Simple Can Be Serious

We occasionally have patients who tell us they have a “simple toothache,” and could we please write them a prescription and send them on their way. We wish it were that simple, but a painful tooth can be caused by many factors, and sometimes a prescription is not the answer. If you are experiencing tooth pain, we need to do a thorough examination to determine the cause of your pain.

Diagnosis: pulpitis

When you called in for an appointment, you told us that you had a fever and your tooth hurt when you bit down. During the exam we found you had other symptoms:

• The gum is swollen. [See top image]
• Your have a nasty tasting discharge.
• The pain gets worse when you lie down.
• The pain worsens when you eat or drink hot or cold foods and beverages.

These are classic symptoms of pulpitis. You might be surprised to know that a “simple toothache,” or pulpitis, affects only about 12 percent of the population.

What causes pulpitis

There is a chamber in the center portion of each tooth, and that chamber contains a mix of nerves, blood vessels and soft, spongy tissue called pulp. Healthy pulp causes no sensations, but when it is attacked by bacteria, pressure builds up in the chamber and you experience pain.

Pulpitis is typically caused by untreated caries (decay) that has inched its way down into the pulp chamber. Your “simple toothache” could have also been the result of a loose filling, periodontal disease, an injury to the tooth or an extensive, invasive dental procedure that came close to the pulp chamber. [The dark area in the image is infection spreading into the pulp chamber.]

If we can catch the decay before it progresses, we usually can remove the decay, place a filling and save the tooth. But sometimes the condition has gone too far and an abscess forms at the end of the tooth’s root. Now we may be left with only two choices: do root canal therapy or extract the tooth. [Bottom image shows an abscess that formed at the tooth root.]

If it’s not pulpitis

Let’s say my examination determines that you do not have a “simple toothache.” We can examine you for other causes, but we may also refer you to a specialist.

Tooth pain can be caused by a sinus infection and mistaken for pulpitis. Perhaps you are under a great deal of stress and you grind or clench your teeth. This is called bruxism and can cause your teeth to hurt. A migraine can make teeth hurt. Nerves in your face can produce tooth pain.

People who have heart disease may experience tooth pain. In rare cases, tooth pain is caused by cancer.

So, you can see that what seems like a “simple toothache” can be a serious condition with serious causes and results.

Preventative homecare

If your pulpitis is caused by caries, our recommendation is to brush and floss twice each day. They are the most important things you can do to keep your teeth healthy and strong. We may also modify your diet and recommend that you use oral care products that contain fluoride.

If you are experiencing tooth pain or have another dental problem, please call our office and schedule an appointment right away. The earlier we can examine you and determine the cause of your dental concern, the better chance we have of preserving your precious teeth.