Toothache - Most Common Causes

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Headaches are alright. You know you will be fine with a paracetamol or a similar analgesic. But no sane person would ever take a risk when it comes to toothache. All we do is rush to our dentist to get rid of the awful pain. Toothache is one of the most dreaded aches. The reason we said “any sane person” is because a neglected tooth ache is potent enough to cause infections as severe as osteomyelitis- infection and inflammation in the bone and the bone marrow. There are a lot many factors which might be associated with the discomfort in your tooth. Read ahead to know these factors.

Grossly, the origin of tooth ache can be divided into two major causes:

  • Odontogenic causes- Pain originating from teeth or adjacent structures like gingival.
  • Non odontogenic causes- Pain arising from structures other than teeth.


1. Infection of the pulp and surrounding area

It is a misnomer that dental caries gives rise to pain in teeth. Had that been true, people would more time in a dental clinic than work place! You would hardly come across people without caries in their teeth. It is that common. But not everyone gets a toothache. The difference lies in infection. Dental caries is mainly an infection caused by some microbes which slowly eat away the affecting tooth. Our teeth contain three layers- enamel, dentin and pulp (out- in). It is only the dentin and pulp which bear the nerve endings, which elicit pain. So unless the dentin and pulp have been involved, there would be no problem. The most severe and sharp kind of pain arises when the infection reaches pulp (pulpitis) and its surrounding structures (abscess).   

 2. Wisdom tooth

This again remains one of the most common causes of tooth ache. Wisdom tooth might erupt normally, or might be wrongly placed- a condition which is called as impaction. Sometimes, the newly erupting tooth might face you cheek and abrade it every time it comes in contact with it. The only solution to an impacted tooth is its removal. Sometimes, even if the tooth emerges out fine, there is collection of food and debris around it, giving rise to a condition called pericoronitis, which is treated by antibiotic therapy.

You might even find it difficult to open mouth adequately because of the erupting wisdom tooth, or you might experience pain whenever you open your mouth.


3.   Periodontal problem

The gingiva and bone supporting the tooth contribute to what is known as the periodontium of the tooth. The main function of periodontium is to hold the tooth firmly in its position, thereby preventing them from trauma from day to day activities. The periodontium can be weakened due to a lot of actors, including excessive force from mastication to infection. Following are the reasons how periodontium causes tooth ache:

  • Infection of the gingiva (gingivitis)
  • Accumulation of heavy debris around tooth
  • Infection and pus formation in the periodontium (periodontal abscess)
  • Loosening of the tooth from its socket (periodontitis)
  • Formation of small space around tooth in which food gets lodged and cause infection (pocket formation).


4. Wearing away of enamel

The reason why enamel is the hardest substance in human body is because it plays the function of protecting the extremely soft pulp which lies on the inside of tooth. However, this enamel is not permanent and once destroyed, it cannot be reformed. It is a physiological or natural process for enamel to gradually recede. When this happens, the inner dentin and finally pulp are exposed to the environment, giving rise to severe toothache. This is known as wasting disease of tooth (or attrition ). Do not be scared. Although the enamel cannot be brought back, wasting disease of teeth can be treated. The tooth is treated by a root canal, in which the pulp is removed and the upper portion of tooth is provided replacement with an appropriate material.


5. Cysts and tumors in jaw

Cysts are pathologic structures associated with an unerupted tooth, infection and other reasons. There are many types of cysts. Their course is highly variable. They can be painless a lot of times, or can cause pain when get infected.

Tumors are the growths in oral cavity, (both benign and malignant). Sometimes tumors too do not cause any pain, but as soon as there is some nerve involvement associated with tumors, they cause excruciating pain. Other features might be associated with cysts and tumors- swelling, loosening of teeth to name a few.


6. Fractured tooth and trauma

Sometimes, a sudden blow to the tooth might induce changes in the inner components to tooth. This makes the tooth painful, tender and mobile. Depending on the severity the tooth is treated using various measures. If the tooth is severely mobile, it has to be removed in entirety. It might be replaced by fixed dentures or implants. If only a part of the tooth is lost and pulp is damaged, the pulp is removed to eliminate the infection, followed by replacement by appropriate material.

7. Bruxism or night grinding

Usually associated with stress or mental trauma is a condition when a patient grinds teeth during sleep involuntarily. This typically results in pain in the jaws around ears bilaterally or sometimes unilaterally. Bruxism also causes the enamel to get prematurely shed away, which in turn results in pain due to exposure of dentin and pulp.

Bruxism can be treated. The first and foremost phase would involve therapy to eliminate mental stress. This would be followed by administration of a device by dentist which would prevent the teeth to grind.


8. Other causes

Above list enumerated the most common causes of pain in tooth. There are other causes which are as follows:

  • Foreign Body Material
  • Damaged dental filling
  • Sinusitis
  • Infection in ear
  • Joint disorders (TMJ)


Yes, all those who have been neglecting the tooth pain are earnestly advised to visit a dentist as soon as possible because the cause of this ache might be more serious than you can ever imagine.

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