Toothaches have more than one cause. A toothache most often occurs when the nerve of a tooth is irritated, but there are many other reasons why a person may experience a toothache. 

Risk factors for toothache include dental infection, gum disease, plaque, tooth decay, injury, broken teeth, poorly placed fillings or crowns, tooth loss (including tooth extraction), temporomandibular joint (TMJ) disorders and obstructive sleep apnea.

However, there are cases where pain originating outside the mouth radiates into the mouth, giving the impression that the pain is dental in origin. This usually happens when there is a problem with the jaw joint (temporomandibular joint or TMJ), ears, nerves, sinuses or muscles. Sometimes, heart problems can also give the sensation of toothache. 

Pregnancy can also be a risk for dental problems that cause pain. Gingivitis and tooth decay can occur during pregnancy due to fluctuating hormone levels during pregnancy.

Conditions Causing Toothache

Toothaches are caused by inflammation of the middle part of the tooth, called the pulp. Pulp inflammation can be caused by anything that comes into contact with the tooth. Common causes of toothache are:

  • Tooth cavities / tooth decay
  • Temperature sensitivity - hot or cold liquids/foods
  • Hot or cold air
  • Tooth clenching
  • Orthodontic movement - braces
  • Abscess tooth
  • Affected wisdom tooth
  • Pregnancy
  • Gingivitis
  • Periodontal disease
  • Gum recession - exposure of the gum or tooth root covered by bone
  • Tooth fracture
  • Acid erosion
  • Damaged/broken fillings or crowns
  • Cold sore or thrush

What symptoms and signs can accompany a toothache?

Toothache and jaw pain are common complaints. It is not unusual for someone to feel mild pain from pressure and hot or cold exposure to the tooth. However, if the pain is severe or persists for more than 15 seconds after the exposure to pressure, heat or cold has ended, it may be an indication of a more serious problem. If the tooth has severe inflammation, the pain may spread to the cheeks, ear or jaw. An area of redness around it can point to the source of the pain. If a person touches an infected tooth, it can make the pain more intense. This sign can indicate a problem tooth, even if the tooth looks normal.

A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear, throat pain or an injury to the temporomandibular joint (TMJ), which connects the jaw to the skull, can be mistaken for a toothache. Pain from a deeper structure (called referral pain) can be passed along the nerve and felt in the jaw or tooth. An evaluation by a dentist is appropriate to determine the source of the pain and provide relief.

Why is toothache more intense at night? 

There are many reasons why toothache is more intense at night. Depending on the type of toothache, what is causing it and how long it goes untreated, you may experience a dull throat, sharp pain or even severe discomfort. Unfortunately, an untreated toothache can seriously affect your oral health if neglected, and the pain and discomfort can jeopardize your sleep and overall well-being. 

Here are some of the most common causes of toothache at night:

The simplest and most common cause of a toothache is food particles stuck between your teeth or gums. For example, popcorn kernels, apple skins, small seeds or nuts can easily get stuck between the teeth and cause discomfort or pain. This can often be improved by simply brushing and flossing to remove the trapped food.

Many people grind their teeth at night, especially during periods of extreme stress. You may be clenching your teeth at night if you wake up with a sore jaw or teeth. However, if you already have a toothache due to an infection, cavity or food trapped between the teeth, the act of grinding can make the pain worse.

Also, being in a supine position at night can contribute to increased blood flow to the head and the throbbing sensation of pain.

When should you consult a dentist?

Toothache is not relieved by over-the-counter medication. Even if it is relieved, a dental examination can be useful, as the pain may be something that can be more easily corrected iIf severe pain is experienced for more than two days after a tooth extraction, it is possible that the tooth socket is not healing properly. A condition known as “dry socket syndrome” may have occurred and the patient should see a dentist immediately.

The pain may be associated with swelling of the gums or face, or the patient may have discharge around a tooth. Fever is another sign of infection in dental diseases. These signs may indicate an infection surrounding the tooth, gums or jawbone. Fever and swelling may indicate the presence of an abscess. A dental abscess may require antibiotics and surgical opening of the abscess (drainage). When this procedure is recommended to be done inside the tooth (endodontic drainage), a 

“Broken teeth are unfortunately common. Unless they are associated with more severe injuries, the dentist should be contacted as soon as possible. The sooner a patient seeks treatment, the lower the risk of infection and the higher the chances of the teeth surviving. It is particularly important that children who have damaged their primary teeth (baby teeth) are treated immediately as such injuries can affect secondary teeth (adult teeth).

High fever or chills: This indicates a more widespread infection that may require stronger medication than oral antibiotics. If the patient experiences headache, dizziness, nausea, vomiting or other symptoms after a facial or mouth injury, the patient may have a more serious injury in addition to the dental injury.

Any jaw pain that occurs with chest pain: Although jaw pain is most commonly caused by dental disease, it is sometimes referred to as pain from other areas. People with heart disease, especially those who have had stents implanted, people with diabetes or those who have had heart surgery, may have jaw pain as a sign of a heart attack (myocardial infarction) or angina (ischemia). If jaw or tooth pain is associated with dizziness, sweating or shortness of breath, the patient should see a doctor immediately.

Can Toothache be Prevented at Home?

You can prevent pain by practicing basic oral hygiene at home. Flossing and brushing can eliminate most dental problems. There are many different products available, such as rinses containing xylitol and fluoride and regular professional cleaning of the teeth. The dentist can apply sealants, varnishes and fluoride, which are especially important for children but can also be valuable for adults and the elderly.
Individuals with toothache, before professional treatment;

Avoid very cold or hot foods as these can make the pain worse.

To relieve pain is to bite a cotton ball soaked in clove oil. Clove oil is available in most pharmacies.

Garlic contains a chemical called allicin, which acts as a natural antibiotic and can fight a tooth infection. Only by eating more garlic, either through supplementation or as an ingredient in daily food, can the infection be counteracted. This does not cure the infection, but it can help with toothache and prevent the infection from growing or spreading.

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