Understanding Tooth Pain

By Jung S Pak, DDS

There are many causes of toothache trauma, enamel erosion or abrasion, sinus infection, periodontal disease (also known as gum disease) and cavities to name a few. Among the above mentioned causes, cavities are the most common source.

Tooth cavities start as very small softened area of enamel due to the acid produced by bacteria called Streptococcus mutans when they break down the sugars that we eat.

Toothache starts as a simple sensitivity to temperature which goes away in matter of seconds after the stimulus is removed from the tooth (reversible pulpitis), but there is still hope. Still at this phase, it is possible to remediate the tooth with a restoration combined with specially medicated protective coating.

If patients ignore these symptoms, this sensitivity begins to last longer and the duration of pain can be counted in minutes (irreversible pulpitis). It is at this level where restorations definitely will not work, and more serious treatment modalities such as root canal therapy, placement of posts, core-build ups and crowns (caps) or extraction and replacement by implants are required.

When the cavity reaches the nerve and kills it, it triggers the most painful phase the necrosis and abscess formation. When this point is reached, the pain becomes constant, dull and aching which worsens with biting or chewing. In addition, the tooth becomes no longer sensitive to temperature.

At this time, the pain is caused by the pressure of the gas and fluid produced by the breakdown of the live tissue inside the tooth that crushes the nerve endings in our bone housing the roots of the tooth.

I have seen many patients to use over the counter products such as Orajel or Anbesol seeking relief from the pain. However, these products do not have a long lasting effect since they are basically topical anesthetics that dentists use to numb the skin or gum prior to injecting the local anesthetic solution and lasts only two to three minutes.

In addition, some patients do place aspirin on the tooth for the same purpose, but this is even more dangerous since the acid contained in aspirin can cause chemical burns to the gums and cheeks. The best way to handle toothache is to seek the immediate care of a dentist.

However, if this is not possible, combination of over the counter medicines a pill of Tylenol combined with one pill of Motrin, Advil or Aleve can help to ease the pain.