A toothache is some of the worst pain that a person can experience. If you are suffering with a toothache, you might have some questions, such as:
- What is a toothache?
- What causes a toothache?
- How can my toothache be fixed?
- Are there ways to avoid getting a toothache?
- Is there anything I can do at home to fix a toothache once I have one?
We will deal with all those questions in-depth in this article.
What is a toothache?
A toothache is when one of your teeth hurts in your mouth. This pain is usually described as constant or sometimes it can be throbbing, almost like a heartbeat.
Sometimes toothache pain can radiate to your ear, to the back of your head, or to the sides of your head. When you have a toothache, you cannot always tell exactly which tooth is causing the pain. You might think the pain is coming from your teeth, but you can’t narrow down the exact spot.
Sometimes the pain lessens, only to come back when you eat or drink something hot or cold. And, sometimes something sweet makes your tooth hurt worse.
What causes a toothache?
The major causes of toothache include:
- A cavity
- Reversible or irreversible pulpitis
- Grinding of the teeth, or bruxism
- A broken, chipped, or cracked tooth
- An infection into the nerve
The cause of a toothache comes down to the anatomy of a tooth. To begin with, a tooth is made of two parts: the crown and the root. The crown of the tooth is the part of the tooth that you see in your mouth. The root is the part of the tooth that is inside the bone. Let’s explore that more.
The crown of your tooth
The crown of your tooth has three layers. The innermost layer or core of the tooth is the “nerve” of the tooth. It’s not just one nerve. It is actually made up of tiny blood and lymph vessels, nerve tissues, and connective tissues.
The layer covering the nerve of the tooth is called dentin. Dentin is a porous, creamy colored layer that is filled with a network of tiny tubes radiating out from the nerve layer.
These tiny tubes are called dentin tubules. Think of these as microscopic hollow straws filled with cytoplasm that generally flows outward from the nerve. The cytoplasm is alkaline and mostly static—or stays in one place—inside the tubule.
A very tiny portion of cytoplasm flows through the third layer of the tooth, or the enamel. The cytoplasm keeps the tooth bathed in alkaline fluid. The enamel layer ranges in thickness from .1mm to 1.5mm. Enamel is the hardest substance in your body. It is made to withstand the saliva of your mouth and the variations in pH that your mouth is subject to because of the things you eat. It is a white and translucent, or even slightly opalescent, layer.
A cavity can cause a toothache because of how it affects the crown of your tooth.
Cavity means “hole.” A cavity may also be known as tooth decay. A specific bacteria called streptococcus mutans eats the tiny bits of simple sugars and simple carbohydrates that you are leftover inside your mouth from food. From this, it produces acid waste.
This acid builds up in debris between your teeth or in the grooves on top of your teeth. The acid can actually overwhelm your tooth’s natural alkaline state to eat a hole in your enamel layer. This hole then exposes your delicate dentin layer to the acid and the bacteria. Once the bacteria get inside your enamel layer, the destruction of the dentin layer can be very fast.
How fast the bacteria destroy your dentin layer with their acid waste depends on how strong your specific bacteria are, but also it depends on your overall health and diet. If you have a healthy diet containing appropriate levels of calcium, phosphorus, and vitamin D (important minerals that help your enamel heal) and you are not eating much sugar, the protective alkaline cytoplasm that is flowing from your nerve through your dentin tends to be stronger. And this means that the cavity will progress more slowly. If you are not in great health, or you have a poor diet, your tooth decay may progress much more quickly.
Even a little cavity can cause tooth pain. When the cytoplasm fluid inside the dentin tubules changes in pressure from a cavity, it disturbs the nerve inside the tooth and causes pain.
Inflammation, or pulpitis
When the nerve layer is disturbed from a cavity, you can experience an even more severe toothache. The technical dental term for this is “pulpitis.”
If the nerve layer is not disturbed to the point of inflammation, then the nerve pain can lessen. In this case, you may only need to fix your cavity, depending on its size, with a filling, onlay, or crown. This type of pulpitis is called “reversible pulpitis.” If you have reversible pulpitis, your tooth may be sensitive to cold or sweet sensations, but it will not be sensitive to heat.
Sometimes bacterium has been inside your dentin layer long enough that they and their acid waste products have gotten close enough to the nerve layer to cause inflammation or infection.
Either inflammation or infection of the nerve layer is the death of that tooth. When inflammation occurs, swelling happens. While microscopic tubules radiate out from the surface of the nerve into the dentin layer, the movement of cytoplasm inside the tubules is very limited. The nerve is inside a very contained and compact area. The swelling of the nerve layer inside its dentin case can cause these tissues to be crushed. The cells burst and die. And, as they die, they cause you pain. Death of the tooth is irreversible. We call this condition “irreversible pulpitis.”
If you have irreversible pulpitis your tooth may still be sensitive to cold and sweet sensations, but now your tooth will also be sensitive to heat and pressure.
Teeth grinding, or bruxism
Grinding your teeth may happen for a variety of reasons, including alignment issues and sleep apnea.
Most commonly, bruxism (or grinding of the teeth) occurs because when you are asleep you bite on your teeth differently that you do when you are awake. Your body senses that something is out of alignment. Unfortunately, your body’s reflexive response to this is to grind the teeth together and smooth out the area that is out of alignment!
Another reason a person might grind their teeth at night is obstructive sleep apnea. This is a condition that causes you to stop breathing repeatedly during the night.
When you are sleeping, there are stages where you cannot wake up. During these stages, if you stop breathing from sleep apnea, your autonomic nervous thrusts your bottom jaw forward to get the base of your tongue out of your throat. Your nervous system isn’t worried that your teeth are in the way—you not breathing is a far more important emergency.
Someone who has obstructive sleep apnea will have telltale grinding patterns on their teeth, with their front teeth shortening as they age.
Either of these types of grinding can cause tooth pain, not just because of the wear on top of your teeth, but because of the excessive force on your teeth. Your teeth rubbing against each other can cause flexing of the tooth at its “neck”—or where the tooth goes into the gums. Flexing in this area causes enamel and dentin to flake and shear off.
This looks like ditching out of the tooth at the gum line. In extreme cases, this flaking off of the tooth will go all the way down to the nerve.
Another reason for a toothache is a broken tooth. A tooth may break if:
- A cavity is making it weak
- It had a large filling placed inside of it, and the tooth could not withstand the mechanical forces of chewing and grinding over time
- It had a root canal in the past, and no crown was done
Root canal treated teeth in particular do not have any cytoplasmic fluid bathing the dentin. These teeth can become brittle over time, and very susceptible to breakage.
Sometimes, it’s not a chunk of tooth that breaks off, but the tooth cracks vertically, through and through. This will also obviously cause a toothache.
How can a toothache be fixed?
The most important answer may not seem like an answer at all—your toothache can be fixed in different ways, depending on what caused your toothache. Some more common treatments include a:
- Night guard for teeth grinding
- CPAP or dental appliance for sleep apnea
- Filling, onlay, or crown for a cavity
- Root canal for nerve inflammation or infection
- Extraction for irreversible pulpitis or a vertical crack
For example, if grinding caused your toothache, you may need a night guard. This is a custom-made appliance that separates your teeth while you sleep and stops them from grinding against each other.
If you have obstructive sleep apnea, you may need a CPAP machine or a dental appliance to stop your symptoms. The dental appliance for obstructive sleep apnea works by keeping your bottom jaw in a slightly open and forward position so that your tongue does not block your airway. This can effectively stop your symptoms so you don’t grind your teeth. And this, in turn, can stop your toothache at its root cause.
If a cavity caused your toothache, then the toothache can be fixed by restoring the tooth with a filling, onlay, or crown depending on how large the cavity is.
If the cavity that caused your toothache is too close to the nerve and you have inflammation or an infection in the nerve, then the nerve will need to be removed with a root canal in order to save the tooth.
Your dentist will start by making a hole into the nerve from the top of the tooth. Then they’ll use specific instruments and medicaments in the nerve canal to remove the nerve layer, and clean the nerve canal out. Finally they’ll fill the nerve canal with a rubber material and special cement.
A crown will then be placed on top of the tooth so that the tooth will not break—because there will be no cytoplasm flowing through the dentin once the nerve is removed.
If you have an irreversible pulpitis—a dying tooth—your only choices for treatment are a root canal or to extract (pull out) your dying tooth.
Your dentist will let you know if your toothache is caused by reversible pulpitis or irreversible pulpitis based on your symptoms. They’ll also gauge your reactions to some tests on your teeth during your dental visit.
There are only two situations where pulling the tooth is the only option to fix a toothache. They are non-restorable tooth, and a tooth with a vertical fracture or crack.
A non-restorable tooth is a tooth where too much of its structure has been dissolved away by bacterial acid. In these cases, there is not enough solid tooth for the dentist to fix and it must be extracted.
A tooth with a vertical fracture or vertical crack has a crack that is down to the bone. There is a layer of ligament, like a coating over the root surface of the tooth. This is an interface between the tooth and bone. This coating is called the periodontal ligament. It only senses pressure inside of it. If your tooth has a vertical fracture, however, the fractured edge that touches this ligament can cause severe irritation. Inflammation of this ligament follows the irritation. This is what causes a toothache on a vertically fractured tooth. The only way to stop the toothache in this case is to remove the tooth.
Are there ways to avoid getting a toothache?
Thankfully, the answer to this question is YES. The best way to avoid a toothache is to live a healthy lifestyle with good oral hygiene.
Good oral hygiene includes:
These habits greatly cut down on the debris and bacterial load in your mouth. Flossing removes any debris and upsets bacterial colonies that are in-between your teeth.
The other part of living a healthy lifestyle is cutting down on simple carbs, processed food, and sugars in your diet. These things are what the bacteria that cause tooth decay eat! If you don’t eat these unhealthy foods, you make it much more difficult for the bacteria that causes tooth decay to live inside your mouth.
Additionally, regular exercise keeps your blood flowing. Chemicals and hormones from exercise also work to combat unhealthy inflammation in your body.
Finally, eating leafy green vegetables, other vegetables, and beans will provide you with phosphorus, vitamin D, calcium and micronutrients that are needed to keep your teeth healthy.
Is there anything I can do at home to fix a toothache?
The short answer is unfortunately, no. If you find yourself with a toothache, come in and see us at AZ Dentist right away. A toothache is a dental emergency. We have tests and procedures that we can do to relieve your toothache pain immediately, no matter the cause of your pain.