The Causes and Treatment of Toothache (Odontalgia)

According to the British Dental Health Foundation “about 5 million people visit their dentist with toothache every year”. Toothache is a common problem that can be prevented with good oral hygiene.

Toothache occurs because the pulp of the tooth is exposed, disturbed or infected. The pulp is the inner layer of the tooth which is engulfed in a layer of dentin and then by the hard layer that we see called the enamel, which is packed full of minerals. Toothache can also occur if just the outer enamel layer is damaged exposing only the dentin.

It is very important that you go to a dentist if you have toothache so that they can find a cause and apply appropriate treatment to ease your discomfort.

The most common dental causes of toothache are:

  • Tooth Root Sensitivities – over-sensitivity when consuming hot or cold, sweet or sour food and beverages.
  • Tooth Decay – also known as tooth ‘cavities’ or tooth ‘caries’.
  • Tooth Abscess – a complication of tooth decay.
  • Gum Disease – also known as gingivitis and in severe cases periodontal disease.
  • Jaw Disease – also known as TMJ (Temporo-Mandibular Joint) dysfunction.
  • A Cracked Tooth.

Tooth Root Sensitivities occur when bacterial toxins get to work and dissolve the bone around the root of the tooth, the gum and bone recede exposing the root of the tooth causing the sensitivity and toothache. This is then likely to lead to chronic gum disease.

Treatment: Visit your dentist. Fluoride gel and sensitivity toothpastes that contain fluoride will both help the root to become stronger and in turn reduce the toothache. If the root sensitivity causes the inner pulp to die a root canal procedure or tooth extraction will need to be carried out to stop the toothache.

Tooth Decay occurs when the minerals of the enamel are dissolved by acid created by bacteria in our mouths (a build up of this bacteria is known as plaque). This demineralisation of the enamel forms a hole in the tooth exposing the dentin causing the toothache. If the toothache is severe then the hole has most likely exposed the inner pulp as well.

The obvious prevention for tooth decay is to eat as little sugar as possible because the acid that causes the enamel to decay is created by the bacteria eating the sugar and starch left in our mouths. So brush your teeth preferably after every meal or snack with fluoride toothpaste. Flossing will also help a lot. Being thorough with your brushing and flossing will stop any build of plaque forming.

Treatment: Your dentist will in most cases apply a filling to the tooth cavity, large cavities may need a crown. If the cavity damages the inner pulp then a root canal procedure or extraction of the tooth may be necessary to stop the toothache.

Tooth Abscesses occur when a dental cavity has been left untreated. The bacteria has infected the tooth from the inner pulp all the way up to the bone tissue at the end of the root causing severe toothache.

Treatment: Your dentist will have to carry out a root canal procedure where the pulp of the tooth is removed and then filled and sealed with an inert material. If this is unsuccessful then the tooth will have to be removed.

Gum Disease occurs when the soft tissue in our mouths becomes infected due to a build up of plaque or tartar along the gum line. It is highly likely that your toothache will be accompanied with bleeding gums if you have gum disease.

Treatment: In mild cases of gum disease your dentist will help you become more informed in order to improve your oral hygiene, they will also remove any build up of plaque. Root planning may need to be done which is the removal of plaque and tartar from the exposed roots. In more severe cases the surface of the inflamed gum tissue will have to be removed which is known as subgingival curettage. Oral antibiotics will also need to be taken alongside these procedures.

Jaw Disease usually occurs when there has been an impact or injury to the head such as whiplash. Bruxism (grinding of the teeth) often leads to TMJ as well as arthritis and having an over-bite. Jaw disease is often characterised by pain in the muscles around the jaw and limitations in jaw movement.

Treatment: Your dentist will fit a special intraoral splint for you to wear. If your bite needs to be fixed then crowns and orthodontic treatment are likely as well as medication to relieve the toothache.

Cracked Tooth can occur for many reasons such as an injury to the mouth, bruxism, chewing on hard objects or extreme changes in temperature on your teeth (such as eating hot food immediately followed by an iced drink) can all cause a tooth to crack and expose the dentin or inner pulp. The toothache may occur when the crack closes after releasing the pressure of a bite. The toothache gets worse over time if left untreated as the inner pulp can become infected.

If you have visible a crack in your teeth that is not accompanied by toothache then it is known as a ‘craze’ line and is considered to be part of the natural anatomy of the tooth, they usually occur as we age.

Treatment: Your dentist will evaluate the treatment needed depending on the severity of the crack. This can involve bonding for a small crack or a root canal treatment for a large crack where the inner pulp of the tooth has been damaged. In severe cases the tooth may need to be removed to stop the toothache.

In very rare cases toothache can also be caused by the following:

  • Angina – a disease of the throat marked by spasmodic attacks of intense suffocating pain
  • Heart Disease.
  • Myocardial Infarction – destruction of heart tissue resulting from obstruction of the blood supply to the heart muscle.

Whatever the cause of your toothache it is important you see a dentist so that they can determine the cause and apply the appropriate treatment or refer you to a doctor. If you have to wait for your appointment then to soothe the pain you can apply a cold compress to the area of the cheek where the toothache is. Rinsing your mouth with warm salt water and taking aspirin will also help. A good oral hygiene routine will prevent any toothache occurring.