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Drinking water or any beverage is a nightmare! Since it increases tooth pain.  

Losing sleep at night due to terrible toothache? 

Eating food is a task to avoid tooth pain along with chewing food.

Have you experienced any of this …. 

Normal lives are disturbed every day all over the world because of these problems. It may look or sound small and simple but wait till you meet someone who has experienced any of the above. 

Testimonials female patients describe Tooth pain worse than labor pain.

I have come across a would-be Mummy saying to me “remove my painful tooth first, the baby can come out afterward.”

Sportsperson describes it worse than a bone fracture. They are able to play with minor fractures but not with excruciating tooth pain.

The motive is to alert you and keep you ready and updated on how to prevent these occurrences.

Pain in the tooth is not necessarily confined to a tooth only. It can be due to other components associated with the tooth that surround it.

So what is it that results in a painful tooth?

The most common causes of teeth pain are the ones closely associated with tooth and surrounding structures. Tooth decay or dental caries is the dark brown destruction of the tooth due to food lodgement. Gum disease which maybe along with tooth decay.

Wisdom tooth pain which occurs due to the lack of sufficient space for the tooth to erupt in the mouth. It can be a result of eruption force generating the pain or the soft tissue called Pericoronal flap which gets infected and causes tremendous pain.

A cracked tooth which occurs due to accidentally biting a hard object.

Trauma or injury to the jaw

The disease of jaw-like tumors or other swellings

Less likely causes for a painful tooth

• Temporomandibular disease

• Heart disease

• Sinus infection

• Ear infection

These may give a false sense of toothache.

The outer layer of a tooth is enamel which is non-living. However, the damage of this layer results later in toothache. It like the walls of a fortress. The moment the enemy breaches the wall the chances of the fort being captured and won over increase.

Similarly like a professional army the patient, Dentist, Dental hygienist work in a synchronized manner to prevent decay and protect this layer.

Once the enamel layer is breached pain in any form is inevitable. We have to strive to prevent this occurrence. However many a time the inevitable happens. We thus should be aware to take necessary steps at all stages whichever is experienced or evidently seen.

Teeth pain is due to an infection in the inner layer called pulp which contains blood vessels and nerves. An inflamed tooth nerve causes a painful tooth.

Tooth decay

Tooth decay starts as a painless white spot

If untreated, this painless white spot is followed by cavitation with brownish/blackish discoloration

The sequence of tooth decay

1. Pain on having cold but disappears on removal

Tooth sensitivity to hot and cold

Due to dentine being damaged it is exposed to the temperature changes in the mouth. This is known as Dentine hypersensitivity. It can be labeled as a precursor to major tooth damage. As long as the cause of the tooth irritation is identified, it can be rectified. A common cause of dentine hypersensitivity is dental caries, improper tooth brushing techniques. Loss of enamel. Gastric disorders or stomach problems such as acidity.Drinking too much of bottled aerated drinks. Furthermore if unattended  the dentine sensitivity progresses it can cause pulp irritation

The condition is called as REVERSIBLE PULPITIS

The situation where you will love to hate your cold and hot drinks

Both Coca Cola and Cappuccino feel painful.

 2. Pain to hot and cold even after removal of cause after which a continuous

              Lancinating or throbbing pain persists.

This is due to extensive inflammation of pulp known as ACUTE PULPITIS it is like touching the raw nerve.

3. If untreated ACUTE PULPITIS  proceeds into CHRONIC PULPITIS or long term untreated pulpitis.

Tooth pain is due to the nerves getting damaged in the pulp.

This stage causes destruction of nerves, reduced pain to cold and hot 

4. Now infection that is being formed has accumulated and starts to cross beyond tooth confines. It starts to invade into tissues around it.

5. Sequela of decay resulting in the diffuse spread of infection throughout the bone causing inflammation and degeneration or Necrosis of  jaw bone (Osteomyelitis) 

6. Cellulitis ( Inflammation and swelling of soft tissues which tends to spread through tissue spaces) of face and neck occurs as a sequela of an abscess or osteomyelitis.

High-risk individuals for tooth decay- Who is most vulnerable to tooth decay. They are the following kind of people:

A socially deprived individual who is not having the proper knowledge or access to oral hygiene procedures or any educational program sponsored by concerned organizations. In an individual, high caries activity of elder siblings gives an indication of family trait and should be intervened methodically 

 Low knowledge of dental caries in the population exposes them to this problem 

Medically compromised people having restrictions on analyzing or understanding these oral diseases. Xerostomia (dry mouth) contributes to developing tooth decay either directly which is due to saliva decrease. Indirectly saliva decrease may occur due to stress or lifestyle or medications. 

Long-term cariogenic medicine, frequent sugar intake habituated population is prone to tooth decay and in widespread areas of the mouth.

The non-fluoridated area where the local municipality fails to follow international standards to fluoridate the water supply. That population is vulnerable to dental caries. To add to the problems if no fluoride supplements are given in either daily salt or other supplements them the problem of being exposed to dental caries and resultant gum disease persists. Fluoride is a naturally existing element freely found in freshwater, rock and other natural sources. It binds with the tooth enamel to make it impregnable to bacterial decay.

Poor oral hygiene maintenance or improper brushing technique also aggravates the risk factor.

New lesions in mouth arising due to allergies or unknown reasons due to poor body resistance is a sign of impending tooth decay.

Premature extractions of milk teeth due to decay creates a situation where future permanent teeth erupt erratically contributing to the occurrence of dental caries.

Front tooth fillings show a high incidence of dental caries. Since front teeth are used for cutting or incising they are not likely to develop dental caries.

However, if dental caries are evident on them then it is concluded that the individual is prone to dental caries and is also not taking any preventive measures.  

No fissure sealants or protective steps are taken to save teeth from decay at a young age results in tooth decay in the vulnerable population.

A large part of the adolescent population above 11-12 years undergo correction of teeth alignment by putting braces. Braces cause food lodgment and require a high level of oral hygiene maintenance. Failing which tooth decay takes place.  

Low-risk individuals for tooth decay-

This is the part of the population in whom the opposite side of the spectrum is visible. Low incidence of caries activity is noted in their elder sibling indicating a lesser trait and chance of dental caries. Their infrequent sugar intake due to restraints and awareness helps them to ward off tooth decay. These kinds of people are residents of the well-fluoridated area where the municipal corporation assures water supply with international standards with respect to fluoridation levels.

Well educated and very well aware of the use of fluoride supplements these sets of people use appropriate supplements.

Good oral hygiene maintenance and general awareness along with periodic attendance of well-being programs help in their low incidence of tooth decay.

In Spite of hectic lifestyle and cut-throat competition some people are well aware and active in self-care remedies and take stress-relieving exercises.

A regularised lifestyle and appropriate diet ensure a normal salivary flow rate. This ensures the natural cleansing of the oral cavity.

Gum disease

It is associated with or without tooth decay. It may be due to infection passing from tooth to gums or disease associated with gums alone.

Symptoms of gum disease

• Bleeding gums which means bleeding on touching or brushing 

• Pain on biting

• pain with swelling gums

• pus discharge from gums.

Gum disease is categorized into GINGIVITIS and PERIODONTITIS 

GINGIVITIS is the inflammation of the gums often seen with bleeding gums.

PERIODONTITIS 

It is the advanced stage of Gum disease which spreads towards the jaw bone.

Infected gum recedes. Plaque accumulation continues to increase and spread to all sides of almost all teeth. The most amount of plaque accumulation takes place in the region where chewing is not taking place. Inadvertently a painful tooth is associated with this region.  Pockets are formed due to gum damage between damaged teeth which become further infected due to food lodgement. These areas are difficult to clean and a vicious cycle starts. In unattended cases bone loss around the affected teeth is visible initially in the radiograph. In severe cases, it is evident in the mouth as we compare it with healthy teeth.

The result is tooth mobility. 

Periodontal disease causes 70% of tooth loss. 

It affects 3 out of 4 people.

Causes of periodontal disease

 Lack of daily oral hygiene maintenance accelerates food debris deposit and resultant calculus accumulation. Broken fillings around a tooth not only create a tunnel for bacteria but the irregular surface invites calculus deposits. 

A broken tooth or cracked tooth is a site where food gets lodged causing dental caries.Misaligned/crowded teeth/overlapping teeth contribute to irregular gum lines due to the disarrangement of teeth alignment. It also allows for food accumulation. The oral hygiene procedures that are followed also show poor results due to difficulty in the toothbrush to reach all surfaces of the tooth to clean them. With the advancement of age, the teeth tend to wear off. Eg. teeth grinding during sleep, a gastric disorder causing teeth damage, improper tooth brushing technique, to name some causes. They lose their original shape and are vulnerable to all sorts of damage.  

A poorly balanced diet devoid of nutrition and supplements permits periodontal disease. During the industrial revolution colonies of east wile major kingdom would launch a huge number of ships and sailors. They would be devoid of land for months together. Lack of freshwater and nutrients would result in a large number of casualties. A significant cause of death was Gum disease or Scurvy. This was caused due to deficiency of Vitamin C. In today’s world this Vitamin is found in the Multivitamins given to patients. Gum disease can be cured if a sufficient amount of citrus fruits such as Oranges, Lemon, etc is included in the diet.    

Medical conditions of various types and varying degrees of severity contribute to periodontal disease. 

 Drugs[causing dry mouth] given for various long time for deep-rooted disease cause a decrease in saliva flow.

Symptoms of periodontal disease

•  Red, puffy or swollen gums

• A tooth that hurts when biting down

• Gum that bleeds during brushing or even touching.

•  Persistent bad breath

• Shifted/loosened teeth

• Pus filled or with pus discharge.

• Sore teeth  

• Dull, throbbing & constant pain 

• The tooth may feel extruded 

• Visible discolored deposits and stained teeth.

Periodontitis caused due to trauma or abnormal clenching habits. Sometimes due to braces treatment which transmits excessive force on teeth to move it to the desired position. 

Periodontitis is also caused due to tooth decay

TREATMENT

  Determining the cause & relieving the symptoms.

 Adjustment of caps or dental crown (in hyper occlusion cases). 

 Removal of irritants (in case of infected pulp) 

 When the acute stage has fallen, the tooth is managed by conservative means.

Tooth Abscess  

An infection in the tooth due to tooth decay or gum disease

A tooth abscess is an accumulation of pus around the tooth and between the tooth and the jaw bone.

How do you Conclude you have a tooth abscess 

WHEN

There is Constant tooth pain or normal activity gives tooth pain

Pain when pressing gum above the tooth

Severe throbbing tooth pain during swallowing 

Pus filled swollen shiny gums which is fluctuant on pressing.

Fever with a painful tooth

Occasionally, bad taste in the mouth which is due to pus discharge or inability to clean teeth. At times the pain is so intense that normal water intake aggravates the pain.

Change in intensity of bad breath generally intensifies and gives a bad feeling.

As the infection progresses,

Pronounced swelling which is visible from outside. The tooth becomes more painful, elongated & mobile causing difficulty to chew or normally swallow water.

It can cause loss of sleep as normal subconscious action become extremely painful 

In the case of the upper front teeth, swelling may extend to one or both the up to below the eyelids on the side of the affected tooth.

In the case of lower front teeth, swelling may involve the lower lip & chin.

 In the case of upper posterior teeth (molar), the cheek may swell to an immense size distorting the facial structures which appear on side of damage and can be seen prominently. 

 In the case of lower posterior teeth, swelling may extend to the ear or around the border of the jaw into the submaxillary region.

In case of a severe form of infection the Lymph nodes which are located below the 

Jaw bone and along the neck also swell up. This gives a sense of severe facial deformity.

 Mild cases- a slight rise in temperature (99-100˚C) 

 Severe cases- temperature above normal (102-103˚C) 

Fever often preceded or accompanies by chills. 

Intestinal stasis, manifesting orally by a coated tongue & bad breath.

Headache & malaise

Stages 

1st stage-Initial stage

Painful teeth

tooth sensitive to touch, 

without swelling of gums

2nd stage-Periodontal stage

tooth hurts when biting down, touch

A slight feeling of an elevated tooth in the socket due to infection extending beyond the tooth into the jaw

3rd stage-Endosseous stage

Tooth pain extreme

Constant, throbbing tooth pain

Tooth hurts with pressure

Patient Wants to get the tooth removed, 

A strong feeling of the elevated tooth

4th stage-Subperiosteal stage

Throbbing pain increasing in intensity, 

The tooth is extremely sensitive to touch,

5th stage-Submucous stage

decrease symptoms of painful tooth

TREATMENT 

If you have symptoms of tooth abscess, schedule an appointment with your dentist.

Your dentist will drain the abscess and prescribe antibiotics.

Tooth abscess drainage gives instant relief in a painful tooth. The drainage can be done through the tooth canal. Draining the pus out from the gum is done by giving a small incision on the most prominent part of swelling. Or in severe cases, both approaches can be used. The tooth is shaped to avoid being pressed on during swallowing or chewing. These steps help in faster healing of the infection. A routine Root Canal Treatment along with curettage of the gums gives highly satisfactory results. The tooth can be finally restored by a crown to allow it to be active during chewing. This prevents any further food lodgement and allows the self cleansing activity to be successful. 

 Local anesthesia is ineffective when injected into acutely inflamed tissue.  

Conduction anesthesia may be administered to reduce the pain. 

 Hot saline rinses are used to assist drainage. 

 If the swelling is extensive, soft and fluctuant, an incision is made through the soft tissue to the bone.  

If it is hard, it can be converted to a soft, fluctuant state by rinsing with hot saline solution 3-5 min at a time repeated every hour. 

 Antibiotics & analgesics are prescribed as needed. 

Wisdom tooth pain

Wisdom teeth are teeth that fail to erupt into the mouth. 

Severe or excruciating pain in the back of your mouth

Tooth pain may be intermittent, constant or periodic

 Tooth pain is referred to as the ear 

You may feel buzzing sound in the ear 

Wisdom tooth proves that weakening of the jaw bone.

Sinus infection

Maxillary Sinusitis is an infection or inflammation of the upper sinus.

Sinus infection may arise from abscess, periodontitis, or after tooth extraction

Sinus infection results primarily from the multiplication of bacteria invading from the mouth or the focus of a dental infection.

Since maxillary premolar and molar teeth are the most neighboring to the sinus floor, infection of these teeth is the most common reason for the disease.

Signs and Symptoms: (Acute) 

 Dull or intense pressure-like pain 

Swelling of the cheek and anterior maxilla 

 Pressure or fullness in the proximity of the maxillary sinus 

Headache 

 Malaise 

 Fever 

Bad breath 

Nasal Congestion or Obstruction

Tooth hurts when biting down

Increased tooth mobility 

Migraine 

Dull headache

Treatment

Antibiotic therapy (Penicillin, clindamycin, and metronidazole are adequate drugs of initial choice) and surgery. 

 Elimination of dental source by tooth extraction, apicoectomy, endodontic therapy, removal of any involved foreign body, might lead to full recovery.

Heart disease

Can a tooth pain be dangerous? 

Tooth pain can indeed be an indication of more serious wellness with a more risky problem than referred to as, so you shouldn’t ignore them. 

The most risky conditions that can cause a painful tooth as a symptom include: Angina pectoris or heart spasm, (caused by insufficient supply of oxygen-rich blood to the center muscle because of reducing of the bloodstream to the heart) is felt usually like a pain to the chest or remaining arm, but in around 10% of situations it extends to the remaining side of the jaw. 

People with a history of cardiovascular illness need to be aware of this possibility, and pay extra interest to sudden tooth pain, especially if they are in good dental wellness.

Severe tooth decay and pus formation is a prime source of bacteria in the bloodstream. The bacteria that cause this infection can survive for long and plant itself in the walls of the heart. A severe form of infection forms known as Subacute Bacterial Endocarditis (SABE) develops. This is an infection of the heart valves. Creating heart disease or complicating an already existing heart condition. 

 Tooth pain may be evidence of cardiac arrest.

Dental infections are a typical cause of painful tooth.

 If a tooth abscess is ignored for a long period, the illness may have continued to the floor of the mouth or to the neck and create a situation known as Ludwig’s angina that can become life-threatening, preventing the air and resulting in breathlessness. 

If you have symptoms such as high temperature, chills, feeling sick which are symptoms of serious illness, or prolonged swelling; see your doctor immediately 

Diagnose your tooth pain. If it is untreated, then the condition becomes worse and causes serious damages.

If you are unable to schedule an appointment with your dentist, then perform the self-care treatment for temporarily healing the pain.

The dentist will take the complete examination of your teeth for determining the location and causes of your painful tooth.

Take radiographs for getting the evidence of tooth decay between the teeth, the extent of the tooth decay. Wisdom tooth position or the cracked tooth.

There are antibiotics for healing the painful tooth speedily as well as for relieving the pain.

Prevent tooth pain by following the regular oral hygiene routine and try to stick to it.

PREVENTION OF TOOTH DECAY: It can be divided into 2 areas

1)AT HOME

2) AT DENTAL OFFICE

Reduce sugar intake

Brushing twice a day 

Rinse mouth with drinking water after every meal. 

 Flossing at least once daily

Use of alcohol – free mouthwash

Healthy snack habit

Limit the number or frequency of meals.

Proper brushing method 

Prevention of gingivitis

Maintain good oral hygiene

Cleaning of teeth

Interruption of bad habits[smoking, mouth breathing] 

Proper brushing technique

Gum massage daily after meals 

Prevention of periodontitis

Scaling

Maintenance of oral hygiene

Flap operation for repositioning gums

Bone grafting to compensate for bone loss. This improves tooth firmness.

Diet regulation. Include Vitamin C which helps in gums disease treatment.

 Proper oral hygiene can limit tooth loss, periodontal disease, and tooth decay.

A record of proper hygiene enhances the quality of life.

Teeth Brushing Technique

What is the right way to brush?

Proper brushing takes at least 2 min. 

Use short gentle strokes

Form a 45-degree angle among brush and tooth surfaces.

 Clean the outer surface of the upper teeth, then lower teeth.

 Clean the chewing surface. 

Make sure to brush your tongue

 Floss after meals 

Moisturize and lubricate lips and mucosa

Type of toothbrush?

Soft bristles with a small head. 

How often should I replace my toothbrush?

When begin to wear or every three months, whichever comes first. 

How important is the toothpaste?

If you have sensitivity to hot and cold, the choice of toothpaste should be a toothpaste containing Potassium Nitrate and Stannous Fluoride. Potassium nitrate is known as a “nerve-calming” agent. Stannous fluoride reacts with your tooth to produce a repairing layer over the vulnerable areas of your teeth. It also forms an impregnable enamel when used judiciously.

Likewise, there are different types of toothpaste according to the need of choice.

Need for Dental Hygiene practices –

Reduces possible sources of infection and maintains the integrity of teeth and gums

Promotes a better appetite 

Distinguishes the suitable use of topical and oral medications

How often should I visit the Dentist?

 All people are encouraged to regularly visit the dentist, at least once every 6 months.

The most common pain relief medicine is?

20% Benzocaine (Lidocaine, Novocaine)

Relieving your tooth pain is not a treatment

Do not use continuously

Visit your dentist for the appropriate treatment based on the degree and extent of disease and damage.