What are the causes of tooth ache or tooth pain

Tooth ache or tooth pain can be caused by one or a combination of;

1. Sensitive Teeth; the sort of discomfort and pain you would normally feel with this sort of issue is short burst of pain when having something cold.  It is not usually hot, sweet and sour sensitive (painful) but can be.  This sort of pain is associated with areas of the teeth where the gum (gingiva) has shrunk away from the teeth and some of the root is exposed.  Patients will often say things like my teeth are getting longer.  Treatment is often symptomatic to start with, with the use of desensitising toothpastes and medications, topically applied to the exposed root area.

It is very important to be aware that by putting the densentising toothpaste on your finger tip and rubbing it onto the affected area a few times a day over a period of say a week, this will work alot better than just using it as a toothpaste, as most people rinse after they clean their teeth (which in general you shouldn’t do).

Other treatments involve placing fillings on the root surface and if necessary other more involved procedures which should be avoided.

The underlying principal of any dentistry is the less you do to your teeth in terms of fillings etc (root surface fillings particularly) the less you need to replace in the future and the less complicated treatment becomes as the work fails, all restoration of filling work in the mouth fails eventually.

2. Hole in tooth that has not infected the tooth yet but is painful or sensitive; 

Teeth that have small holes or decay in them can become sensitive or painful, it is usually sugar or sugary substances and dare I say it chocolate that causes pain in these particular teeth.  It is usually the first sign that you should visit the dentist and have it checked.  If a tooth starts to become quite sensitive to both hot and cold and a lingering kind of pain more than a second, then you probably have an issue that has moved onto the next problem.

Treatment for this usually involves doing a filling, depending on the size and shape etc you have different materials to choose from.

3. Hole in tooth that has infected the tooth or caused an irreversible inflammatory response which is causing the living tissue inside the tooth to die or become necrotic which is definitely painful and usually very uncomfortable.

Unfortunately over time decay or holes in your teeth will grow and spread internally in the tooth without you knowing, when a tooth crumbles then the hole is very big.  Especially in our fluoridated world where the outer surface of our teeth are kept strong by the fluoride, once the hole penetrates the enamel or hard shell it spreads quicker.  People and patients will sometimes only come to the dentist when they are in pain or notice a hole in their teeth, my response to this is always “well that just cost you more money than it needed too”.  Unfortunately major pain or discomfort, ultrasensitive teeth to hot and cold with lingering pain and/or pain that has woken you at night usually indicates you have a large hole in your tooth which has caused the tooth to become infected and the internal living tissue to start to die and become necrotic, causing a major inflammatory response which then leads to pain and sometime lots of pain.

Unfortunately your only options in this case generally are to remove or extract the tooth, or carry out a root canal therapy to try and save the tooth.  I will write another blog about root canal therapy to explain the myths of root canals later on.

These teeth are savable most of the time but costly to save.  The average cost of a root canal therapy in my practice is about $600-1000 depending on the size of the tooth.

4. Gum or periodontal pain;

There are occasions when severe gum issues or periodontal disease can cause pain, this is more an infection of the gums rather than the teeth, but it can also cause the teeth to hurt as well.  Generally speaking the gums will be very red and possibly swollen and if pressed puss will be released along the gum line.

There are certain medical conditions and medications that can also cause gum issues and pain.

Treatment; Make sure you see your dentist, get his advice as to whether you need some basic blood tests done and an overall health check from your GP or a modification of your medications.  Also you will need some periodontal or gum maintenance cleaning, this is not sure normal sort of dental clean but a more intense cleaning of the gums and periodontal tissues (these are the tissues that hold out teeth in our head)

5. Wisdom teeth pain;

Wisdom tooth pain comes in two different main forms;

a. Teething pain; basically when the teeth are on the move and are pushing through the gums, then this hurts the tissues get inflamed and you are teething again.

Treatment; Warm salty water, gently brush the area, it will bleed don’t panic this is normal.

b. Pericoronitis; this is the pain caused from wisdom tooth, when they are partially erupted (basically only partially through into your mouth) and bacteria gets caught under the skin around the tooth and causes an infection.  This does not mean your wisdom teeth need to be removed, please read my wisdom tooth blog.  Your glands on that side of your jaw, particularly if it is a lower wisdom tooth playing up will feel sore and tender, there will be a generalised dull ache radiating around the jaw and up to the ear.

Treatment; see your dentist make sure you don’t have a large hole causing the pain and if not then get a script of antibiotics and the problem should subside in 24 hours.

6. Cracked teeth;

Cracked teeth or broken teeth come in two main forms;

a. You have chipped or cracked a chunk of tooth off, thus generally will act like a sensitive tooth, so cold sensitive, sweet and hot a little, short burst of discomfort while the simulus is on the tooth.

b. You have fractured the tooth and it is flexing, this generally starts as a biting or chewing pain, quite a sharp sudden pain that may linger a little but generally subsides quickly.  When it lingers and then starts to ache this is an indication that the crack is propigating and heading towards the living tissue inside the tooth.  If it catastrophically fractures, this terminology is used when you basically split a tooth in two and it is very painful starts aching quite badly and there may even be a piece which feels loose.

Treatment; treatment of fractured teeth is very case specific.  If you have just fractured a chunk of tooth off then you can fill the tooth.  If you have a fracture that is flexing and causing pain whilst you are chewing then unfortunately this comes down to a judgment call by you and your dentist, my personal position with fracturing teeth are if you have slight occasional biting pain then changing the biting pressure in that area by trimming it down a little is a good start.

If it has become a little more regular and then may be a little sensitive it is time to try and locate the fracture and possible remove the fractured piece of tooth and place a filling, if this doesn’t work then unfortunately crowning the tooth or wrapping and holding the tooth together is the only option.  This doesn’t always work and occasionally you will need to carry out a root canal to stop the biting discomfort.  If it is discovered the fracture has entered into the living tissue area then a root canal will also need to be carried out.  You can try conservative initially but generally speaking treating fractured teeth is not conservative in nature.

Catastrophic fractures are just that, we can’t do too much about it that will last very long without being a problem again so unfortunately extraction (removing the tooth) is the only option.