A toothache—described as any pain, soreness, or ache in or around a tooth—can be a frustrating and unpleasant experience. In addition to a sharp or dull pain, your tooth may be sensitive to temperature or painful when chewing or biting. In order to get to the bottom of your tooth pain, your dentist will consider several potential diagnoses based on your medical history, dental exam, and sometimes an imaging test, usually an X-ray.
We will be talking about a summary of the most common causes of a toothache, ranging from tooth sensitivity and decay to serious infections, like abscess formation.
Gum disease is characterized by infection of the gums. More specifically, with gingivitis, the gums become inflamed and become hot, red, and swollen. When an infection occurs in the gums, periodontitis occurs.2
Eventually, if left untreated, the infection causes bone loss and deterioration of the gums. Gums become detached from the teeth, forming pockets that fill with more bacteria. Tooth roots are then exposed to plaque and become susceptible to decay and sensitive to cold, touch, and chewing.
Tooth decay refers to erosion and cavity formation in the outer surface (enamel) of the tooth. When plaque—a sticky layer of bacteria—forms on the tooth enamel, it feeds on the sugars and starches from food particles in your mouth. This produces an acid that eats away at the enamel, causing weak areas and holes. Over time, the enamel breaks down and a cavity forms.3
While cavities are generally painless, as the decay spreads inward toward the middle layer of the tooth (dentin), it can create symptoms such as sensitivity to temperature and touch.3
Sometimes you may experience discomfort when your teeth or a specific tooth are exposed to cold air, liquids, and certain foods. This means your teeth may have developed a sensitivity linked to one or more stimuli, like cold temperatures.4
Teeth sensitivity develops from exposed dentin—the tissue that lies underneath both the enamel (the hard outer layer of your tooth) and the cementum (the tissue that covers the tooth root).4
Dentin may become exposed as a result of cavities, worn fillings, or from cracked teeth. Receding gums in gum disease (or due to forceful brushing) can also expose dentin, leading to teeth sensitivity.
Bruxism—characterized by clenching and teeth grinding, often while sleeping—may occur without you knowing it. But, particularly over time, it may cause tooth sensitivity, as well as tooth or facial pain. Evidence of wear on the front teeth, making them look shorter in height, is one of the tell tale signs that you may potentially be bruxing.
Inflammation of the Tooth Pulp (Pulpitis)
When tooth decay extends deep into the pulp of the tooth, pulpitis occurs. This means that the tissue in the center of the tooth (nerve/tooth pulp), which is rich in blood vessels and nerves, becomes inflamed and irritated. This inflammation causes pressure to build inside the tooth and subsequently within the surrounding tissues.
Besides tooth decay, other conditions that may cause pulpitis include:
- Trauma to a tooth
- A tooth that requires multiple invasive procedures
The main symptom of pulpitis is an exquisite sensitivity to various stimuli, largely temperature (hot or cold).6
It’s important to mention there are two types of pulpitis—reversible pulpitis and irreversible pulpitis.6
If the pulpitis is reversible, the pain or sensitivity stops within a couple seconds of the stimuli being removed. If the pulpitis is irreversible, the pain can linger for minutes after the stimulus is taken away.6
A cracked or fractured tooth may occur from trauma to the mouth, such as when an athlete receives a blow to the face. In addition, the force from biting down on a hard object like ice or a popcorn kernel can sometimes cause a tooth to crack. Severe bruxism may also damage and crack teeth.
Symptoms of a cracked tooth may include a sharp pain when biting or chewing. Your cracked tooth may also be sensitive to hot and cold temperatures or to sweet and sour foods.7
Keep in mind, there are different types of cracks in teeth—and identifying the type of crack you have will ultimately guide your treatment plan.
The American Association of Endodontists (AAE) has identified five types of cracks in teeth:7
- Craze lines: When shallow, tiny cracks develop on the outer enamel
- Fractured cusp: When a piece of the tooth’s chewing surface breaks off, usually around a filling
- Cracked tooth: When a crack extends from the chewing surface of your tooth vertically toward the root of the tooth; the crack may or may not extend below the gum line.
- Split tooth: When the tooth splits into two parts
- Vertical root fracture: When a crack forms in the root of the tooth; since fracture roots are usually not visible, it may go unnoticed until an infection develops.
A dental abscess, which usually results from an untreated cavity or pulpitis, is caused by the buildup of bacteria inside the pulp chamber. The infected pulp chamber then tries to drain itself out of the very tip of the tooth root.8
The pressure from the draining infection causes a constant pain that is worse when chewing or when percussed (tapped on). If left untreated, the pain can become severe with swelling.
Teeth can become impacted when they are prevented from moving into their proper position in the mouth by other teeth, gums, or bone.9
The most common teeth to become impacted are wisdom teeth because they are usually the last to erupt. When the jawbone cannot accommodate these extra teeth, the teeth remain stuck under the gum. This impaction can create pressure, pain, and even jaw soreness.