A toothache occurs due to the irritation or inflammation of the pulp (central portion of the tooth)containing blood vessels and nerve endings that are very sensitive to pain. Pulpitis (pulp inflammation) can be reversible or irreversible.

Causes Of Toothache

Common causes of toothache are

• Dental caries ( decay)
• Tooth sensitivity
• Gum disease
• Abscess
• Dental trauma resulting in a fractured or cracked tooth
• Broken filling
• Impacted wisdom tooth
• Sometimes pain can be originating from other sources like ear, throat or sinuses & radiate towards the jaw, giving symptoms of a toothache.

Tooth Sensitivity

 Experiencing sharp pains on the consumption of hot or cold food and drinks could likely be due to a dental cavity. It may also be a sign of tooth sensitivity due to receding gums or wearing off of tooth enamel. 

Abscess

A dental abscess will have symptoms of a persistently throbbing pain, keeping you up at night. There are 2 types of dental abscess. The periapical abscess occurs when a dental infection spreads from within a pulp chamber of the tooth and spreads to the root tip or around the root. Abscess results when the tooth has essentially lost its ability to fight off infection, resulting in bacterial invasion and multiplication of the pulp chamber. A periodontal abscess originates from gingival pocketing outside of the tooth next to the root due to gum disease. Treatment will depend on the source of infection.

•  Localized swelling and pain that gets progressively worse over the next few days. 
• A tender and sore mass 
•  gingival bleeding might be experienced Periapical abscesses may be very sensitive to cold and heat.

Sometimes root canal treated teeth can develop an abscess, due to the lack of adequate sealing of the tooth allowing bacteria to enter the tooth.

Dental trauma

A blow to the tooth can immediately sever the tooth’s blood supply, which in turn results in a loss of nutrient supply, resulting in pulp necrosis. Occlusal trauma from bruxism or clenching causes a gradual, progressive tooth injury. Dental treatment such as a crown or a filling performed quite close to the pulp chamber in a vital tooth, can lead to pulp exposure and resulting pain.

Gum disease

Gum inflammation, pocketing and recession all result in mild pain and discomfort lasting for long hours. The solution is looking for the exact cause to plan accordingly for scaling, root planing, periodontal surgery or other treatments.

 Symptoms

Based on the exact cause of pain, a toothache can range from moderate to severe pain, that can alleviate on the consumption of hot/ cold food & drinks, Pain on chewing, Bleeding or discharge from around the tooth and swelling in the area surrounding the affected tooth, usually accompanied by fever. In reversible pulpitis, pain occurs for 10-15 seconds, when the stimulus is present. As inflammation increases with time, the pain becomes dull and throbbing but lasts for hours. 

What to do if you have a toothache

• Book an appointment with a dentist if your toothache lasts for 24 hours or more. In the meantime, a few temporary relief measures can be taken 
•  Over-the-counter pain medications 
• Warm, salt water rinses 
• Rinsing with a mouthwash containing alcohol, disinfect & numb your tooth for a while.
•  Numbing pastes or gels — to help dull the pain as a temporary relief, long enough for you to sleep
• Keeping your head elevated keeps the blood from rushing to your head, preventing blood pooling in your head & preventing intensifying pain.
•  Avoid acidic, cold, hard and sticky foods, as they might trigger pain.

Toothache Treatment

After assessing the cause of your toothache, the dentist will recommend the best treatment for you.

Decay

If the dental decay is above the pulp no carious lesion or the dental decay hasn’t spread very caries is removed followed by a dental filling. With a deep carious lesion extending into the pulp, a root canal treatment is needed. 

Cracked tooth

Depending on the extent and the depth of the crack in the tooth, it can be repaired or the tooth has to be extracted.

Broken filling

A broken filling can be repaired & the pain is relieved after that.

Impacted Wisdom tooth

Toothache due to an impacted wisdom tooth is either due to the accumulation of food & plaque because of a lack of proper cleaning or dental decay. Pain due to the accumulation of food & plaque can be resolved by maintaining meticulous oral hygiene by regular brushing, flossing & mouthwash. If the cause is the latter, wisdom tooth extraction is the only treatment option.