Know Your Common Toothache!! (Part 1)

Toothache can be a very annoying experience and sensation that ones can get. Unfortunately, everyday in my clinic I always see many cases of patient coming into the dental clinic to seek for dental treatment to relieve their toothache. In some stage of our life, toothache may occur due to certain conditions pretty much related to our teeth or general health, where they can be avoided.

Simply looking at its meaning, toothache or also known as odontalgia is the pain of the tooth and around it. As annoying as it is, we should know a little bit regarding its causes, so that you will know what to expect and how to deal about it. For the first part, we will look at the pain due to caries and infected pulp.

Here are the common cause of toothache:

• Dental caries or cavity
• Infected dental pulp that required some form of root canal treatment or extraction (removal)
• Gum disease
• Emergence of wisdom tooth
• Cracked tooth
• Jaw disease
• Exposed root of tooth
• Dry socket following removal of tooth

Dental caries and infected dental pulp are two very common condition. I see it everyday. Some other form of toothache are also caused heart disease (heart attack, chest pain)

CARIES or CAVITY

Dental caries is a very common mouth disease that affected over 90% of the adults worldwide. Dental caries involved damaging the tooth structures that may resulting holes on the tooth. The damage occurs first at outer hard layer called enamel, which then goes into dentin and cementum.

If left untreated, the cavity which mainly contain bacteria will continue to destroy more tooth structures until when it reach the dentin. The dentin consists of tubules that connect deep into the pulp. The tubule is sort of like a tunnel and when the cavity passes through it into the pulp, where the nerves are, the nerve inside the pulp will inflammed or swollen to cause pain. As for this, i recommend you to get it treated by removing the infected caries and placing some filling material to fill the tooth.

INFECTED DENTAL PULP

When the dental pulp is affected usually due to caries process, the pulp will undergoes changes into inflammatory (swelling) status accompanied with pain. The pain is usual because the inflamed pulp cause increase in pressure and the surrounding tissue. The pain can spread to adjacent tooth, thus we may feel pain but confused to pin point the exact pain location. This is called pulpitis.

Pulpitis can be divided into two condition - reversible pulpitis and irreversible pulpitis.

When I get reversible pulpitis?

• When you have sharp and transient pain but does not disturb your sleep
• Pain occurs with taking cold, sweet or sour food
• Caries or cavitated tooth
• Upon examination, the dentist will notice that your infected tooth is not tender to percussion (when the dentist lightly knocking your tooth), respond to cold and hot test, respond to tooth vitality (still alive) and no tooth mobility (loosening)

How we deal it? Simple, we relieve pain with prescribing medication, remove the caries and do pulp capping...we seal the pulp basically.

When I get irreversible pulpitis?

• When you have sharp, throbbing and lingering pain that truly disturbs your sleep
• Pain occurs spontaneously but get worsen with hot, sweet and sour food - some get comfort from taking cold food
• Upon examination, the dentist will notice that your infected tooth may or may not have localized swelling, not respond well to cold and hot test, not respond to tooth vitality (stage of dying tooth)
• and no tooth mobility

How we deal it? Because the tooth is in dying stage, it should be manage accordingly. Pain control, do root canal treatment or optionally extraction (removal). Do forge out more money for the former option and do prepare to lost a tooth for the latter option.

That's all for now...next time...the series will continue with toothache from other causes....