Toothache - WikiHQ

Toothaches, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

Common causes include inflammation of the pulp (usually in response to tooth decay, dental trauma, or other factors), dentin hypersensitivity, apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the root apex), dental abscesses (localized collections of pus), alveolar osteitis ("dry socket", a possible complication of tooth extraction), acute necrotizing ulcerative gingivitis (a gum infection), and temporomandibular disorder.

Pulpitis is reversible when the pain is mild to moderate and lasts for a short time after a stimulus (for instance cold); or irreversible when the pain is severe, spontaneous, and lasts a long time after a stimulus. Left untreated, pulpitis may become irreversible, then progress to pulp necrosis (death of the pulp) and apical periodontitis. Abscesses usually cause throbbing pain. The apical abscess usually occurs after pulp necrosis, the pericoronal abscess is usually associated with acute pericoronitis of a lower wisdom tooth, and periodontal abscesses usually represent a complication of chronic periodontitis (gum disease). Less commonly, non-dental conditions can cause toothache, such as maxillary sinusitis, which can cause pain in the upper back teeth, or angina pectoris, which can cause pain in the lower teeth. Correct diagnosis can sometimes be challenging.

Proper oral hygiene helps to prevent toothache by preventing dental disease. The treatment of a toothache depends upon the exact cause, and may involve a filling, root canal treatment, extraction, drainage of pus, or other remedial action. The relief of toothache is considered one of the main responsibilities of dentists. It is one of the most common reasons for emergency dental appointments. In 2013, 223 million cases of toothache occurred as a result of dental caries in permanent teeth and 53 million cases occurred in baby teeth. Historically, the demand for treatment of toothache is thought to have led to the emergence of dental surgery as the first specialty of medicine.

Both the pulp and periodontal ligament have nociceptors (pain receptors), but the pulp lacks proprioceptors (motion or position receptors) and mechanoreceptors (mechanical pressure receptors). whereas pain from the periodontal ligament will typically be well localized, When a tooth is intentionally stimulated, about 33% of people can correctly identify the tooth, and about 20% cannot narrow the stimulus location down to a group of three teeth. Common causes include tooth decay, dental trauma (such as a crack or fracture), or a filling with an imperfect seal.

Because the pulp is encased in a rigid outer shell, there is no space to accommodate swelling caused by inflammation. Inflammation therefore increases pressure in the pulp system, potentially compressing the blood vessels which supply the pulp. This may lead to ischemia (lack of oxygen) and necrosis (tissue death). Pulpitis is termed reversible when the inflamed pulp is capable of returning to a state of health, and irreversible when pulp necrosis is inevitable.

Dentin hypersensitivity

Dentin hypersensitivity is a sharp, short-lasting dental pain occurring in about 15% of the population, which is triggered by cold (such as liquids

or air), sweet or spicy foods, and beverages. Teeth will normally have some sensation to these triggers, The pulp of the tooth remains normal and healthy in dentin hypersensitivity.

Apical periodontitis

thumb|Apical abscess associated with roots of a lower molar.

Apical periodontitis is acute or chronic inflammation around the apex of a tooth caused by an immune response to bacteria within an infected pulp. It does not occur because of pulp necrosis, meaning that a tooth that tests as if it's alive (vital) may cause apical periodontitis, and a pulp which has become non-vital due to a sterile, non-infectious processes (such as trauma) may not cause any apical periodontitis. or relieved immediately by using a tooth pick or dental floss in the involved area.

A variant of the periodontal abscess is the gingival abscess, which is limited to the gingival margin, has a quicker onset, and is typically caused by trauma from items such as a fishbone, toothpick, or toothbrush, rather than chronic periodontitis. The occurrence of a periodontal abscess usually indicates advanced periodontal disease, which requires correct management to prevent recurrent abscesses, including daily cleaning below the gumline to prevent the buildup of subgingival plaque and calculus.

Acute necrotizing ulcerative gingivitis

thumb|right|Mild presentation of ANUG on the gums of the lower front teeth

Common marginal gingivitis in response to subgingival plaque is usually a painless condition. However, an acute form of gingivitis/periodontitis, termed acute necrotizing ulcerative gingivitis (ANUG), can develop, often suddenly. It is associated with severe periodontal pain, bleeding gums, "punched out" ulceration, loss of the interdental papillae, and possibly also halitosis (bad breath) and a bad taste. Predisposing factors include poor oral hygiene, smoking, malnutrition, psychological stress, and immunosuppression. ANUG is treated over several visits, first with debridement of the necrotic gingiva, homecare with hydrogen peroxide mouthwash, analgesics and, when the pain has subsided sufficiently, cleaning below the gumline, both professionally and at home. Antibiotics are not indicated in ANUG management unless there is underlying systemic disease.

Pericoronitis

Pericoronitis is inflammation of the soft tissues surrounding the crown of a partially erupted tooth. The lower wisdom tooth is the last tooth to erupt into the mouth, and is, therefore, more frequently impacted, or stuck, against the other teeth. This leaves the tooth partially erupted into the mouth, and there frequently is a flap of gum (an operculum), overlying the tooth. Bacteria and food debris accumulate beneath the operculum, which is an area that is difficult to keep clean because it is hidden and far back in the mouth. The opposing upper wisdom tooth also tends to have sharp cusps and over-erupt because it has no opposing tooth to bite into, and instead traumatizes the operculum further. Periodontitis and dental caries may develop on either the third or second molars, and chronic inflammation develops in the soft tissues. Chronic pericoronitis may not cause any pain, but an acute pericoronitis episode is often associated with pericoronal abscess formation. Typical signs and symptoms of a pericoronal abscess include severe, throbbing pain, which may radiate to adjacent areas in the head and neck, There may be trismus (difficulty opening the mouth), Persons typically develop pericoronitis in their late teens and early 20s, The pain is moderate to severe, and dull, aching, and throbbing in character. The pain is localized to the socket, and may radiate. It normally starts two to four days after the extraction, and may last 10–40 days. set of pain-sensitivity symptoms that may accompany a tooth fracture, usually sporadic, sharp pain that occurs during biting or with release of biting pressure, or relieved by releasing pressure on the tooth.

The prognosis for a cracked tooth varies with the extent of the fracture. Those cracks that are irritating the pulp but do not extend through the pulp chamber can be amenable to stabilizing dental restorations such as a crown or composite resin. Should the fracture extend though the pulp chamber and into the root, the prognosis of the tooth is hopeless. Successful root canal therapy is required before periodontal treatment is attempted. Classically, sinusitis pain increases upon Valsalva maneuvers or tilting the head forward.

Painful conditions which do not originate from the teeth or their supporting structures may affect the oral mucosa of the gums and be interpreted by the individual as toothache. Examples include neoplasms of the gingival or alveolar mucosa (usually squamous cell carcinoma), conditions which cause gingivostomatitis and desquamative gingivitis. Various conditions may involve the alveolar bone, and cause non-odontogenic toothache, such as Burkitt's lymphoma, and osteomyelitis. Various conditions of the trigeminal nerve can masquerade as toothache, including trigeminal zoster (maxillary or mandibular division), cluster headache,

Enamel is not a vital tissue, as it lacks blood vessels, nerves, and living cells.

The teeth and gums exhibit normal sensations in health. Such sensations are generally sharp, lasting as long as the stimulus. not only because the list of potential causes is extensive, but also because dental pain may be extremely variable, and pain can be referred to and from the teeth. Dental pain can simulate virtually any facial pain syndrome.

Prevention

Since most toothache is the result of plaque-related diseases, such as tooth decay and periodontal disease, the majority of cases could be prevented by avoidance of a cariogenic diet and maintenance of good oral hygiene. That is, reduction in the number times that refined sugars are consumed per day and brushing the teeth twice a day with fluoride toothpaste and interdental cleaning. Regular visits to a dentist also increases the likelihood that problems are detected early and averted before toothache occurs. Dental trauma could also be significantly reduced by routine use of mouthguards in contact sports. Another risk in persons with toothache is a painful chemical burn of the oral mucosa caused by holding a caustic substance such as aspirin tablets and toothache remedies containing eugenol (such as clove oil) against the gum. The field of regenerative endodontics is now developing ways to clean the pulp chamber and regenerate the soft and hard tissues to either regrow or simulate pulp structure. This has proved especially helpful in children where the tooth root has not yet finished developing and root canal treatments have lower success rates. As samples for microbiologic culture and sensitivity are hardly ever carried out in general dental practice, broad-spectrum antibiotics such as amoxicillin are typically used for a short course of about three to seven days. apical abscess, and they should be used restrictively in dentistry. Local measures such as incision and drainage, and removal of the cause of the infection (such as a necrotic tooth pulp) have a greater therapeutic benefit and are much more important. Irreversible pulpitis is thought to be the most common reason that people seek emergency dental treatment.

History, society and culture

thumb|right|[[Saint Apollonia, patron saint for toothaches, holds one of her own extracted teeth in a pair of forceps (Nuremberg Chronicle, Hartmann Schedel, 1493)]]

thumbnail|right|American advertisement from 1885 offering "instantaneous cure" for toothache with "Cocaine toothache drops". [[Cocaine was the first local anesthetic, but its addictive and other dangerous side effects eventually led to its use being virtually abandoned by modern health care.]]

thumb|A monk with a toothache examines himself in a mirror, painting by [[Carl Bloch from 1875. ]]

The first known mention of tooth decay and toothache occurs on a Sumerian clay tablet now referred to as the "Legend of the worm". It was written in cuneiform, recovered from the Euphrates valley, and dates from around 5000 BC. The belief that tooth decay and dental pain is caused by tooth worms is found in ancient India, Egypt, Japan, and China, it is thought that ancient people suffered less dental decay due to a lack of refined sugars in their diet. On the other hand, diets were frequently coarser, leading to more tooth wear. For example, hypotheses hold that ancient Egyptians had a lot of tooth wear due to desert sand blown on the wind mixing with the dough of their bread. The ancient Egyptians also wore amulets to prevent toothache. as in Massinger and Fletcher's play The False One. Toothache also appears in a number of William Shakespeare's plays, such as Othello and Cymbeline. In Much Ado About Nothing, Act III scene 2, when asked by his companions why he is feeling sad, a character replies that he has toothache so as not to admit the truth that he is in love. There is reference to "toothworm" as the cause of toothache and to tooth extraction as a cure ("draw it"). In Act V, scene 1, another character remarks: "For there was never yet philosopher That could endure the toothache patiently." In modern parlance, this translates to the observation that philosophers are still human and feel pain, even though they claim they have transcended human suffering and misfortune. In effect, the character is rebuking his friend for trying to make him feel better with philosophical platitudes.

The Scottish poet, Robert Burns wrote "Address to the Toothache" in 1786, inspired after he suffered from it. The poem elaborates on the severity of toothache, describing it as the "hell o' a' diseases" (hell of all diseases).

A number of plants and trees include "toothache" in their common name. Prickly ash (Zanthoxylum americanum) is sometimes termed "toothache tree", and its bark, "toothache bark"; whilst Ctenium Americanum is sometimes termed "toothache grass", and Acmella oleracea is called "toothache plant". Pellitory (Anacyclus pyrethrum) was traditionally used to relieve toothache.

thumb|"toothache tree", Vaishya Dev shrine, [[Kathmandu, Nepal.]]

In Kathmandu, Nepal, there is a shrine to Vaishya Dev, the Newar god of toothache. The shrine consists of part of an old tree to which sufferers of toothache nail a rupee coin in order to ask the god to relieve their pain. The lump of wood is called the "toothache tree" and is said to have been cut from the legendary tree, Bangemudha. On this street, many traditional tooth pullers still work and many of the city's dentists have advertisements placed next to the tree.

The phrase toothache in the bones is sometimes used to describe the pain in certain types of diabetic neuropathy.

Notes

References

External links

WebMD Dental Health & Toothaches
Mayo Clinic Toothache First Aid
U.S. National Library of Medicine: Toothaches