TOOTHACHE
Toothache is an unpleasant, sharp, or mild aching sensation in teeth. Toothache is the most common oral health issue seen at every stage of human life either in adolescents, children, adults, or old age often caused by tooth decay, inflammation to the innermost layer of the tooth (PULP), or underlying infection. The pain can vary from mild to severe, constant to intermittent, or dull to sharpshooting depending on how long the tooth has been left untreated.
SIGNS AND SYMPTOMS OF TOOTHACHE:
1. Pain while eating or when you bite.
2. Sharp pain while lying down on the bed at night
3. Swelling, redness, or bleeding around the gum line.
4. Swelling on the extraoral surface(facial region).
5. Sensitivity to hot, cold, sour even by air.
6. Difficulty in chewing food.
7. Bad breath.
8. Constant pain in the area associated with the main affected tooth such as the eye, ear, neck, head, jaw, etc.
9. A rise in body temperature.
CAUSES OF TOOTHACHE:
a. Tooth decay / Cavity.
b. Gum diseases ( Gingivitis, periodontitis ).
c. Sensitive tooth.
d. Tooth Abscess.
e. Any fracture / cracked tooth.
f. An eruption of a new tooth / Impacted tooth.
g. After a tooth extraction.
h. Referred pain
There are some causes that are not related to underlying infection such as getting something stuck between teeth, Loosening of artificial tooth that are crowns and bridges (caps) or implants, biting something hard, or using a toothpick, or pins to remove food particles.
Loosening of artificial teeth that is crowns and bridges can be corrected by visiting the dentist and getting it refixed by using a luting agent or asking for the placement of a new set of bridges and crowns.
1) TOOTH DECAY / CAVITY:
Tooth decay is the damage in the form of a tiny black hole on the outer layer of the tooth which is called enamel (hardest tissue in the human body), the most common cause for tooth pain. It happens when acid produced by bacteria present in the mouth act on sugary, sticky food debris that is not being cleaned properly leading to the formation of tiny black hollow space at the initial stage and if not treated at an early stage can extend to the innermost layer of the tooth called the pulp.
2) GUM DISEASE :
Swelling and redness around the gums area cause mild to severe pain in the associated teeth. Gum inflammation(GINGIVITIS) usually exceeds gum disease(PERIODONTITIS).
GINGIVITIS: Mild inflammation of the tooth surrounding tissue is called gingivitis. It can be identified as mild swelling, redness, or bleeding from gums.
PERIODONTITIS: When gum inflammation is left untreated it progresses to bone destructive disease called periodontitis. It damages the tooth surrounding soft tissues and underlying bone. In the proceeded stage it leads to painful chewing issues, loosening of teeth, bad breath, swollen gums, profuse bleeding gums, sensitive teeth, and even sometimes loss of a healthy tooth.
Factors that contribute to gum disease are Smoking, alcohol drinking, cardiac issues, HIV/AIDS, mental disorders, obesity, diabetes, etc.
3) TOOTH SENSITIVITY :
Tooth sensitivity is a widespread dental issue. It’s a painful sensation when the upper layer of the tooth gets abraded which means when the second layer (dentin) and innermost layer(pulp) of the tooth get exposed to hot, cold, sour, sweet, or even sometimes cold air.
Factors that aggravate sensitivity: Harsh brushing, stress leads to grinding of teeth, continuously getting teeth whitening (bleaching), gum disease, fractured tooth, the recession of gums(shrinking gums), a large deposit of food particles around the tooth and gum line.
4) TOOTH ABSCESS :
A tooth abscess is a bacterial infection, if tooth decay is not treated at the initial stage then it leads to the accumulation of pus that is initiated from the infected pulp (innermost layer of teeth) and extends beyond the root tip including the tooth-supporting structure inside the gum. It causes a severe form of tooth pain with swollen gums, white pus discharge, bad breath, bad taste in the mouth, fever, severe facial swelling, and difficulty in mouth opening, chewing, and swallowing food.
5) FRACTURED /CRACKED TOOTH :
Any crack or break in the layers of the tooth while chewing or biting hard, wear and tear, grinding teeth at night, any accidental hit, or sometimes it can occur naturally as you get old leads to sharpshooting tooth pain. The fracture can vary from a slight chip off of just a small part of the tooth fracture including all three layers of the tooth (Enamel, Dentine, and pulp) even including surrounding bone structure.
6) ERUPTION OF NEW TOOTH/IMPACTED TOOTH :
Teething in babies, children getting permanent teeth, or adults getting wisdom teeth, new growing teeth causes severe pain while coming out of the jawbone. Mainly wisdom teeth eruption also called the third molar causes unbearable severe pain as it’s the very last permanent tooth to appear in the mouth. If there is no space present in the upper and lower jaw for their proper positioning, it will get stuck fully or partially (IMPACTED) in the jaw bone, and the pressure of forceful eruption causes pain and inflammation.
Because of poor visibility, it’s difficult to clean that tooth and the associated area which further leads to food lodgment, gum infection, and tooth decay.
SIGNS AND SYMPTOMS :
a) Severe unbearable pain in the tooth and associated gum area, pain may radiate to the eye, ear, head, and neck.
b) Swelling inter-oral ( gum area) and extra-oral (facial swelling ).
c) Restricted mouth opening.
d) Severe cheek biting.
e) Difficulty in chewing, and swallowing food.
f) Pus discharge can be seen if inflammation reaches nerves in the jaw.
7) AFTER TOOTH EXTRACTION/ DRY SOCKET
It is a very painful condition that occurs after the tooth is removed, after tooth removal when the blood clot is not formed as before the wound heals it leaves underlying bone, nerve, and tissues open to bacteria to act in that empty space which leads to the formation of” dry socket”.The main symptom is pain along with bad breath, difficulty in chewing, and limited mouth opening.
8) REFERRED PAIN :
Pain that occurs at a different site from its area of origin is called “Referred Pain”. There are many conditions that cause tooth pain, even though the origin of the pain location is other than teeth. Examples are sinusitis, trigeminal neuralgia, and temporomandibular joint injury.
a. SINUSITIS: It is an infection in which inflammation or swelling of spaces present within the passage of the nose is seen, and occurs due to viral, allergies, bacterial, or fungal infection. It is the most common referred pain as the sinus is present very close to the upper teeth and sinus infection can cause pain in the upper back tooth region.
b. TRIGEMINAL NEURALGIA: It is basically a severe facial pain condition that affects the trigeminal nerve carrying sensation running from the face to the brain often triggered by speaking, laughing loudly, brushing, or chewing.
c. TEMPOROMANDIBULAR JOINT PAIN: It is a disorder of jaw joint nerves and surrounding muscles, dysfunction in the joint can cause pain and discomfort in the upper and lower tooth back regions with restricted mouth opening.
DIAGNOSIS
1. A visual examination should be done.
2. Proper inter-oral examination should be done by using instruments like a probe, mirror, and explorer.
3. Radiographs containing panoramic x-rays of teeth and jaw should be taken to detect the actual cause with confirmation.
4. Past medical and dental history should be taken.
PREVENTIVE MEASURES
1. Brush properly with soft bristles gently twice a day for two minutes.
2. We should use a fluoride-based toothpaste.
3. We Should do flossing to remove food lodged between teeth, where the brush can’t reach.
4. Eat a nutritive balanced fibrous diet and limit sugary and sticky foods.
5. Rinse mouth daily with fluoride-based mouthwash or do warm saline rinses.
6. Should visit the dentist every 6 months to know the current condition of oral health.
7. Any bad habits like smoking, drinking alcohol, and chewing tobacco should be stopped.
8. Don’t use any sharp objects like a toothpick, safety pins, nails, or any kind of paper to remove food deposits it can harm gums or tooth structure
TREATMENT
1) TOOTH DECAY/CAVITY
a) If tooth decay is at the initial stage (the tiny hole) with no pain or no hot-cold sensitivity the decayed tooth structure can be saved by filling with a dental filling material.
b) If the tiny holes are untreated and there is sharp shooting pain continuously aggravates at night with severe hot and cold sensitivity that means it has reached or infected the innermost sensitive layer of the tooth called “pulp” in that case “Deep cavity filling “ or Root Canal treatment” should be done depending on radiographs and severity of pain.
c) Faulty filling or prolonged untreated teeth should be properly filled or treated according to the current condition of the tooth.
2) GUM DISEASE
a) Gum paints should be applied but with proper guidelines by the dentist.
b) Proper deep cleaning of gums and underlying tissues should be done by the dentist if there are hard deposits accumulated around the tooth and gum line, especially in medically compromised patients.
3) TOOTH SENSITIVITY
a) Desensitizing paste and toothpaste for sensitivity should be used with dental consult.
b) Fluoride gel and sealants can be used to seal the exposed tooth area.
c) If you have teeth-grinding issues while sleeping or due to stress first remove the cause and then should use a mouth guard to protect teeth from grinding.
d) If the tooth’s upper layer is scraped off and exposed to hot and cold, the filling should be done to the exposed area.
e) If sensitivity causes severe pain, then root canal treatment should be done as per the x ray report
4) TOOTH ABSCESS
a) The incision should be done, to remove pus lodged around the tooth.
b) Root canal treatment should be performed if the tooth and its supporting structures are in good condition.
c) If the tooth is grossly decayed or faulty root canal treated and the supporting structure is not in good condition then removal of the tooth is the best option.
d) Deep tooth and gum cleaning should be done.
5) FRACTURED TOOTH/CRACKED TOOTH
a) If there is just a slight chip off of the outermost layer of the tooth(enamel) with no symptom of pain, the dentist can treat it and revert it back to natural tooth appearance by using dental tooth color filling material.
b) But if a tooth fracture includes all three layers of the tooth(enamel, dentine, and pulp) then root canal treatment( replacing the originally infected nerve with man-made material) is supposed to be done.
c) If fracture includes your tooth-supporting structure and loss of a large part of the tooth then removal of the tooth is suggested.
6) ERUPTION OF NEW TOOTH/IMPACTED TOOTH
a) Surgical removal of a tooth is often suggested mainly in wisdom teeth if there is very little space present for its eruption and its position is tilted means it’s hitting the neighbouring teeth.
b) If it is erupting straight with no symptom of pain but being overlapped by gum, a slight incision can be made with a blade to provide open space for its eruption.
7) AFTER TOOTH EXTRACTION(REMOVAL)
a) Patients should follow all instructions given by the dentist after extraction.
b) The dentist will clean it properly and pack your socket with medicated gel placed in gauze.
c) Warm saline rinse should be done after every meal.
d) Medicine including antibiotics and anti-inflammatories should be prescribed along with proper oral hygiene protocol as it can infect surrounding bone and supporting structures.
8) REFERRED PAIN
a) SINUSITIS: It can be treated by using antibiotic medicine or Decongestant medication. In severe cases, patients need to undergo surgery but this is to be done by a specialist.
b) TRIGEMINAL NEURALGIA: It can be treated as a nerve disorder, the anticonvulsant drug is mainly recommended. If the medicine is proven ineffective then go for surgical management.
c) TEMPOROMANDIBULAR JOINT(TMJ) DISORDER: In some cases, symptoms of TMJ pain may go away with treatment like bite guards, medication(anti-inflammatory, pain reliever), and physiotherapy, or if it persists then surgical treatment is needed.
Keep your teeth protected to enjoy your lifestyle without any pain and visit the dentist every 6 months to know the current condition of your oral cavity.
KEEP SMILING AND STAY SAFE.
