Toothache

Reviewed by Ms Lisa Taylor, dentist

What is toothache?
The most common cause of toothache, or pain in the region of the jaws and face, is pulpitis - inflammation of the pulp of the tooth. The short, sharp pains usually occur in response to hot, cold or sweet stimuli.

If left untreated, the pulp dies and becomes infected, leading to the formation of a dental abscess. The pain from a dental abscess tends to be in response to pressure on the tooth, and is throbbing and continuous.

What causes toothache?

• Dental decay.
• A fracture of the tooth.
• A cracked tooth. This may be invisible and so can be difficult to diagnose.
• Irritation of the pulp following dental treatment. Regardless of how well it is done, dental treatment and the materials used to fill the tooth can sometimes cause pain later.
• An exposed tooth root, which can occur if the gums recede or are damaged by over-vigorous brushing.

The following problems can also cause symptoms similar to toothache, even though the teeth themselves may be free of disease:

• an abscess in the gum (lateral periodontal abscess).
• ulceration of the gums (acute ulcerative gingivitis).
• ulceration of the soft tissues can sometimes be mistaken for toothache.
• inflammation of the gum around a tooth which is in the process of growing/breaking through (pericoronitis).
• inflammation of the sinuses (sinusitis) can be mistaken for toothache in the upper jaw.

Several other conditions may also cause pain in the mouth - always seek advice from your dentist if you have toothache.

It is worth remembering that the nerves supplying the teeth sometimes give the wrong message to the brain. This means that, although you feel pain in a particular tooth, the problem may actually be in a different tooth - even one located in the opposite jaw.

How can toothache be avoided?
The best way to prevent toothache is to keep your teeth and gums healthy. Try to avoid cavities by reducing your intake of sugary foods and drinks - have them as an occasional treat, and at mealtimes only.

Brush your teeth twice daily using a toothpaste containing fluoride. To get the most benefit from the fluoride, do not rinse the toothpaste away after brushing.

Clean between your teeth using dental floss, woodsticks or an inter-dental brush according to your dentist's advice. Visit your dentist regularly. This way, problems can be diagnosed early and your treatment will be more straightforward.

What should I do if I have toothache?
If you have toothache, seek immediate advice from your dentist before the problem becomes severe.

Pulpitis is often reversible and, once your dentist has identified and treated the problem (usually with a simple filling), the toothache will disappear. A dental abscess will require extraction of the tooth or a more complicated filling (root canal treatment ) if the tooth is to be saved.

However, the following advice may be helpful until you are able to see your dentist:

• avoid hot, cold or sweet stimuli. This will help prevent pain from pulpitis.
• if the pain is prolonged and severe, painkillers such as ibuprofen may provide some relief. Remember even if the pain goes away, without treatment it will eventually become worse.
• if the pain is caused by exposed root surfaces, toothpaste for sensitive teeth, either used normally or rubbed onto the exposed root, may be helpful.
• a hot saltwater mouthwash (a teaspoon of salt to a cup of water) used to thoroughly rinse the painful area may help if the problem is caused by a tooth erupting.
• a saltwater mouthwash can also prevent infection if you have mouth ulcers.
• visit your dentist as soon as possible. This way any treatment will be simple.

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