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Toothache And Dental Pain:
Some Other Causes
The Inflamed Nerve
Garden variety toothaches can be charted on a continuum, and the quality and intensity of the pain usually changes as the inflammation in the pulp gets more severe.
Whenever the nerve area of a tooth gets inflamed, you have a "hyperemic tooth." Inflammation can come from just about anything the nerve does not like - a cavity, a broken filling, a crack in the crown or root of a tooth, etc., etc.
The best case scenario for toothache is when the pain is a dull one and comes and goes, especially when exposed to cold or sugar. The ache will be relieved with aspirin or Ibuprofen, or, if sugar exacerbated it, washing the mouth with warm water. Inflammation is minimal and there is no serious damage to the pulp. The cause is usually a small cavity or a broken filling. When the decay is removed and a new filling placed, the problem is usually solved.
As a tooth pulp's inflammation gets worse the pain gets more constant and more intense. A specific tooth may become extremely sensitive to cold and the pain is a more lasting throb.
When the tooth is so inflamed that it is beginning to die, the tooth is very hyperemic (inflamed and filled with blood). It will be hyper-sensitive to cold and touch for a while. It is not yet dead or infected. Sometimes a sedative filling will work but often it is too late and the pulp cannot recover.
From Pain-with-Cold to Pain-with-Hot: At some point, the sick and hyperemic pulp will die and cold will no longer bother it. There may be a time period now in which there is no pain. The patient guesses the problem went away, but this is wrong.
Disintegration of the dying pulp soon starts to produce gases that may expand when heated (or in a descending airplane or under scuba diving) and place pressure on the nerve and tissues around the tooth. Hot soup, tea or coffee on the tooth may cause a pain that wells up, hurts a bit and then disappears. This tooth needs a root canal or extraction. If it is ignored it will probably become infected and abscessed. Often this period of heat sensitivity is not noticed, as the tooth soon dies and only later becomes infected.
See the dental pain link on this site for pain medication advice. Sometimes, if inflammation and not infection is the problem, cortisone-like drugs can be used temporarily to allow the patient to get a night's sleep and to afford temporary relief. These must be used with care the advice of a doctor and under his or her supervision, and these drugs are not for everyone.
"Cracked Tooth" Syndrome
The tooth with a crack in the exposed part of the tooth (the crown) usually does not present as an excruciating pain and it usually does not last. Rather, it is a sharp pain that occurs at the time of biting down on something hard. Sometimes a patient will have a recurrent pain when biting for a while and then, one day, a piece of tooth actually breaks off and the pain goes away. Why? Because the pain comes from the flexing of the tooth where the crack lies. Sometime, just a new filling is needed. Sometimes a cracked tooth will need a crown. In a very few cases the crack will extend into the nerve chamber and a root canal will be necessary.
When the root of the tooth is cracked, an abscess in the bone adjacent to the crack can form. This acts like a periodontal abscess and often occurs in molars that have had root canal since root canal teeth are more brittle and the root canal itself weakens the tooth. (This is the reason why crowns are often recommended after root canal as a way to hold the tooth together.)
Cracks in teeth are notoriously hard to diagnose and are the dentist's nemesis. If a tooth is cracked in the crown area, often a new filling or crown is what is needed. However, if the tooth has a crack in the root, it may not be diagnosed until the tooth has had a filling, a crown and a root canal that fails (a crack into the nerve or across the root holds bacteria in it and produces inflammation and infection.) Sometimes only upon extraction can the crack be seen as the dentist holds the tooth in his or her hand and inspects it. This scenario does not happen frequently, but when it does, it is expensive and frustrating to patient and dentist alike.
When a Piece of Tooth Falls Off!
Sometimes a back tooth with a big existing filling will have weakened tooth cusps and these cusps may fall or fracture off. The tongue may feel a large missing area (the tongue magnifies things--it's sensitive). There is usually no pain but there may be a sharp edge that can cut the cheek or tongue. This is usually not an emergency. The knife edge piece of tooth or filling that is left can be filed with a nail file just a tad and this may help a lot. Orthodontic wax from the drug store can be placed over the hole as well. As a dentist I have noticed that these pieces of tooth tend to fall off on holidays or the patient's vacations.
Temporary Glue?
I cannot tell you whether you can go out and purchase glue or cement that will work temporarily. There are too many variables and possibilities. But I ask you to remember that cyanoacrylate (Crazy Glue) only works on a dry surface (saliva gums it up) and if you are putting something back (a denture tooth, a veneer, whatever) you had better practice a few times and know that you are putting it on correctly! Also, if cement drips around the gum it becomes a serious irritant you can get a pretty sore gum. And I do not know if cements from the hardware store will hurt the nerve area a tooth or not.
Temporary dental filling material is traditionally made from zinc oxide and eugenol (oil of cloves) and some drugstores carry a little do-it-yourself kit. It can be used for holes and temporary crowns.
Grinding and Clenching
Many people grind teeth (usually during sleep) Grinding can lead to excessive wear on the tops of the teeth and sometimes sore jaw muscles.. This wear can be a few flat areas or half the tooth can be gone). See your dentist for an appliance or other treatment.
Clenching is different. It involves closing teeth together with a lot of force Teeth can close with more than 200 lbs/square inch so of clenching can break teeth or inflame the little fibers that hold the tooth in the bone. Teeth can become loose and sore. Both clenching and grinding are hardwired to some extent into the human neuromuscular system. Tension and life's problems can be precipitating factors and relaxation is helpful of course.
Temporomandibular Joint Dysfunction
This subject cannot be addressed properly in a paragraph. The TM joint is your jaw joint, where your jaw is attached to your skull. It is right in front of your ears and most TMD hurts there. In my opinion and in the opinion of the ADA, conservative measures should always be tried first (a bite plate to stop grinding, non-narcotic pain medications, heat, cold, whatever works.) You need to see a dentist. If your jaw "pops out" and gets stuck (doesn't happen much but does happen, usually while flossing or yawning) a dentist or oral surgeon will have to push it back where it belongs!
Maxillary Sinus Infection
When the sinus lies close to the roots of the upper back teeth, inflammation, a cold, or infection in the sinus can feel like a kind of toothache. When I get it, I feels itchy and unrelenting, like I want to "tear my upper teeth out." The problem can be a garden variety cold, but if it lasts or recurs, treatment is needed.
For Mouth Ulcers and Cold Sores see Canker Sore.
Please remember that this information on this site is not all-inclusive and it may or may not apply to your situation and you need to call your own dentist.
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