Dental Pain

dental pain

Summary

Dental pain includes pain felt in or around the teeth, gums and jaw. The pain can range from a mild, dull ache to severe and excruciating pain. The pain may come and go or be persistent. It may be aggravated by chewing or by exposure to extreme temperatures (cold or heat).

Dental pain can be caused by a wide variety of conditions and diseases. Most instances of dental pain are caused by tooth decay and gum disease. Food debris stuck between the teeth and gums also can cause pain. Jaw pain may be caused by TMJ disorder. Dental pain may also be caused by cracked teeth, teeth grinding, dry socket and an abnormal bite. Dental pain is sometimes caused by nondental conditions or diseases, including heart disease, migraines, and sinus or ear infections.

Patients experiencing dental pain should consult their dentist. The cause of the pain can usually be identified after a patient’s teeth and gums are examined and x-rays are taken. If nondental causes of dental pain are suspected, a patient may be referred to a physician or medical specialist.

Treatment of dental pain will depend on its cause. Most often it will include dental treatment that can be provided by a dentist or dental specialist – such as fillings, crowns, root canals or cleanings. Certain at-home remedies and pain medications may help reduce pain before a patient is able to see a dentist.

Preventing dental pain primarily involves preventing the most common causes of dental pain, such as tooth decay and gum disease. Proper daily brushing and flossing and regular visits to the dentist are important prevention techniques.

About dental pain

Dental pain is pain felt in the mouth area (e.g., teeth, gums, jaw). It usually indicates an oral health problem (e.g., tooth decay, gum disease, TMJ disorder), although the pain can sometimes be the result of a condition elsewhere in the body, such as heart problems or sinus or ear infections. Dental pain is an indication of a problem, and patients who experience pain should contact their dentist.

In a healthy mouth, the teeth, gums and jaw work together to chew food and break it down enough that it can be swallowed. Regular brushing and cleanings can keep the teeth and mouth clean and its parts functioning adequately. Dental pain can result from several processes that affect different parts of the teeth and jaw.

Most dental pain occurs due to tooth decay, which usually affects an individual tooth. It begins when bacteria normally present in the mouth break down food particles into acids. These acids can damage enamel and dentin, the two outer layers of a tooth, and cause cavities.

When a cavity gets larger, it is more likely to irritate the pulp, the center of the tooth that contains blood vessels and nerves. The pulp may also be irritated when the tooth is touched or contacts food or beverages that are cold, hot or sweet. In advanced cases of tooth decay, destruction of the enamel and dentin can allow bacteria to invade the pulp, which can become infected (tooth abscess). Whenever the pulp is irritated, its nerves send messages to the brain, causing pain.

Tooth decay does not heal without treatment (e.g., filling, crown, root canal). The pain may dissipate, especially if the pulp’s nerves are damaged, but the decay remains and will continue to worsen without treatment. Pain may return if the tissue and bone surrounding the tooth becomes infected.

Gingivitis or gum disease may also contribute to dental pain. The soft tissue of the gums may become inflamed due to the build-up of plaque along the gum line. Gums loosen and detach from the teeth, creating deep pockets of space between the gums and teeth. Bacteria in these pockets can cause swelling, bleeding and pain. Tooth and bone loss can occur in severe cases, when bacteria dissolve the bone surrounding tooth roots.

Tooth sensitivity can occur when the lower portion of teeth become exposed, due to bone loss or receding gums. Nerve endings contained in the lower parts of the tooth react to exposure to certain stimuli, causing dental pain.

Dental pain in the jaw area may be the result of muscle strain. The muscles that control the temporomandibular joint (TMJ) – the joint that connects the lower jaw to the skull – can spasm and cause pain. In patients with an unstable bite, missing teeth or teeth that are improperly aligned, jaw muscles may have to work harder to bring the teeth together, causing jaw pain.

Other symptoms related to dental pain

Depending on the cause of the dental pain, additional oral symptoms may appear that are related to dental pain. These include:

  • Sensitivity to certain stimuli (e.g., cold, heat, chewing, air)
  • Loose teeth
  • Red, swollen gums
  • Bleeding gums
  • Receding gums
  • Cracking sound when jaw opens
  • Difficulty opening or closing the mouth
  • Foul-tasting discharge
  • Pus near the source of the pain
  • Halitosis

Symptoms in other areas of the body may occur along with dental pain. These include headaches, fever and difficulty breathing or swallowing. Patients who experience dental pain should consult their dentist or physician. If breathing or swallowing problems occur, patients should seek immediate medical attention.

Potential causes of dental pain

Dental pain may be caused by a wide variety of conditions, illnesses or diseases. Most commonly, the cause of dental pain is one of the following oral conditions:

  • Tooth decay. The most common cause of toothaches. Tooth decay causes cavities, which can cause a tooth to be sensitive and painful in response to certain stimuli. Untreated tooth decay can lead to painful infection (tooth abscess). When tooth decay is the cause of dental pain, it is usually focused on a specific tooth.
  • Gum disease. A common cause of toothaches and jaw pain. Gingivitis and periodontitis can lead to infection of the gums. In severe cases, when there is bone loss and/or the gums recede, pain may be experienced as a result of exposed areas of the teeth. This type of sensitivity may affect many teeth (rather than a particular tooth). In addition, excessive use of over-the-counter teeth whitening products can irritate the gums, causing sensitivity.
  • Debris. When food gets stuck in between the teeth and gum pain can result. This is particularly likely with certain types of food, such as popcorn hulls. Pain caused by debris is typically felt in only the affected area, and may become more severe over time if the debris is not removed.
  • Temporomandibular joint (TMJ) disorder. Muscles surrounding the TMJ may spasm, causing jaw pain. Muscles may become strained due to clenching teeth, physical trauma to the area or arthritis, which can result in jaw pain.
  • Bruxism (teeth grinding). Grinding and clenching the teeth may result in dental pain, particularly upon awakening.

Additional causes of dental pain include:

  • Trauma to head or teeth
  • Fractured, cracked or broken teeth
  • Exposed tooth root
  • Dry socket (complication of tooth extraction)
  • Abnormal bite
  • Tooth eruption (in children) or impaction
  • Meth mouth (caused by use of methamphetamine)
  • Recent dental work (may be sensitive to cold for several weeks)

Dental pain may also be caused by conditions that are not dental in nature. These include:

  • Sinus infection
  • Heart problems (the pain usually increases with exertion)
  • Ear infection
  • Migraines
  • Salivary gland dysfunction
  • Neurological conditions (e.g., trigeminal neuralgia)
  • Burning mouth syndrome

Diagnosing causes of dental pain

Pain is an indication of a problem. Patients experiencing dental pain should consult their dentist as soon as possible. A dentist will most likely update a patient’s dental history, and may ask questions regarding the patient’s symptoms. Questions may include:

  • When did the pain start?
  • What does the pain feel like?
  • How intense is the pain?
  • How long does it last?
  • How often does it occur?
  • Where exactly is the pain?
  • What, if anything, appears to trigger it?
  • Is there anything that relieves the pain?
  • Do other symptoms appear with the pain?
  • Do you clench or grind your teeth?
  • Do you have difficulty opening or closing your mouth?
  • Do you hear a “clicking” sound when opening your mouth?

Patients may also wish to inform their dentist about any recent dental treatment, their current medications and specific health risks, conditions or concerns.  

A dentist will perform a visual examination of the teeth and gums to look for signs of tooth decay or gum disease. A decayed tooth may feel soft when probed with a sharp instrument. Diseased gums may be swollen and red, and may bleed easily. A dentist may check the patient’s bite – pain when biting may indicate a cracked tooth.

X-rays may be taken to confirm the presence of these problems. Areas of decay may appear darker than the rest of the tooth on an x-ray. A dentist may also examine the salivary glands or lymph nodes in a patient’s neck for inflammation or tenderness that may indicate infection or disease.

If no dental cause can be found for the pain, and some other disease or condition is suspected, patients may be referred to a physician or other medical specialist for further evaluation.

Treatment options for dental pain

Treatment of dental pain depends on the cause of the pain. In most cases, a specific type of dental treatment may be necessary. The dentist may perform these procedures, or the patient may be referred to a dental specialist (e.g., endodontist, periodontist). These treatments may include:

  • Fillings, crowns. These are generally used to treat small and large cavities, respectively. Crowns may also be used for smaller tooth fractures.

  • Root canal, tooth extraction. These are typical treatments for a tooth infection (abscess). Tooth extraction may also be necessary in advanced cases of gum disease, where there has been significant bone loss, or for tooth fractures. Surgical extraction is required in cases of pain caused by impacted teeth. In some cases, complications that develop after tooth extraction cause pain, such as dry socket.

  • Cleaning. This is generally used to treat various stages of gum disease. It may include dental hygiene, the removal of plaque in a dentist’s office (dental cleaning), scaling and root planing. The type of cleaning depends on the level and extent of gum disease.

  • Subgingival curettage (gingival flap surgery). This surgical procedure may be performed in cases of advanced gum disease.

  • Fluoride. Topical fluoride treatments performed by a dental hygienist along with fluoride toothpaste may be recommended in cases of pain due to tooth sensitivity. Fluoride helps to make teeth stronger and less sensitive to the oral environment.

  • Medication. Oral anti-inflammatory medications may be used to treat TMJ disorder. Antibiotics are used in cases of infection. Pain-relieving medications (analgesics) may be prescribed by the dentist for some patients.

  • Braces, splints. May be used in cases of pain caused by TMJ disorder. This helps maintain proper positioning of the upper and lower jaw.

At-home remedies that may help reduce dental pain while patients are waiting to see a dentist include:

  • Brushing and flossing. This can remove food particles that may be trapped between the teeth.

  • Over-the-counter pain medication. This may offer temporary pain relief. Aspirin should never be placed directly on the teeth or gums because it can severely burn gum tissue. Aspirin should also never be given to children or teenagers due to the risk of Reye syndrome, a potentially life-threatening condition associated with the use of aspirin in children and teens.

  • Saltwater mouth rinses. Place one teaspoon of salt in a glass of warm water. This solution can be swished in the mouth for about a minute, and then spit out.

  • Over-the-counter antiseptic with benzocaine. These products may be applied to the affected area to temporarily numb it and relieve pain.

  • Oil of cloves (eugenol). May be topically applied to a sore tooth. It should not be applied to the gums, which it may burn. Application should be made by a cotton swab dipped in a tiny amount of the oil. Too much oil in the mouth may be poisonous. Clove oil has been a traditional remedy for toothaches, but there is insufficient clinical evidence to support its use. As a supplement, it is not regulated by the U.S. Food and Drug Administration (FDA) and patients should be cautious with its use.

  • Head elevation. Elevate the head when lying down. Blood travels more easily to the head when lying down, which can worsen pain. Keeping the head elevated may help lessen dental pain.

  • Reduced chewing. Eat soft foods that do not require a lot of chewing. This may alleviate dental pain caused by sore muscles. It may also help other types of dental pain by avoiding further aggravation to the affected area.

  • Cold compress. A cold compress or ice pack may help facial swelling.

  • Warm, moist compress. This may help pain associated with TMJ muscle strain.

Prevention methods for dental pain

Preventing dental pain involves efforts to reduce the likelihood of its potential causes (e.g., tooth decay, gum disease, TMJ disorder). Preventive methods that may help include:

  • Regular brushing and flossing. Brushing and flossing help remove food particles and plaque that stick to or between the teeth and gums. A soft brush may be less damaging to gums and tooth enamel.
  • Fluoride. Using fluoride toothpastes and mouth rinses can help to strengthen teeth and prevent tooth decay that can cause dental pain.
  • Sensitivity-reducing toothpastes. Certain toothpastes are designed to protect the teeth and decrease sensitivity to stimuli such as heat and cold. This can help prevent pain associated with sensitive teeth.
  • Encourage saliva production. A lack of saliva (dry mouth) increases a person’s risk of developing tooth decay, which is the most common cause of dental pain. Saliva helps neutralize acids created by bacteria in the mouth and cleans away food particles and bacteria from the mouth. Chewing sugarless gum, drinking plenty of water and avoiding medications that may cause dry mouth can help.
  • Regular dental examinations and cleanings. Dental experts recommend that people visit the dentist twice a year for examinations and cleanings. This helps to identify any oral problems early, while they are easy to treat and may help prevent dental pain.
  • Avoid clenching or grinding the teeth. Avoiding these behaviors can reduce the likelihood of muscle soreness that can cause dental pain.

Questions for your doctor regarding dental pain

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their conditions. Patients may wish to ask their doctor the following questions related to dental pain:

  1. What do you think is causing my dental pain?
  2. How will you be able to diagnose the cause of my pain?
  3. If no dental cause is found, will I need to see a medical specialist? What kind?
  4. How do I know if my dental pain is an emergency?
  5. Are there other symptoms I should be on the lookout for that may indicate a medical emergency, such as a heart attack?
  6. What kind of treatment will I need?
  7. Can I prevent this from occurring in the future?  How?
  8. Are there specific over-the-counter medications for pain relief you recommend for me? Are there ones I should avoid?
  9. Are there dental hygiene products (e.g., toothpastes, mouth rinses) that may help me? What specific types do you recommend?
  10. I just had some dental work done – is it common that the tooth still hurts? How long can I expect this pain to last?
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