“Toothache” is a pretty broad term that describes many different conditions. There is a wide variety of problems that can lead to tooth pain. In order to understand both the symptoms and causes of tooth pain, you need to understand a little anatomy of the teeth first.
How a Tooth Causes Pain
A normal, healthy tooth does not cause pain. Teeth are hollow, and the internal hollow chamber contains nerves and blood vessels. These nerves can send signals to the brain, triggering pain when something is wrong. Typically, there are no signals to send because the outer coating of enamel protects the nerve from any external stimulus.
Enamel is the hardest substance in the human body, and its job is to protect the tooth’s internal nerve while withstanding the heavy forces of chewing. Healthy enamel is a single, continuous coating around the core structures of the tooth. The structure directly beneath enamel is dentin, which is softer than enamel and contains tiny channels leading directly to the nerve. So anything that disrupts the enamel or exposes dentin allows certain sensations to reach the nerve inside the tooth. That is one mechanism of tooth pain.
Another mechanism of pain is when some irritant or injury to a tooth causes inflammation of the nerves and blood vessels within the hollow chamber. Inflammation causes swelling, but inside the tooth, there is no room for the tissue to swell. This means a very sharp increase in the pressure inside the chamber, which causes severe pain.
In cases without treatment, the nerve inside a tooth will often die, so the pain can stop. Dead nerves do not send any signals to the brain. The problem is that dead nerves progress into infections that spread to the ligaments and bone around a tooth. Usually referred to as an abscess, these infections cause pain and swelling in the jawbone and gum tissues.
Symptoms of Tooth Pain
The symptoms of tooth pain vary widely, and they give us clues about the causes of the pain. Your dentist will put the puzzle pieces together to determine the cause. Your job is to accurately describe the symptoms you are experiencing. It can be helpful to look over a list like the one that follows and select all that apply to you.
- Sensitivity to cold food and drinks
- Sensitivity to hot food and drinks
- Sensitivity to sweets
- Tenderness or dull ache on chewing
- Soreness when you tap on the side of the tooth
- Sharp, zinging pain on chewing
- Sharp pain after exposure to cold that lasts for more than 10 seconds
- Pain on impact (like jogging) or if you place your head upside down
- Throbbing pain/can feel your heartbeat in the tooth
- Spontaneous pain (when not eating or drinking anything)
- Pain that wakes you in the middle of the night
- Pain in all of the teeth on one side of your mouth
By describing the symptoms as accurately as possible, you will give your dentist precise information he or she needs to properly diagnose your dental problem.
Causes of Tooth Pain
We can divide tooth pain into two categories based on where it originates. There is pain that comes from the nerve inside the tooth, and there is pain that comes from the nerves in the tissues surrounding a tooth.
Pain from Within the Tooth
Pain that originates in the nerve within the tooth is usually caused by something that disrupts the single, continuous covering of enamel. The two most dangerous enemies of tooth enamel are cavities and cracks. Both break through the protective outer shell of enamel and allow sensations to reach the inner nerve. Over time, they also allow bacteria to penetrate the nerve and cause an infection within the innermost part of the tooth.
Other, less common, causes of pain within the tooth are dental restorations like fillings and crowns that are broken or leaking. Recent dental treatment may cause temporary pain within a tooth with sensitivity to cold temperatures. This is because the dental work causes a reversible inflammation in the nerve. “Normal” post-operative sensitivity goes away within 2 weeks. Any pain or sensitivity that lasts longer than 2 weeks after the treatment is cause for you to return to your dentist.
Many people experience sensitivity to cold as a result of receding gums that exposes the roots of the teeth. Roots do not have a protective coating of enamel, and they allow the cold fluids to reach the nerve through those tiny channels in the dentin.
Pain from Around the Tooth
As mentioned above, an infection from a dead or dying nerve can spread into the tissues surrounding a tooth. The body’s response to infection is inflammation, so swelling, heat, pain, and destruction of the bone around the root quickly develops. Infection is not the only cause of pain around a tooth, though.
There is a small ligament containing nerves and blood vessels that connects the tooth to the bone. We can easily bruise and inflame this ligament with heavy or improper biting forces. Clenching your teeth all night or having a new crown placed that doesn’t fit perfectly can lead to pain on chewing from inflammation around the tooth.
You can also experience pain around a tooth, especially upper molars, when you have severe sinus pressure. The roots of the upper back teeth extend up into the floor of the maxillary sinus cavity, and if there is excess pressure within that cavity, it puts pressure on the roots of the teeth.
Are You Experiencing Tooth Pain?
Call your nearest Premier Dental of Ohio location today to schedule an evaluation with one of our dentists. We will determine the cause of your pain and give you various options to treat it.