Dentists recognize that an aching tooth can be an intimidating and frightening experience. I assure you that the dental profession takes a very gentle approach to make you comfortable once again. For most of our patients, the greatest amount of fear stems from a fear of the unknown. I hope that the information on this page helps reduce some anxiety, should you have any.
Most of us have experienced some type of toothache over the course of our lifetime, and the number of reasons for this discomfort are so great that I cannot expound on all of them here. Often, the first idea that comes to mind is, "Uh oh, I have a cavity." I can assure you that a great number of our patients have happily learned that this was not the case.
To understand the source of a toothache, it is first important to understand the anatomy of a tooth. Our teeth are living entities, complete with nerves and a blood supply to keep them healthy. Underneath the enamel of the crowns that we brush is another hard (but more yellow) mineral substance called dentin. Dentin is composed of thousands of microscopic pores which communicate with the nerves inside our teeth. When these "windows" are exposed, they produce sensitivity to heat, cold, sweets or other stimuli. Such pores are also prominent in the roots of our teeth since our roots do not have an outer enamel coating.
Cavities are certainly one way to expose the dentin of our teeth, essentially when bacteria tunnel holes through the enamel of our teeth. Fracturing enamel or losing an old filling may also expose the tubules which can cause discomfort. If you have gum recession, which exposes more of the roots of your teeth, there may be exposure for this reason and often painting a sealant on such teeth is all that is needed.
Our teeth may hurt for other reasons as well and include more extensive etiologies such as infection, trauma or mobility. We have all heard of a dental abscess and these occur when a tooth gets infected and builds up pressure around the root of a tooth. As with any infection in our body, it is very important to have this treated by a medical professional. Trauma comes in many sorts, including long term self-induced trauma such as bruxism, or grinding of your teeth. When we grind our teeth, we create forces which not only wear away the enamel on our teeth, but also can cause gum recession and irritate the tissues and ligaments around our teeth. There are several devices and treatments available which can alleviate these symptoms as well. Sometimes, mobile teeth can also cause irritation. Stabilizing these teeth (e.g., splinting to adjacent teeth) may be a treatment option. If you have impacted wisdom teeth, their "movement," or eruption, may also be a cause.
Teeth are not the only sources of toothaches. If the ligaments or gums around your teeth are irritated, you may be interpreting this as a toothache as well. Such inflammation may be reduced by a dental cleaning and improved home dental hygiene. Even less obvious reasons for toothaches include causes of referred pain. This occurs when nerves in other parts of our body are irritated and our nervous system interprets this as a toothache. Rarely, heart disease or myocardial infraction can create a toothache in lower molars and must certainly be considered by the dentist if no other reasons for a toothache are apparent. Another example of referred pain is when a patient has an earache due to a cavity in a lower molar.
I hope that this information alleviates some anxiety you might be having about dental treatments. It is impossible to know the definitive causes of a toothache without a complete dental exam.
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