Tooth pain can have many origins and although most of the time they are associated with dental cavities, there are other reasons too. Here is a list of all the potential causes of tooth pain.
Cavities:
In their beginning stage, cavities are painless. As the bacteria release acid and damage the tooth further, the pain will increase progressively.
Dental caries pain can be triggered by cold drinks or sweets. In these cases, the cavity needs to be cleaned out and a resin or ceramic restoration is placed over it to restore the tooth function.
If the damage is extensive and reaches the nerve, then the pain will be intensified. Now the bacteria will infect the nerve tissue as well.
Nerve infections:
The nerve is usually infected by an excessively big cavity. When the nerve is infected, it dies, and gases are emitted by the necrotic tissue.
These gases are released to the tip of the root, causing infection of the surrounding tissue, the bone, sometimes an abscess, a pimple-like lesion can appear in the gum right above the problemed tooth. Tapping on the tooth or chewing can be extremely painful.
Other reasons can be physical tooth trauma, hitting the tooth hard enough can cause nerve damage. When the nerve is affected, most of the time it needs root canal treatment.
Tooth Cracks:
Sometimes teeth crack due to grinding, clenching, or by external habits such as biting on ice chips or a pen.
A tooth that has had a root canal treatment but has not been fully covered by a dental crown, can crack more easily since it becomes more fragile by not having a nerve.
Usually, vertical cracks that run all the way down to the root are extremely hard to see on x-rays and CT scans are needed in these cases.
A vertical crack causes pressure to the surrounding tissue when we talk or chew, it can also be infiltrated with bacteria. In most cases, vertical cracks cannot be restored, and the affected tooth needs to be extracted.
If the crack is on the crown part of the tooth and does not involve the root, there is a good chance a restoration can be placed over it. In the worst-case scenario, if the crack has affected the nerve, that tooth can be extremely sensitive, and it is most likely to go under root canal treatment.
Widening of periodontal ligaments:
Clenching and grinding cause pressure on the ligaments that attach the tooth to the bone. These widened ligaments can be seen in radiographs as a wide black band surrounding the root of the tooth.
If the teeth are misaligned, the chances of having this condition when grinding or clenching is higher. Sometimes premature tooth contacts between the top and bottom teeth can also cause this condition.
Pain is typically low but can feel uncomfortable. Resolving this issue involves eliminating premature contact by strengthening the teeth, slightly reducing the contact point, or releasing the pressure by using a nightguard.
Bone loss:
Bone loss is associated with advanced periodontal disease. The pain arises when more than 50% of the bone surrounding the tooth is lost, and teeth start to shift and move from the lack of support. Unfortunately, periodontal disease is irreversible. In severe cases, tooth extractions are needed, and periodontal maintenance cleanings are done frequently to prevent further loss of teeth and keep your gums taut
Tooth sensitivity:
If the enamel is worn out, then the inner layer, the dentin might be exposed. The dentin is the layer connected to the tooth nerve, meaning if the dentin is exposed, any sensation such as cold, hot, sweet, or acidic can travel faster to the nerve and cause sensitivity or pain.
Some causes why you may have exposed dentin are from clenching and chipping the enamel at the gum line, brushing aggressively with medium or hard bristle, causing gum recession and wearing out the root, defective or old fillings where the border of the restoration has come apart from the tooth, chipped or cracked teeth, wearing out the chewing surfaces of the teeth by parafunctional habits such as grinding, and multiple episodes of stomach acid reflux or vomiting can wear out the enamel as well.
Tooth sensitivity can be managed by eliminating damaging habits and using topical agents such as fluoride varnishes or restoring the damage with resin or ceramic restorations.
Wisdom teeth:
They are the last teeth to come out, and sometimes they do not have enough space. They can be partially out or completely impacted in an awkward position. If partially out, food can get impacted between the gum and the exposed part of the wisdom tooth, then inflammation takes place making it painful to even open the jaw.
If completely impacted and tilted towards the front tooth, it can keep pushing the adjacent tooth so much, it creates a pocket between both teeth where food and bacteria can also be trapped and cause cavities, bone loss, and destroy the tooth next to it.
Sinus infections:
The sinuses are located right above our top teeth. Sometimes the tip of the root can be right on the sinus floor. In this case, if you have a sinus infection, it can cause pressure towards the tooth and mimic tooth pain, but do not worry, as soon as the sinus infection clears, the tooth discomfort will go away too.
Tooth pain? Conclusion
To figure out where your pain is coming through, it is indispensable for your doctor to take a radiograph of the problem area. Besides an x-ray, a visual exam and a questionnaire about your dental habits and symptoms will be asked.
Toothaches are not fun and can be prevented with periodic dental exams. Schedule an appointment and be proactive about your oral health.
Jennifer Pettit, CRDH.
HQ DONTICS Team.
If you have any questions or need more information, you can contact us!
