Toothache

What to do when you have a toothache ?

A toothache may be caused by a number of dental problems. But what can you do to ease the pain until you see the dentist? Which symptoms require immediate dental care?

Various treatments can minimize or eliminate toothache, depending on the diagnosis.

Dentinal hypersensitivity

Dentinal hypersensitivity can cause severe pain or frequent discomfort. It is characterized by pain arising from exposed dentin surfaces in response to the following stimuli:

  • Cold or heat
  • Sweet or acidic food
  • Breathing in cold air
  • Tooth brushing

This type of pain can also reveal the presence of tooth decay or of an underlying disease. Exposed dentine, degraded enamel or receding gums can also cause dentinal hypersensitivity. Usually, the pain occurs occasionally, but it can become constant. It is felt like an electrical shock at the junction of the gum and the tooth.

Preventing dentinal hypersensitivity

In order to prevent the risk of developing hypersensitivity, it is important to maintain good oral hygiene. It would be wise to use a soft-bristled brush. The pain can be reduced by brushing your teeth and gums more gently. You can hold your toothbrush with two fingers instead of your full hand. To limit discomfort, you could use toothpaste for sensitive teeth for a while. A fluoride mouthwash can also help strengthen teeth and block microtubules that communicate with the nerve endings in your tooth.

Dental sensitivity is a good reason to see a dentist. Even if the toothpaste for sensitive teeth eases the pain, this product can also contribute to hide a more serious problem and your sensitivity can be a symptom of other issues. This is why it is important to undergo a dental check-up. Depending on the cause of the pain, your dentist will find a treatment plan that is adapted to your needs.

A tooth that is sensitive to pressure

In general, this type of pain occurs during or after a meal.

The three main causes are:

1.    Build-up of food residues in interdental spaces:

Food particles that are caught between teeth can cause inflammation of the gums and underlying bone. If food gets stuck in a hole left by a missing filling, it can also cause diffuse pain. It is recommended to carefully brush and floss the painful area. You can also rinse your mouth with an antiseptic mouthwash.

2.    Tooth infection:

If you feel severe and persistent toothache, it is likely that you have a tooth infection (abscess). While waiting to see your dentist, you can relieve pain by taking acetaminophen or paracetamol. Anti-inflammatories are not recommended. Your dentist will be able to treat the infected tooth and will prescribe an antibiotic, if necessary.

3.    Tooth devitalization (root canal treatment):

A recently devitalized tooth can be sensitive. After removing the nerves and vessels (the pulp) of a tooth, pain can be felt at or near the site of the treatment for 3 to 5 days. It is also possible that the tooth feels slightly loose, but this situation is only temporary.

Pain after a root canal treatment can be relieved by painkiller drugs. If it becomes unbearable, it is best to go back to your dentist as soon as possible. If sudden swelling occurs, this could be a sign of an infection which must absolutely be taken care of quickly. It should be noted that the tooth will lose its sensitivity to cold, which is quite normal.

Pain after a tooth extraction

When a tooth is removed, it is possible to experience pain at the extraction site. Normally, a blood clot should form in the empty tooth socket and protect the underlying bone: this is part of the normal healing process.

However, if the wound does not heal properly or if an infection develops in the socket, a painful complication called “dry socket” can occur. It can happen in patients with poor oral hygiene, in smokers or in women who take oral contraceptives. Exposure of the underlying bone and nerves, that are no longer protected by a blood clot, results in intense pain.

It is important to see your dentist in the days following a tooth extraction. The dentist will prescribe an antibiotic if there is an infection or clean the empty socket and remove food residue to promote healing. The same type of pain can also result from the placement of a dental implant. With appropriate care, dry socket will subside in about 10 days. A painkiller like paracetamol or acetaminophen may relieve the discomfort.

How to prevent dry socket and promote better healing?

  • Brush and floss your teeth gently, being careful not to touch the wound.
  • Apply a sterile gauze after the extraction to promote blood clot formation.
  • Do not rinse your mouth or spit during the first 24 hours after surgery.
  • Eat soft foods, lukewarm or cold.
  • Avoid hot, pickled, or spicy foods because they impede the formation of the blood clot in the tooth socket.
  • Avoid small food particles that can get trapped in the extraction site (rice, semolina, seeds).
  • The heat of cigarette smoke and alcohol can slow down the healing process and increase the risk of bleeding. It is therefore best to avoid alcohol and tobacco during the first 72 hours after a tooth extraction or an implant placement.

Pulpitis

If you are experiencing a pulsating sensation triggered by cold foods or drinks or if you have throbbing pain, this could be the sign of a deep cavity, a crack, an abscess or a pulpitis (inflammation of the pulp of the tooth). The pain is normally worse when lying down. It is essential to consult a dentist immediately when such symptoms appear to avoid a possible necrosis of the tooth or an infection of the pulp. The dentist will treat the cavity or perform a root canal treatment (removal of the pulp), depending on how affected the tooth is.

To reduce the pain, it is best to sleep in a semi-sitting position to reduce blood flow to the tooth.

Pain in gums and mucous membranes of the mouth

Pain can be caused by small sores inside the mouth. These lesions, also called canker sores, are often recurrent and last from one to two weeks. You can use an antibacterial mouthwash for pain relief. These ulcerations of the mouth appear on the inside of the cheeks, lips and tongue and, occasionally, on the palate or on the gums. These types of lesions are not contagious. On the other hand, a mouth sore that does not heal after two weeks must be examined by a specialist.

Moreover, it is important to not confuse oral herpes lesions and canker sores. Oral herpes is caused by a virus and occurs outside of the mouth. Herpes lesions are contagious and can be found around the lips, below the nose or on the chin. There is no treatment available but over-the-counter local anesthetics can relieve the pain.

If thick white lesions are present on the inside of the cheek, a biopsy is recommended. It is possible that we’re dealing with leukoplakia due to tobacco consumption. These can develop into cancer. To treat them, it is necessary to stop smoking since tobacco is often the cause of this pathology.

Oral candidiasis

Oral candidiasis or thrush is an infection causing a whitish, beige or red rash on the tongue or the oral mucosa. It is caused by a fungus. This condition is common among newborn babies, people with braces and those with a weakened immune system.

Here are a few ways to prevent thrush:

  • Clean your orthodontic appliances properly;
  • Maintain a good oral hygiene;
  • As directed by a health care professional, undergo an antifungal treatment.

Salivary glands

The salivary glands may become infected and cause pain. The floor of the mouth or cheek is swollen and the resulting pain can radiate into the ear. During meals, it is difficult to eat. It may be accompanied by fever. Antibiotics prescribed by your dentist or doctor will be used to treat the infection. While waiting to see your dentist, it is possible to relieve pain by taking acetaminophen as needed.

Wisdom teeth pain

The third molars can create tension and pain when they grow. They appear between the ages of 16 and 25.

The pain associated with the eruption of wisdom teeth can be reduced by taking acetaminophen. However, if the gum that overlies the tooth becomes swollen or prevents the mouth from opening, this could be the sign of an infection. Please, see your dentist as soon as possible.

Also, it is possible that there is not enough space in the jaw for a developing wisdom tooth: this is what we call an impacted tooth. In this case, do not delay in contacting your dentist as soon as you are aware of the situation. The extraction of the tooth is often necessary and avoids many complications.

Muscle and jaw joint pain

Pain from the temporomandibular joint (TMJ), that joint located in front of the ears, can spread and lead to headaches. When you bite and chew, the TMJ sustains an enormous amount of pressure. Grinding and clenching your teeth at night also puts a lot of strain on that joint and on the muscles of the jaw.

Malocclusion can also cause pain. Teeth that don’t fit together properly cause an uneven pressure on each side of the jaws.

Symptoms to watch for:

  • Clicking or popping sounds when opening the mouth or when chewing;
  • Throbbing pain in front of the ear;
  • Difficulty opening the mouth;
  • Pain in the jaw muscles.

Relieving TMJ pain

For pain relief, you can take painkillers, anti-inflammatories or muscle relaxants. It is important to seek advice from your pharmacist or your dentist before taking medication. Don’t forget that your dentist is able to diagnose TMJ disorders. If necessary, the dentist will refer you to a maxillofacial surgeon.

 To avoid tensions in your jaws, it is recommended to:

  • Avoid eating hard and sticky foods (chewing gum, candies, etc.);
  • Alternate cold and heat treatments;
  • Rest your jaws from time to time by keeping your mouth open with a space between the upper and lower teeth;
  • Wear a bite plate at night.

Diffuse facial pain (facial neuralgia or trigeminal neuralgia)

Neuralgia of the trigeminal nerve can cause excruciating pain that can be brought on by mild stimulation of your face. The crises may repeat for several days or weeks and headaches may also occur. This condition can be detected by your dentist who will check if there is a dental origin. If necessary, the dentist will refer you to a specialist.

Paracetamol or acetaminophen can relieve this type of neuralgia. However, it would be preferable to get the opinion of a specialist. Trigeminal neuralgia can effectively be managed with medications, injections or surgery.

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