Oral diseases are becoming increasingly common, hence dental education is important for maintaining good oral health and hygiene thus ensuring overall wellbeing. However, physical and mental limitations, emotional stress and chronic illnesses can significantly affect one’s ability to maintain good oral hygiene. This can result in dental problems, which often leads to dental pain.1
Dental pain can arise from problems associated with the teeth or gums or unrelated issues, and is typically described as a continuous throbbing sensation that intensifies at night or when consuming hot or cold foods and drinks. 2
People with disabilities and their caregivers can greatly benefit from better knowledge about such pains. This understanding can help them articulate or assist in describing details like type and location of the pain during dental visits, thus providing essential information for the dentist to offer effective care. 2,3,4
This article provides an overview of dental pain, including its common types and the typical causes that impact oral health.
Dental pain due to bacterial infection
When the innermost layer of the tooth which consists of blood vessels and nerves, also known as tooth pulp, becomes inflamed, tooth pain may occur.
Tooth decay is one of the most common causes of dental pain. Such pain can differ with each requiring equal attention and quick intervention.2
- A short, sharp pain that lasts only for a few seconds and occurs when eating cold or “sweet” food is generally not a severe problem. Although major interventions and medications are not required, a dental visit should be scheduled as soon as possible to avoid further damage.
- A dull, aching, “pulsing” pain that occurs spontaneously and when consuming hot foods and drinks, likely shows that there is relative damage to the tooth pulp. This pain can disrupt sleep and may last for hours. Medications maybe ineffective and such situations require immediate dental intervention.
If left untreated, the tooth may become more infected, leading to tenderness, swelling, and eventually pus, which would require antibiotics. The patient’s general health can be affected because of compromised airway due to the spread of infection, and eventually the need for hospitalisation.
Other causes of dental pain
Dental pain can also be caused by dental and non-dental related issues. Understanding and locating the site of pain is critical for treatment. Some causes of dental pain include:
- Cracked tooth
When the outer hard tissues of the tooth are cracked due to biting on hard foods or from a fall, simple movements like chewing can cause the tooth pieces to move, resulting in pain possibly due to the biting pressure. The cracked tooth may become sensitive to hot or cold food extremes of temperature and begin to hurt all by itself. Many times, it is difficult for one to point out the exact tooth causing the discomfort. 5
- Broken filling
Dental filling serves as a physical barrier protecting the inner delicate parts of the tooth from pressure, heat, cold, acid, food debris, and bacteria.
When the filling is broken, the vulnerable parts are exposed, resulting in sensitivity to pressure while chewing or when food particles get stuck. This can be felt as pain or discomfort, which goes away when the pressure if removed from the problem tooth. 6
- Pericoronitis
Pericoronitis happens when the gum tissue around a trapped or a partially erupted wisdom tooth becomes inflamed. This results in severe pain around the back teeth, discomfort while opening the mouth and swallowing, redness and swelling of the gum area, face swelling and fever. There may be pus discharge as well.
If left unattended, it could result in mild, temporary achiness near your back teeth, bad breath and a bad taste as food and debris can get entrapped in the area and cause infection. 7
- Bruxism
Bruxism or teeth griding, is often related to stress or anxiety, sleep problems and habits like excessive smoking and drinking. The person might experience jaw pain due to constant clenching or grinding of teeth, worn down or broken teeth, face, neck and shoulder pain, headache, earache and disturbed sleep. 8
- Gum pain
Gum pain in the form of a minor irritation to severe pain can result from:
– Small painful ulcers in the gums,
– Accidental injuries like cuts from food, objects or bites on gums,
– Swelling (Inflammation) of the gums due to bacterial build up,
– Hormonal fluctuations,
– Improper flossing or brushing techniques,
– Sinusitis,
– Tooth abscess (pus-filled sac in the mouth) due to bacterial infection.9
- Orthodontic pain
Pain is the most common reason why many patients avoid orthodontic treatment. Many patients generally describe the pain as a sensation or feeling of pressure, tension, or tooth soreness. While fixed braces produce significant concerns, removable appliances are more comfortable but are still associated with periods of significant discomfort. 10
Some non-dental related causes:
- Sinusitis
Sinusitis happens when there is a bacterial or viral infection in the sinuses causes swelling of the sinus cavity.
Besides symptoms such as stuffy nose, nasal discharge, clogged ears or earaches, a hoarse or sore throat, fatigue, and fever, some people with sinusitis experience gum pain and toothache. In fact, pain in the upper back teeth is common due to its location near the sinuses. 11
- Temporomandibular Joint Disorder
Temporomandibular joint (TMJ) disorder occurs when the jawbone connecting each side of the skull becomes irritated or inflamed. Besides jaw pain, there can also be aching near the ear, difficulty eating and difficulty in opening the jaw (locked jaw).
TMJ pain can radiate to the face, neck, and head even near the teeth. Pain from TMJ can be dull, sharp, searing, sporadic or constant.
As certain types of toothaches can cause similar pain, it is advisable to visit a dental clinic to rule out other issues like chipped or broken teeth and cavities. 12
- Trigeminal neuralgia
Toothaches are a common occurence when the trigeminal nerve, which controls facial sensations and sends important signals to the brain, malfunctions. Pressure on this nerve can cause sharp, intense pain in the teeth and mouth and sometimes on one side of the face or both. Patients usually visit a dentist first, where an X-ray may be taken first to rule out dental conditions before consulting a doctor. 11,13
Less common causes of dental pain
Heart and lung diseases can cause toothaches due to the location of the vagus nerve that passes through the jaw.
In some cases, toothache may be a warning sign of a heart attack. People with known heart conditions must pay attention to any toothache that comes from sudden physical strain. Persistent jaw or tooth pain might provide invaluable early warning of an impending heart attack. 11,14
By being aware of the root cause of the type of dental pain, patients can work better with healthcare providers to implement the right treatment methods.
This article is contributed by Dr Sneha Sundar Rajan. Dr Sneha has a master’s degree in dental surgery (MDS) from Manipal University, India. She was a researcher with the National University of Singapore at the Faculty of Dentistry and Centre for Advanced 2D materials before taking a break for motherhood.
References
Shah, A., Naseem, M., Khan, M.S., Asiri, F.Y.I., AlQarni, I., Gulzar, S. et al., 2018, ‘Oral health knowledge and attitude among caregivers of special needs patients at a comprehensive rehabilitation centre: An analytical study’, Annali di stomatologia (Roma) 8(3), 110–116. https://doi.org/10.11138/ads/2017.8.3.110
Macauley, Yvonne & O’Donnell, Patrick & Duncan, Henry. (2013). Dental pain. BMJ (Clinical research ed.). 347. f6539. 10.1136/bmj.f6539.
Abullais, S.S., Al-Shahrani, F.M.F., Al-Gafel, K.M.S., Saeed, A.A., Al-Mathami, S.A., Bhavikatti, S.K. et al., 2020, ‘The knowledge, attitude and practices of the caregivers about oral health care at centers for intellectually disabled, in southern region of Saudi Arabia’, Healthcare (Basel) 8(4), 416. https://doi.org/10.3390/ healthcare8040416
Miranda, G.H.N., Fagundes, C.F., Da Costa e Silva, A.B., Davis, L.L., Raiol Dos Santos, M.A. & Lima, R.R., 2020, ‘Perception and practices of caregivers of childhood and youth shelters concerning oral health in the city of Belém, Brazil’, O Mundo da Saúde 44, 144–151. https://doi.org/10.15343/0104-7809.202044144151
https://www.casasadobesdentistry.com/blog/four-signs-of-a-cracked-dental-filling
https://my.clevelandclinic.org/health/diseases/24142-pericoronitis
https://www.nhs.uk/conditions/teeth grinding/#:~:text=Symptoms%20of%20teeth%20grinding&text=face%2C%20neck%20and%20shoulder%20pain,headaches
https://www.medicalnewstoday.com/articles/324356#treatment
https://www.valleyoakdentalgroup.com/4-non-dental-toothache-causes
