis): This acute or chronic inflammation is usually caused by bacteria. The affected gums are swollen and reddened. In addition, the gums often bleed and hurt when brushing your teeth.
- Inflammation of the periodontium (periodontitis): The periodontium includes the gums, root cementum, periodontal membrane and jawbone. If these structures become inflamed, the gums may bleed and become swollen and reddened. They gradually recede, exposing the pain-sensitive tooth necks. The inflammation itself is also noticeable through dull pain that is difficult to localize. In the medium term, periodontitis can destroy the jawbone.
- Tooth eruption: When milk teeth erupt in babies or wisdom teeth in adults, this can also be associated with pain.
- Tooth fracture: Teeth can also break, for example as a result of an accident or if you bite down on something hard. As with a broken arm or leg, this can be very painful.
- Barotrauma: Cavities, for example as a result of tooth decay or under leaking fillings and crowns, often react painfully to differences in pressure. Divers are often affected by this, but the phenomenon occurs less frequently at high altitudes or when flying.
- Dental treatment: Grinding down teeth in preparation for fillings or crowns irritates the dental nerve and can cause temporary pain after treatment.
Another possible cause of toothache is pain-sensitive teeth: a cold draught of air, ice cream for dessert or the dressing in a salad often triggers a short, sharp toothache in people with pain-sensitive teeth (so-called flash pain). This is usually caused by exposed tooth necks with unprotected dentinal tubules (e.g. as a result of periodontitis). Sour, sweet, cold and hot foods can then penetrate through the dentinal tubules into the tooth nerve and irritate it.
But there are other reasons for hypersensitive teeth:
- Worn chewing surfaces, for example due to permanent incorrect loading caused by night-time teeth grinding or as a result of the natural ageing process
- Frequent exposure to acids (due to repeated vomiting, for example in the case of bulimia, reflux disease or frequent consumption of fruit, vegetables, salads)
- too much pressure when brushing your teeth (scrubbing)
- Barotrauma: Cavities, for example as a result of tooth decay or under leaking fillings and crowns, often react painfully to differences in pressure. Divers are often affected by this, but the phenomenon occurs less frequently at high altitudes or when flying.
Dental treatment: Grinding down teeth in preparation for fillings or crowns irritates the dental nerve and can cause temporary pain after treatment.
Another possible cause of toothache is pain-sensitive teeth: a cold draught of air, ice cream for dessert or the dressing in a salad often triggers a short, sharp toothache in people with pain-sensitive teeth (so-called flash pain). This is usually caused by exposed tooth necks with unprotected dentinal tubules (e.g. as a result of periodontitis). Sour, sweet, cold and hot foods can then penetrate through the dentinal tubules into the tooth nerve and irritate it.
- But there are other reasons for hypersensitive teeth:
- Worn chewing surfaces, for example due to permanent incorrect loading caused by night-time teeth grinding or as a result of the natural ageing process
- Frequent exposure to acids (due to repeated vomiting, for example in the case of bulimia, reflux disease or frequent consumption of fruit, vegetables, salads)
- too much pressure when brushing your teeth (scrubbing)
- Earache: Diseases of the ears, such as middle ear infections, often radiate to the jaw and teeth.
- Cysts: Cysts in the jaw area can also cause toothache.
- Medication and radiation: Inflammation caused by certain medications (bisphosphonates) and radiation of the jawbone are other possible causes of toothache.
How does toothache actually develop?
Teeth are by no means lifeless. On the contrary, each individual tooth contains nerve fibers as well as blood vessels. These penetrate through openings in the jawbone from below into the root of the tooth and lie in the middle of the pulp. The nerve fibers react very sensitively to even the smallest stimuli. A protective coating of dentine (dentin) and enamel surrounds the pulp and protects it from irritation caused by heat or food debris. However, in the case of dental diseases such as caries or periodontitis, this natural barrier is destroyed, allowing irritants to reach the inside of the tooth unhindered – resulting in toothache.
Toothache: what helps?
How to effectively relieve toothache depends largely on the cause of the pain.
Dental treatment for tooth problems
- In the case of caries, for example, the dentist drills away the affected areas and closes the hole with a tight filling.
- In the case of gum inflammation, the gum pockets are cleaned. Sometimes it is also necessary to take a sample to determine the type of bacteria and treat it with appropriate antibiotics.
If you have an acute toothache, you can take a painkiller as a first aid measure. However, avoid the active ingredient acetylsalicylic acid, as this inhibits blood clotting. The subsequent dental treatment can then lead to increased bleeding. Painkillers with the active ingredient paracetamol are more suitable.
Why dental treatment is important
Untreated dental problems repeatedly cause pain and can even affect other areas of the body. This is because the bacteria that have penetrated through the teeth enter the bloodstream and can lead to the rare inflammation of the heart valve. Chronic foci of inflammation also increase the risk of vascular disease in the long term. In pregnant women, the risk of miscarriage is increased by certain bacteria that cause gum inflammation.
Therefore, always have a toothache checked by a dentist. A visit to the dentist is particularly urgent for:
- persistent toothache, despite good and thorough oral hygiene
- Toothache that suddenly occurs at night or gets worse and worse
- Frequently bleeding, reddened gums
- Toothache when chewing
Treatment of other causes of pain
If the cause of the toothache is not in the mouth, it is advisable to consult other specialists (ENT specialist, internist, etc.). The dentist may advise the patient accordingly, depending on where he suspects the cause of the toothache lies.
Accompanying symptoms can also indicate which specialist is responsible for clarifying the symptoms (e.g. an ENT specialist in the case of accompanying earache). This doctor can then find out the exact cause of the pain and initiate suitable treatment (e.g. painkillers and possibly antibiotics for middle ear infections).
If the toothache is unusually severe, affects the entire lower jaw rather than a single tooth and is accompanied by an unusual tightness in the chest, shortness of breath or pain up to the shoulder, please contact an emergency doctor immediately! In this case, a heart attack may be the cause of the toothache.
Home remedies for toothache
Do you suffer from toothache at the weekend or on public holidays – i.e. when your dentist is not on duty? Then tried and tested home remedies can provide first aid:
- A damp cloth or an ice pack wrapped in a towel on the cheek soothes toothache by restricting the blood flow to the inflamed area.
- A tea made from two parts peppermint, four parts each of St. John’s wort and lemon balm, as well as a little quendel and valerian relieves toothache.
- Mouthwashes with sage tea have an anti-inflammatory effect.
- A highly concentrated, lukewarm salt water rinse can also help. Keep the solution in your mouth for two minutes until the pain subsides.
Home remedies have their limits. If the discomfort persists over a longer period of time, does not get better or even gets worse, you should always consult a doctor.
Prevent toothache
The most effective protection against toothache is in your own hands: thorough oral hygiene. Because regular tooth brushing with the right technique prevents tooth decay, periodontitis and the like and thus helps to prevent toothache.
Dentists recommend cleaning your teeth at least twice a day. This is the only way to remove plaque and food debris from the tooth surface, which provide an ideal breeding ground for bacteria. It doesn’t matter whether you use an electric or manual toothbrush. It is more important that you brush systematically so that all areas are cleaned. A tried and tested tooth brushing technique is the bass method, for example:
- Now move the toothbrush along the outer surface of each molar, shaking it and applying slight pressure in light stroking movements. The bristles also penetrate into the spaces between the teeth. This not only removes plaque, but also massages the gums. This stimulates blood circulation and protects against periodontitis.
- Then work your way to the opposite side and back again on the inside.
- Then brush over the chewing surfaces of the upper row of teeth.
- Repeat the whole procedure on the teeth in the lower jaw.
In addition to brushing, you should use dental floss or interdental brushes once a day to thoroughly clean plaque from between the teeth. After all, the most common form of tooth decay occurs in this area, which is difficult for the toothbrush to reach.
More tips for healthy teeth:
- To keep your teeth healthy, you should avoid sugar as much as possible. This is because the bacteria that cause tooth decay feed on the glucose it contains.
- Snack as little as possible on sweets between meals to avoid constantly providing the oral bacteria with new food.
- Take advantage of your twice-yearly dental check-up. This enables your dentist to detect the onset of caries at an early stage and stop it before toothache occurs.
Tips for hypersensitive teeth
If the sensitive tooth necks and with them the so-called dentinal tubules are exposed, every bite can hurt the teeth. Cold, hot, sweet and sour foods and drinks in particular often trigger a brief but extremely severe pain. You can protect your hypersensitive teeth with these tips:
- When brushing your teeth, be careful not to scrub and do not press the toothbrush too hard. This will prevent your gums from receding even further.
- Seal the dentinal tubules. Toothpastes and mouth rinses with strontium chloride or potassium salts seal the tubules. This makes the teeth less sensitive to external stimuli. The dentist can also seal the exposed surfaces: The neck of the tooth is protected with fluoride varnish or a fine layer of thin flowing plastic.
- In particularly severe cases or in the case of congenital disorders where the tooth enamel is missing, crowning the teeth can be the final measure against toothache.
Further information
Guidelines:
- Guideline “Caries prophylaxis for permanent teeth – basic recommendations” from the German Society for Tooth Preservation and the German Society for Oral and Maxillofacial Medicine (2016)
