All about toothache

Toothache can be soothed with different pharmacological remedies and some practical measures to be implemented even before going to the dentist.

Toothache can be soothed with different pharmacological remedies and some practical measures to be implemented even before going to the dentist.

Almost everyone agrees: toothache is one of the strongest and most unbearable pains you can experience. Often it arrives without any warning, forcing those who suffer from it to long sleepless nights and tormented days, which can be even more than one if you have the misfortune to see toothache appear on Friday evening of a weekend bridge, August 15 or Christmas Eve.

What can you do while waiting for your dentist (or a reliable replacement) to be available for treatment? Depends on. Because toothache is not all the same and to get real relief it is essential to understand the nature of the pain you are experiencing. Here are some useful indications to orient yourself and act appropriately.

Main types of toothache

Although what you feel is always pain, the types of toothache that you can experience are different, each characterized by a different origin, intensity and mode of presentation. In addition, they must be managed in a targeted manner to be able to alleviate discomfort in an appreciable and lasting way.

Here are the main causes of dental pain:

Dental sensitization Accentuation of reactivity to hot/cold, sweet/salty and acidic compounds
Dental neuralgia Irritation and inflammation of the nerve of the eroded tooth
Pulpitis Inflammation of the tooth pulp
Gingivitis Inflammation of the gum tissue
Decay Enamel and dentin erosion
Abscess Bacterial infection

A very common type of pain even among those who have apparently healthy teeth is dental sensitization, characterized by an accentuation of the reactivity to heat / cold, to sweet/salty and acidic compounds and due to erosion of the enamel or alteration or withdrawal of the gingival collar.

In severe cases, sensitization can turn into irritation and inflammation of the nerve of the eroded tooth (dental neuralgia): a particularly painful condition, even in the absence of external stresses. Other causes of dental neuralgia may be chronic grinding (bruxism) or anatomical/postural abnormalities of Various types.

A second type of toothache that almost everyone knows since childhood is that resulting from the presence of caries (a lesion of the teeth involving the enamel and / or dentin due to the action of germs) or pulpitis (inflammation of the tooth pulp): it can be more or less intense, It is usually well localized and is also triggered or aggravated by foods and hot or cold drinks, sweet or savory and from the touch or contact between teeth when closing the mouth.

In the case of mild caries, the dentist simply fills the tooth. If, on the other hand, the caries has reached deep, to avoid having to extract the diseased tooth, it is advisable to devitalize it, or remove the infected dental pulp, disinfect the root canal and seal it, and then reconstruct the tooth. If necessary, while waiting for the visit, analgesics can be used to reduce pain.

Another very common form of oral pain is gingivitis, caused by inflammation of the gum tissue. In these cases, you Try especially burning, accompanied by slight swelling and bleeding at the level of the affected gums.

An inflammatory toothache really difficult to bear is the one that appears in case of inflammation of the wisdom tooth. Recognizing it is easy because the pain extends to the entire arch corresponding, radiating to the ear, and may be accompanied by swelling of the glands of the neck.

Sometimes, even an already devitalized tooth can hurt. This should be brought to the attention of the dentist as soon as possible. possible because, typically, the disorder depends on the presence of a abscess at the base of the root of the tooth, then from an infection Bacterial. The characteristic pain is very intense, it is triggered or aggravated by heat (not cold) and touch or contact between teeth when closing the mouth.

When enamel spoils

Brushing your teeth badly, with too much vigor or with excessively “hard” toothbrushes or worn bristles, using toothpastes with a high abrasive action (as are the majority of whitening products), often consuming very acidic drinks or foods (including carbonated drinks), suffering from gastroesophageal reflux or unintentionally grinding teeth during the night are all frequent causes of damage to tooth enamel.

If one or more of these conditions persist for a fairly long period of time, on the order of a few months or years, the enamel progressively thins and the underlying dentin is exposed, causing hypersensitivity to stimuli of various types, usually harmless to the intact tooth.

When this happens, not only drinking an iced drink, but also eating ice cream, candy, peach or a cup of strawberries with lemon can become a real suffering, overcome only by the torture of trying to brush your teeth immediately after.

The repeated stress of one or more worn teeth (or damaged by accidental trauma) by food and beverages can greatly irritate the nerves involved, resulting in persistent inflammation, i.e. neuralgia. In this case, very intense and quite difficult to attenuate pain is present regardless of the application of additional external stimuli and can extend, causing a significant headache (similar to a migraine).

Enamel erosion, combined with the difficulty of brushing teeth thoroughly due to the pain caused by hypersensitivity and the consequent accumulation of bacterial plaque, also greatly increases the risk of developing tooth decay. A process, the latter, which leads to the total and irreversible localized destruction of enamel and dentin, up to damaging the deepest parts of the tooth if you do not intervene in time with adequate dental care.

Even when caries develops, regardless of whether or not it is preceded by generalized erosion of the enamel, the tooth initially becomes hypersensitive to cold, heat and acidic and sugary substances. In a second phase, pain also appears, generally pulsating, which becomes significant when caries reaches the inner chamber of the tooth, where the dental pulp is located, rich in blood vessels and nerve endings.

As a rule, the incisors and canines are mainly affected by dentine hypersensitivity, while caries mainly affects the teeth engaged in chewing, i.e. molars and premolars.

Inflammation and infections lurking

Once caries has opened the gap in the internal tissues of the tooth, the pulp can become inflamed, giving rise to a pulpitis, and become infected, greatly worsening both the state of the tooth and gum and the associated pain.

If at this point, despite the considerable suffering already suffered, you have not yet turned to your trusted dentist, you can face severe and risky complications, not only for the tooth (now substantially lost), but also for general health.

The leakage of pus rich in pathogenic bacteria, in fact, causes inflammation and infection also of the tissues that surround and support the diseased tooth, causing acute responses (apical abscesses) or chronic (apical granulomas). The bacteria can also lurk inside the tooth, forming a periodontal pocket in which pus accumulates, typical of lateral periodontal abscesses.

In pulpitis to cause a strong and sudden pain, not always well localized, are the compression of nerve fibers and the increase in blood supply associated with inflammation.

The typical pain of the abscess is instead more localized and “gloomy”; increases during chewing and percussion of the tooth and can disturb sleep, up to preventing sleep if you do not take a powerful enough analgesic drug; It is often associated with swelling of the gum and, sometimes, some line of fever and painful enlargement of the lymph nodes in the neck.

In the case of lateral periodontal abscess it can also happen to feel a bad taste in the mouth and pus containing bacteria can escape from the periodontal pocket.

The gums are also responsible

A toothache “physiological” and completely harmless to the health of the mouth even if, like any other toothache, very unpleasant is the one connected to the eruption of the teeth. Inevitably all children suffer from it: in the first years of life, when milk teeth sprout; later, at the time of moving on to the final dentition.

In both cases, in reality, it is more of a nuisance than real pain, which becomes such only when the four infamous wisdom teeth “come out”, in late adolescence or during early adulthood. For each wisdom tooth that arises, several days of increasing soreness, chewing difficulties and, in less fortunate cases, one or more troubled nights must be taken into account.

Since they often do not find space in the mouth crowded with other teeth, when they sprout they assume abnormal positions that favor inflammation. Here, then, appear pain in the jaw and sometimes difficulty opening the mouth. In case of infection, an abscess appears, which is manifested by swelling of the cheek and gum.

In case of pain, which can reach the ear, it is essential the intervention of the specialist who can help the tooth escape with surgery or with the extraction of the tooth itself.

Another source of pain of gingival origin is represented by the more or less marked inflammation of the tissues that compose them due to accumulation and stagnation of bacterial plaque. The gum loses its compact appearance and rosy color, to become turgid and reddened. In this case, we are dealing with gingivitis which, in addition to pain, leads to ease of bleeding (spontaneous or while eating or brushing teeth) and, sometimes, slight swelling. The pain is mild, but can become severe if you touch your gum or brush your teeth.

To control swelling and redness due to gingivitis, anti-inflammatories, a specific mouthwash and the removal of plaque and tartar by the dentist can be useful.

The persistence or recurrence of gingivitis, even modest, can cause the gradual withdrawal of the gingival collar that holds the tooth, exposing it to a greater risk of deterioration and falling.

Whatever the triggering cause of gingivitis, pain, redness and swelling are always due to the release of prostaglandins, molecules involved in the onset and maintenance of the inflammatory response.

Plaque and other enemies of teeth

Caries and gingivitis are mainly caused by bacterial plaque, a patina consisting of bacteria (especially of the group of streptococci), saliva and very small food residues, more abundant in areas difficult to reach with the toothbrush and, therefore, generally characterized by less cleaning.

The bacteria at the origin of caries are always present even in healthy mouth, but as long as they are periodically removed from the dental collar, from the surfaces of teeth, gums and tongue and from the spaces between tooth and tooth (with the help of dental floss and / or brush) they are not a problem. Trouble begins when oral hygiene becomes inaccurate and streptococci and other pathogenic bacteria find in plaque a breeding ground to proliferate, corrode and infect tooth tissues.

If it is not removed regularly, plaque can also calcify and form tartar, which irritates the gum, causing gingivitis, as well as being very unpleasant on an aesthetic level.

On the other hand, if you want to have healthy gums, you should not even exaggerate with brushing, which can irritate them due to excessive stress or cause real mechanical trauma. Other risk factors for gum health include vitamin deficiencies, hormonal imbalances, cigarette smoking and alcohol abuse, all of which should be carefully avoided.

To promote caries, at any age, are mainly the diet rich in sugar(present in sweets, bread, pasta, potatoes, etc.), which promotes the growth of plaque bacteria, and the presence of acidic substances harmful to the tooth.

In this regard, it should be remembered that after each meal or snack and after drinking carbonated drinks, if you do not brush your teeth immediately, the pH of the oral cavity is lowered (becoming more acidic), allowing the bacterial plaque to proliferate undisturbed and to lead in a short time to decalcification of the enamel and consequent appearance of the typical opaque and dark spot of caries.

It should also be remembered that each individual can be more or less predisposed to the development of caries and gingivitis and that trauma, deep breaks or defects in the alignment of the teeth, wearing imperfect dentures or orthodontic appliances can increase the risk of more or less significant dental disorders and pain.

Periodontitis

It consists of an inflammation of the supporting tissues of the tooth (periodontal ligament, cement and bone), which undergo modifications, making the teeth less fixed.

Typical lesion of periodontitis is the so-called gingival pocket, due to the detachment of the gum from the tooth.

Initially, the disorder affects one or two teeth, but if left untreated, periodontitis tends to extend, seriously endangering all the teeth and causing chewing disorders.

This creates the ideal conditions for bacterial proliferation and the start of a vicious circle that further favors the retraction of the gums and the loss of bone.

For periodontitis, there are different types of treatments, chosen according to the extent and severity of the disorder. In some cases, a thorough cleaning of the gum pockets by the specialist may be sufficient to remove plaque and tartar, while in others it may be necessary to resort to surgery that involves removing the tooth and replacing it with a dental implant.

What to do while waiting for the dentist

Taking care of your teeth is essential: wash them well after each meal, brushing with a rotary movement for at least 2 minutes, and with particular care in the evening before sleeping, helps to counteract the attack of enamel by acids and bacterial fermentation, which are the basis of most toothache.

Once caries has appeared, while waiting for the dentist’s intervention, the only possibility is to try to alleviate the pain. In general, it is better to avoid drinks that are too cold or hot, which increase irritation, and do not chew hard foods. If there are food residues in the cavity dug by caries, it is necessary to gently remove it with toothbrush and toothpaste, avoiding using toothpicks.

If there is pain in the decayed tooth or gums, immediate relief can be obtained with mouthwash-based rinses (which is spelled correctly with a single “t” and not “mouthwash” as often happens) or, possibly, sucking cloves, rich in an essential oil with anesthetizing effect.

In case of gingivitis and when the pain is caused by the leakage of the wisdom tooth, it may be useful to rinse the mouth with a cold infusion, obtained by leaving 5 grams of flowers or mallow leaves in immersion for a few minutes in 100 ml of boiling water.

Rinses based on alcoholic beverages, on the other hand, have a temporary anesthetic effect and are to be avoided if a child has cavities or oral pain. Against the discomfort of milk teeth that “sprout” it is useful to apply a gauze soaked with fresh water and press lightly on the gum, while if the wisdom tooth emerges, the external application of ice on the cheek, in front of the ear, offers relief.

The most effective remedy against toothache remains, however, the pharmacological one, remembering that the suitable drug on a case-by-case basis must be identified with the help of the dentist (if the origin of the pain is not immediately clear) or pharmacist.

More precisely, against the pain of caries and gingivitis treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is indicated; in case of neuralgia, a pure analgesic is more appropriate; if there is an infection of the dental pulp (pulpitis) or an abscess it is necessary to take antibiotics (always and only on medical prescription) to fight the bacteria that caused them.

To avoid stomach discomfort it is good to use these drugs only when they are really necessary and do not take more painkillers or anti-inflammatories at the same time, unless otherwise indicated by a doctor. If the pain is very strong, the doctor may possibly advise to combine several drugs, whose activities add up without increasing the side effects at the gastric level.

Even when, thanks to these remedies, toothache is greatly reduced, it is important to contact your dentist as soon as possible for a check-up. It must be remembered that anti-inflammatory and analgesic drugs can act on the symptoms (pain and inflammation), but not on the cause that generated them, which in most cases can only be eliminated by targeted dental care.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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