Toothache: Understanding This Painful Dental Condition

A toothache is an umbrella term used by patients to describe pain in or around their tooth. That means the actual tooth could be hurting or the surrounding periodontium (gums and jaw bone) could also be the cause.

However, from a dentist’s perspective, a toothache is an unhelpful term and is certainly NOT a diagnosis. All that it tells us is that you’re having pain which is merely a symptom that could be caused by a million dental conditions.

In other words, simply telling your dentist that you’ve tooth pain does not give them any idea of what the etiology is and how they should treat it. All it means is that you need to come in for an in-person clinical evaluation because we need more information.

Overview

A toothache is not a diagnosis because it is a symptom and it is used to refer to pain in or around your tooth. The cause of your aching tooth could stem from within it or from the outside surrounding tooth structures such as the gums or bone.

We like to call it an “umbrella term” since the general populace uses it to describe all types of tooth pain. The descriptions are as wide as your imagination and the treatments for it are equally as vast.

Types of toothaches

Even though we’ll be referring to these as “types of toothaches”, they’re more like symptoms.

• A constant dull ache.
• Sharp stabbing pain.
• Throbbing tooth pain like a heartbeat.
• Intermittent pain that comes and goes.
• Extreme or severe tooth pain.
• Raging toothache that wakes you up at night.
• Swelling in your gums.
• Can be linked to a headache.
• Associated with an earache.
• TMJ muscle pain.

If you’re experiencing any of the above, consider yourself eligible to call it a toothache.

Etiology

Tooth pain can develop due to numerous possible causes. They can be so different from one another that the way you must treat and manage them will be different.

How long does a toothache last?

Depending on the underlying cause, a toothache can potentially last until you finally get treated by a dentist. Cavities and infections may constantly persist or they may come and go periodically. However, they won’t completely go away until they’re properly treated.

On the other hand, a very mild toothache can be temporary and dissipate within a few days. Examples would be the gums getting scratched by food or you injure it from aggressive flossing. These should heal on their own granted you keep your mouth clean.

Can a toothache go away on its own?

Only very mild tooth pain can go away on its own. The underlying causes are typically self-resolving and temporary in nature.

Treatment & Management

Tooth pain should be addressed with prompt attention because it rarely ever goes away if you do nothing for it. Inaction will allow the condition to progress and become more severe. In other words, you’ll most likely end up in more pain.

Professional treatment

Your dentist can provide you a thorough evaluation which includes the clinical exam along with x-rays. Putting together all of the information you can finally get a diagnosis and be prescribed the appropriate treatment for permanent toothache relief.

The dental treatments will vary and each one is geared towards a specific diagnosis.

Dental Fillings

If you have a small cavity or chipped a piece of your enamel, your dentist will probably recommend a tooth filling. Your tooth can be restored by bonding a composite resin or by even placing an amalgam restoration.

During this procedure, any damaged portions of your tooth will be removed and then restored with the material of choice. You will be numb for it but at least your tooth will be as good as new afterwards.

Dental Crowns

Large cavities or fractures that may have decimated the bulk of your tooth will require more extensive treatment. A filling wouldn’t suffice because it isn’t strong enough to support your tooth so dentists often recommend a crown instead.

A dental crown is often referred to as a “tooth cap” which is placed over your entire tooth to protect and strengthen it. It is often made of ceramic and porcelain to also help enhance the aesthetics while reducing the risk for further damage.

An alternative would be an inlay or onlay. These are indirect custom ceramic restorations that fit into your tooth like a puzzle piece. They’re often used if the damage is more than what a filling can handle but less than what is necessary for a crown. You can think of it as an in-between treatment for moderate sized damage.

Root Canal Therapy

Any conditions which affect the tooth nerve such as decay from bacteria or injury to the pulp will require a root canal. That is the only type of nerve treatment available which can alleviate pain from an unhealthy or infected nerve.

This procedure removes the inflamed nerve, blood vessels and connective tissues from inside your tooth. After it’s been completely disinfected, your dentist will fill your pulp chamber and root canals with a filling material called gutta percha.

In most cases, you’ll also need a crown to protect the tooth since it does become weakened after the procedure. The blood supply is now cut off so it no longer receives nutrients which means it will become more brittle without any protection.

Tooth Extraction

The dental community prefers to save natural teeth whenever they can but sometimes it may not be possible if the condition is too severe. This is especially true for a tooth that is broken down to the gum line or a dental abscess with severe facial swelling.

For severe situations, the tooth will need to be completely removed with an extraction. Most people are familiar with wisdom teeth extractions but sometimes even your permanent teeth need to be removed too.

During this procedure, your dentist will carefully remove the tooth from the jaw and clean out any infection in the socket. After it’s been pulled, your treatment is not done because you should discuss replacement options.

Options to replace a missing tooth:

• Bridge: Connected crowns that replace a missing tooth with a pontic and at least two abutments.
• Implant: A titanium screw gets fixed into the alveolar bone. Afterwards an implant crown can be placed over it to restore your smile.
• Flipper: A temporary partial denture often used for missing front teeth. It can buy time until the patient is ready to decide which permanent option they prefer.
• Partial dentures: Yes, dentures can be used to replace one or more teeth, it doesn’t have to be for the entire dentition.

Dental Abscess Drainage

Any type of fluctuant swelling in the mouth or face will not go away without being drained. The only way to deflate it is with a procedure called an “I and D” (incision and drainage).

As the name implies, an incision is first made into the swollen abscess. Then the fluctuant mass gets drained with a hemostat, digital pressure, and potentially with a penrose drain.

The penrose drain is a sterile flexible tubing which gets sewn into the wound in order to keep it open. The purpose is to allow the pus and exudate to freely flow out of it and prevent you from swelling back up again.

Prescription Medication

While not a primary form of treatment, prescription medication can be used as an adjunct to dental procedures. They often help accelerate healing and alleviate pain while you recover from the treatment.

Commonly prescribed medications:

• Antibiotics. The most common dental antibiotic is amoxicillin which is a type of penicillin. It can treat most dental infections.
• Antibiotic rinse. A popular antibiotic rinse which helps speed up gum healing is called chlorhexidine. It may taste terrible but it works wonders in the mouth.
• Painkillers. Pain relieving medication like ibuprofen and acetaminophen are the workhorse of pain management in dentistry. Although for major surgeries where an unbearable toothache may be expected, opioids (Vicodin & Percocet) can be given.

It is important to note that NSAIDs (non-steroidal anti-inflammatory drugs) are preferred over painkillers without anti-inflammation properties. It is crucial to reducing tooth pain.

At home management

Home remedies for toothaches can help temporarily alleviate the pain if it is mild. But if you’re having an unbearable toothache that is rated a 8+ out of 10 on the pain scale, you need to see a dentist for treatment. That is unmanageable at home.

Nonetheless, here are some at home remedies to try for mild tooth pain.

OTC medication

Over the counter painkillers and topical numbing gels can help alleviate your toothache.

• Painkillers – ibuprofen, acetaminophen, aspirin, naproxen, etc.
• Numbing gels – orajel and anbesol.

However, did you know that combining ibuprofen and acetaminophen provides a synergistic pain alleviation effect? That is essentially what is in advil dual action.

Saltwater rinse

Salt is a proven natural antiseptic. Rinsing with warm saltwater can reduce inflammation, expedite healing in your mouth and provide pain relief.

Hydrogen peroxide rinse

Hydrogen peroxide is a very potent antiseptic, even more so than salt. A diluted rinse with this little brown bottle can eliminate half of the bacteria in just 15 seconds.

Please do not rinse with hydrogen peroxide at full strength because it can burn your mouth. For your own safety, just remember to always dilute and never swallow.

Cold compress

Applying a cold compress to the affected area helps to numb the area for pain alleviation and also reduce inflammatory swelling. You can wrap a bag of ice or frozen veggies in a clean towel, and then hold it against your outside jaw for about 20 minutes. Repeat several times a day.

Essential oils

Believe it or not but most essential oils do have analgesic properties, which means it can help numb the pain. Some even have antibacterial properties.

• Clove oil
• Tea tree oil
• Basil oil
• Oregano oil
• Peppermint oil

Other types of remedies

Aside from the commonly known home remedies, here are a couple of less common ones.

• Willow bark – Contains salicin which is the predecessor to modern day aspirin.
• Toothache plant – Has a tingly numbing sensation when chewed on. It is exotic and you probably won’t find this!

There are other purported remedies but you should stay away from the dangerous ones.

• Bleach
• Gasoline
• Brake fluid

Prevention

There may be times where it is impossible to prevent a toothache but there are good practices which can reduce the chances of them occurring.

Best practices to reduce your risk:

• Brush at least twice a day using a fluoride toothpaste and a soft-bristled toothbrush.
• Floss between your teeth once a day.
• Use a mouthwash after every meal.
• Minimize your intake of sugary foods and drinks.
• Visit your dentist biannually for exams and cleanings.
• Inquire about possible sealants and fluoride treatments.

In our experience, those who frequently go to the dentist often have no problems or very mild problems. These typically require conservative and inexpensive treatment.

However, those who infrequently go to the dentist often have more complex problems that are often more expensive.

When should I see a dentist?

We at afterva, recommend seeing a dentist for all toothache severity which includes the mild ones to the most excruciating. Try to have it checked out and treated as soon as possible.

However, you should call a dentist right away if you experience:

• A toothache that has not gone away after 2-3 days.
• Swelling in your face, mouth, or jaw.
• If you can’t open or close your mouth.
• Pain that interrupts your daily activities or prevents you from sleeping.

Do I need to go to the ER?

You should head to your local emergency room if you have:

• Swelling below your eye or a knot on your jaw.
• Bleeding that won’t stop with applied pressure.
• A fever over 101 degrees Fahrenheit (38.33 Celsius).
• If your dentist is not open and you’re having excruciating pain.