Considerations

A toothache is generally the result of dental cavities (tooth decay) or sometimes an infection. Tooth decay is often caused by poor dental hygiene. Sometimes, pain that's felt in the tooth is actually due to pain in other parts of the body. This is called referred pain or radiating pain. For example, an earache may sometimes cause tooth pain.

Common Causes

• Abscessed tooth
• Earache
• Injury to the jaw or mouth
• Heart attack (can include jaw pain, neck pain, or toothache)
• Sinusitis
• Tooth decay
• Carbohydrates (sugars & starch) increase risk of decay
• Frequent snacking increases the time that acids are in contact with the surface of the teeth
  
  

Home Care

For tooth ache caused by an abscess, the practitioner may recommend antibiotic therapy in combination with other treatments i.e. root canal therapy or extraction.

Call your health care provider if

Seek medical care if:

• You have a severe toothache
• You have a toothache that lasts longer than a day or two
• You have fever, earache, or pain upon opening the mouth wide

Note: The dentist is an appropriate person to see for most causes of toothaches. However, if the problem is referred pain from another location, you may need to see your primary health care provider.

What to expect at your health care provider's office

The dentist will examine you. The physical examination may include an examination of the mouth, teeth, gums, tongue, throat, ears, nose, and neck. You may need dental x-rays. The dentist may recommend other tests, depending on the suspected cause.

The dentist will ask questions about your medical history and symptoms, including:

• When did the pain start?
• How severe is the pain?
• Where is the pain located?
• Does it involve the jaw or ears?
• Does it radiate to other parts of the body, such as the neck, shoulder, or arm?
• What makes it worse?
• Is it worse after cold foods or liquids?
• Is it worse after sweet foods or liquids?
• Is it worse after chewing?
• Is it worse after drinking?
• Is it worse when you touch the area?
• Is it worse after physical exertion?
• Does the pain wake you up at night?
• What makes it better?
• Is it better after you use medications? (Which ones?)
• Is it better after you use a heating pad?
• Is it better after you rest?
• What other symptoms do you have?
• Fever ?
• Nausea?
• Sweating?
• Indigestion?
• Chest pain?
• Bleeding?
• What medications do you take?
• Have you been injured?
• When was the last dental checkup?
• Have you had previous dental problems?

Treatment may involve fillings, tooth removal, or a root canal, if the problem is severe. If there is a fever or swelling of the jaw, an antibiotic will usually be prescribed.

Oral anatomy
The teeth are vital in assuring that an individual can eat a proper diet and a variety of foods to remain healthy. Good oral hygiene prevents many of the dental and oral disorders that need to be prevented in order to have healthy teeth and mouth.

Dental cavities

Causes, incidence, and risk factors

Tooth decay is one of the most common of all disorders, second only to the common cold. It usually occurs in children and young adults but can affect any person. It is a common cause of tooth loss in younger people.

Bacteria are normally present in the mouth. The bacteria convert all foods -- especially sugar and starch -- into acids. Bacteria, acid, food debris, and saliva combine in the mouth to form a sticky substance called plaque that adheres to the teeth. It is most prominent on the back molars, just above the gum line on all teeth, and at the edges of fillings. Plaque that is not removed from the teeth mineralizes into tartar. Plaque and tartar irritate the gums, resulting in gingivitis and ultimately periodontitis.

Plaque begins to build up on teeth within 20 minutes after eating (the time when most bacterial activity occurs). If this plaque is not removed thoroughly and routinely, tooth decay will not only begin, but flourish.

The acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large and affect nerves or cause a tooth fracture. If left untreated, a tooth abscess can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately causes the loss of the tooth.

Carbohydrates (sugars and starches) increase the risk of tooth decay. Sticky foods are more harmful than nonsticky foods because they remain on the surface of the teeth. Frequent snacking increases the time that acids are in contact with the surface of the tooth.

Symptoms

There may be no symptoms. If symptoms occur, they may include:

• Tooth pain or achy feeling, particularly after sweet, hot, or cold foods and drinks
• Visible pits or holes in the teeth

Signs and tests

Most cavities are discovered in the early stages during routine checkups. The surface of the tooth may be soft when probed with a sharp instrument. Pain may not be present until the advanced stages of tooth decay. Dental x-rays may show some cavities before they are visible to the eye.

Treatment

Treatment can help prevent tooth damage from leading to cavities.

Treatment may involve:

• Fillings/ composite restoration
• Crowns
• Root canal therapy
• Removal of offending tooth and replacement with a dental implant.
• Crowns are made form gold, porcelain , stainless steel, porcelain fused to metal , & zirconia
• Nitrous oxide with Novocaine must be changed to conscious sedation

Dentists fill teeth by removing the decayed tooth material with a drill and replacing it with a material such as silver alloy, gold, porcelain, or composite resin. Porcelain and composite resin more closely match the natural tooth appearance, and may be preferred for front teeth. Many dentists consider silver amalgam (alloy) and gold to be stronger, and these materials are often used on back teeth. There is a trend to use high strength composite resin in the back teeth as well.

Crowns or "caps" are used if tooth decay is extensive and there is limited tooth structure, which may cause weakened teeth. Large fillings and weak teeth increase the risk of the tooth breaking. The decayed or weakened area is removed and repaired. A crown is fitted over the remainder of the tooth. Crowns are often made of gold, porcelain, or porcelain attached to metal.

A root canal is recommended if the nerve in a tooth dies from decay or injury. The center of the tooth, including the nerve and blood vessel tissue (pulp), is removed along with decayed portions of the tooth. The roots are filled with a sealing material. The tooth is filled, and a crown may be placed over the tooth if needed.

Expectations (prognosis)

Treatment often saves the tooth. Early treatment is less painful and less expensive than treatment of extensive decay.

You may need numbing medicine (lidocaine), nitrous oxide (laughing gas), or other prescription medications to relieve pain during or after drilling or dental work.

Nitrous oxide with Novocaine may be preferred if you are afraid of dental treatments.

Complications

• Discomfort or pain
• Fractured tooth
• Inability to bite down on tooth
• Tooth abscess
• Tooth sensitivity
• Abscess formation
• Spread infection in to facial spaces

Calling your health care provider

Call your dentist if you have a toothache.

Make an appointment with your dentist for a routine cleaning and examination if you have not had one in the last 6 months to 1 year.

Prevention

Oral hygiene is necessary to prevent cavities. This consists of regular professional cleaning (every 6 months), brushing at least twice a day, and flossing at least daily. X-rays may be taken yearly to detect possible cavity development in high risk areas of the mouth.

Chewy, sticky foods (such as dried fruit or candy) are best if eaten as part of a meal rather than as a snack. If possible, brush the teeth or rinse the mouth with water after eating these foods. Minimize snacking, which creates a constant supply of acid in the mouth.

Avoid constant sipping of sugary drinks or frequent sucking on candy and mints.

Dental sealants can prevent some cavities. Sealants are thin plastic-like coatings applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves on these vulnerable surfaces. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants.

Fluoride is often recommended to protect against dental caries. It has been demonstrated that people who ingest fluoride in their drinking water or by fluoride supplements have fewer dental caries. Fluoride ingested when the teeth are developing is incorporated into the structure of the enamel and protects it against the action of acids.

Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions (applied to a localized area of the teeth) as part of routine visits.

Tooth abscess

Periapical abscess; Dental abscess; Tooth infection; Abscess - tooth

A tooth abscess is a collection of infected material (pus) resulting from a bacterial infection in the center of a tooth.

Causes,incidence,and risk factors

A tooth abscess is a complication of tooth decay. It may also result from trauma to the tooth, such as when a tooth is broken or chipped. Openings in the tooth enamel allow bacteria to infect the center of the tooth (the pulp). Infection may spread out from the root of the tooth and to the bones supporting the tooth.

Infection results in a collection of pus (dead tissue, live and dead bacteria, white blood cells) and swelling of the tissues within the tooth. This causes a painful toothache. If the pulp of the tooth dies, the toothache may stop, unless an abscess develops. This is especially true if the infection remains active and continues to spread and destroy tissue.

Symptoms

The main symptom is a severe toothache. The pain is continuous and may be described as gnawing, sharp, shooting, or throbbing.

Other symptoms may include:

• Bitter taste in the mouth
• Breath odor
• General discomfort, uneasiness, or ill feeling
• Fever
• Pain when chewing
• Sensitivity of the teeth to hot or cold
• Swollen glands of the neck
• Swollen area of the upper or lower jaw -- a very serious symptom

Signs and tests

The patient will feel pain when the dentist taps the tooth. Biting or closing the mouth tightly also increases the pain. The gums may be swollen and red and may drain thick material.

Treatment

The goals of treatment are to cure the infection, save the tooth, and prevent complications.

Antibiotics may be given to fight the infection. Warm salt-water rinses may be soothing. Over-the-counter pain relievers may relieve the toothache and fever.

Do NOT place aspirin directly over the tooth or gums, because this increases irritation of the tissues and can result in mouth ulcers.

A root canal may be recommended in an attempt to save the tooth.

If there is a severe infection, the tooth may be removed or surgery may be needed to drain the abscess. Some people may need to be admitted to the hospital.

Expectations (prognosis)

Untreated abscesses may get worse and can lead to life-threatening complications.

Prompt treatment usually cures the infection. The tooth can usually be saved in many cases.

Complications

• Loss of the tooth
• Mediastinitis
• Sepsis
• Spread of infection to soft tissue (facial cellulitis, Ludwig's angina)
• Spread of infection to the jaw bone (osteomyelitis of the jaw)
• Spread of infection to other areas of the body resulting in brain abscess, endocarditis, pneumonia, or other complications

Calling your health care provider

Call your dentist if you have a persistent, throbbing toothache.

Prevention

Prompt treatment of dental caries reduces the risk of tooth abscess. Traumatized teeth should be examined promptly by the dentist.