Toothache

Toothache or tooth pain can often be caused when the nerve to a tooth is irritated. Tooth or dental pain could be caused by:

Dental infection
Gum disease and plaque
Dental decay or cavities, injury
Cracked teeth
Poorly placed fillings or crowns
Failing or leaking fillings or crowns
Loss of a tooth (including tooth extractions)
Temporomandibular joint (TMJ) disorders
Obstructive sleep apnea

There are instances, however, where pain originating outside the dental area radiates to the mouth, thus giving the impression of tooth pain. This often happens when there is a problem with the jaw joint (TMJ), ears, nerve, sinuses, and/or muscles. Occasionally, heart problems can give the sensation of tooth pain.

One can prevent the majority of dental problems by flossing, brushing, and using many different products, such as xylitol- and fluoride-containing rinses and toothpaste, and having teeth professionally cleaned on a regular schedule. The dentist may apply sealants, varnishes, and fluoride, which are especially important in children but can also be valuable to adults and the elderly, too.

Toothache Symptoms and Signs

Toothache and jaw pain are common complaints. It is not unusual for one to feel mild pain from pressure and hot or cold exposure to the tooth. However, if the pain is severe and persists for longer than 15 seconds after the pressure or temperature exposure, then this could be an indication of a more serious problem. If there is severe inflammation of the tooth, the pain can radiate to the cheek, the ear, or the jaw. The signs and symptoms that might lead one to seek care include the following:

Pain with chewing
Hot or cold sensitivity
Bleeding or discharge from around a tooth or gums
Swelling around a tooth or swelling of the jaw or cheek
Injury or trauma to the area
These signs and symptoms may sometimes be associated with dental decay or gum disease (periodontal disease). Dental decay or an area of redness around the tooth's gum line may point to the source of pain. If one taps an infected tooth, it may make the pain more intense. This sign may point to the problem tooth even if the tooth appears normal.
A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear or throat pain, or an injury to the temporomandibular joint (TMJ) that attaches the jaw to the skull may be confused with toothache. Pain from a deeper structure (called referred pain) may be passed along the nerve and be felt in the jaw or tooth.

When to Seek Medical Care for a Toothache

One should call the doctor or dentist for advice for the following concerns:

Dental pain is not relieved by over-the-counter medications. Even when it is relieved, a dental evaluation can be beneficial as the pain could be something that can be fixed more easily when treated earlier.
If one experiences severe pain more than two days after a tooth is pulled, it is possible that the tooth socket is not healing properly. A condition known as "dry socket syndrome" may have occurred and the patient should see a dentist immediately.
Pain may be associated with swelling of the gums or face, or the patient may have discharge around a tooth. A fever is another sign of infection in dental disease. These signs may indicate an infection surrounding the tooth, the gum, or the jaw bone (maxilla or mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended to be done inside the tooth (endodontic drainage), a "root canal" is performed.
Broken or knocked-out teeth unfortunately are common. Unless associated with more severe injuries, the dentist should be contacted as soon as possible. The sooner a patient seeks treatment, risk of infection is decreased and teeth have a higher chance of being saved. It is particularly important that children who have damaged their primary teeth (baby teeth) be treated right away in that such injuries can affect secondary teeth (adult teeth).
Pain may be present at the angle of the jaw. If opening the mouth causes pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big. The dentist may be able to suggest solutions to this problem.
Wisdom teeth can cause pain. As wisdom teeth (molars) come out, inflammation of the gum around the erupted crown often occurs. This can then lead to gum infection. The pain usually occurs in the lower third molar and may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot close properly. In severe cases, pain in the throat and the floor of the mouth may make it difficult to swallow.