Your tooth has been keeping you awake at night for 2 weeks!? Now it is swollen and unbearable and you want me to touch it!?
Welcome to the dentist’s world.
Cause of Toothaches:
- Dental decay– The tooth is made in three “layers”: enamel, dentin, pulp (nerve). The enamel is non-living and is the protective covering over the teeth. The dentin is living and is fed by the pulp tissue inside the root canal. When the decay gets large enough to infect the pulp chamber, the body tries to fight it off. The cardinal signs of infection are swelling, redness, heat and pain. Normally, this happens in an area of the body with the capacity to actually swell, but inside the tooth swelling is impossible. The pressure of swelling gets higher than the blood pressure of the body and this blocks blood from flowing inside the tooth. If no blood flow, then no oxygen. If no oxygen, then the tissue dies and the bacteria wins the fight. The bacteria can now live inside the necrotic tooth with impunity. When this happens an abscess starts to form at the base of the tooth and the pressure from this causes pain. Extreme pain!
- Periodontal disease– Bacteria cannot only invade inside the tooth but can also invade around the gum line. This invasion causes the cardinal signs of infection as well (swelling, redness, heat and pain). This swelling is from blood vessels moving into the area to fight off the infection. The simplest explanation is that the extra blood vessels in the area need to have more room so the bone moves away to accommodate. The more accurate explanation has to do with exotoxins produced by the bacteria and the bodies response to them. Once the bacteria begin to make a “pocket” around the tooth it becomes more difficult for the patient to clean their teeth properly. The infection can continue until the pockets are so deep the tooth begins to get loose and falls out. In some cases this can be painful, but in other cases the teeth can feel perfectly fine. Popcorn and other similar type foods can get in the gum line and cause an acute periodontal abscess. This is a sudden swelling of the gums with bleeding usually between two adjacent teeth. If the food lodges into the gum line, bacteria attack and begin to digest the food between the teeth. This dumps massive amounts of toxins into the area and the body responds by swelling, redness, heat and pain. Once the bacteria have liquified the food the pain begins to go away. This can be a recurrent problem and is often associated with a small space between the teeth. This small space can be from natural causes, post extraction drift/shifting, broken fillings, open contact from a filling, or post orthodontics. If this small space it not rectified it can lead to a more established, chronic periodontal disease.
- Traumatic occlusion– Having a “bad bite” can cause the tooth to hurt. It is similar to a bruise that you can get in other parts of your body. In some instances the tooth can die from this biting trauma.
- Physical trauma– Getting hit in the mouth is never good for the teeth. It can either bruise the tooth (subluxation), chip off part of the tooth, break root(s) in half, or knock the tooth/teeth completely out (luxation). The pain can be immediate or delayed for decades.
- Saving the tooth (if it can be saved) is usually a root canal, post and crown.
- Not saving the tooth is an extraction.