Inflammation of a tooth nerve can cause a sudden and severe pain that drives patients to seek emergency care. Fortunately, most toothaches are temporary and due to a sensitive tooth, according to the Lucille Packard Children's Hospital at Stanford. However some are more serious and involve a more complex diagnosis and treatment.
Dental Causes
Tooth decay is the leading cause of a toothache, according to the Children's Hospital of Pittsburgh. Other causes include cracks, gum disease, dental treatment and trauma. Each of these can lead to either inflammation or infection of the dental pulp within the tooth or bone and soft tissues surrounding the tooth. Inflammation and infection cause pressure on sensitive nerve fibers resulting in pain. Pulpitis is inflammation of the dental pulp within the tooth. A pulpitis results in significant pain due to encasement of the nerve within hard tooth structure. This prevents the pulp from swelling and relieving some of the pressure. Infection causes pain as pus accumulates with the bone and gum around a tooth.
Symptoms
A toothache may begin as a mild sensitivity to hot, cold, and sweets. This indicates a pulpitis that may be reversible. Removing shallow tooth decay and placing a dental filling in the space will allow the tooth to return to its normal and pain-free state. Placing a filling or crown on a tooth may also alleviate the pain caused by a minor crack. Prolonged sensitivity to hot and cold, pain when biting on a tooth and spontaneous pain indicate the pulp is irreversibly inflamed and in need of more extensive treatment, according to the American Association of Endodontists. This inflammation eventually results in an infection of the pulp and the surrounding bone, ligament and gum tissue. Whether irreversibly inflamed or infected, removal of the pulp is necessary for pain relief.
Diagnosis
The accurate diagnosis of a toothache requires a careful examination performed by a dentist. This starts with listening to a patient's description of the location, severity and description of the toothache. A dental X-ray of the tooth believed to be the cause of the toothache provides several pieces of key information such as the presence of decay or infection. The tests include palpating the soft tissue around the tooth, tapping on the tooth with a metal instrument, a biting test and a thermal test usually performed with ice. Information gained from these informs the test of the condition of the tooth or teeth in question. The most common diagnoses for toothaches are irreversible pulpitis and necrotic pulp or abscessed tooth. Other possibilities include pain from a gum abscess or referred pain from another tooth, sinus, temperomandibular joint or even a heart attack.
Treatment
Root canal treatment or tooth removal are the only treatment alternatives for irreversible pulpitis or abscessed tooth. The diseased pulp has no chance of healing spontaneously or with the use of medications. If the infection causes swelling of the gum or jaw it may require an incision to drain the infection. Toothaches of non-dental origin require the proper medical referral and treatment such as antibiotics for sinusitis.
Medications
According to the American Dental Association, over-the-counter analgesics manage most dental pain. Occasionally a severe toothache requires the prescription of narcotic analgesics. Root canal treatment or tooth extraction will usually result in a quick resolution of a dental infection. Some cases do require an oral antibiotic.
Prevention/Solution
Regular dental checkups prevent the development of a severe toothache. Contacting a dentist when a symptom first occurs may prevent the development of a more serious problem.
