Causes of Tooth Pain and Treatment Options

A toothache, which is any pain or soreness in or around a tooth, can be a frustrating and unpleasant experience. In addition to feeling a sharp or dull pain, your tooth may be sensitive to temperature. You may also experience pain when chewing or biting.

Toothaches may be triggered by trauma, tooth sensitivity, decay, or infections.

This article explains common and rare causes of a toothache. It also covers when it's best to see your doctor, how toothaches are diagnosed, as well as preventative measures and treatment options.

What Causes a Toothache?

Common causes of a toothache include:

• Gum disease
• Tooth decay
• Sensitive teeth
• Bruxism, grinding of the teeth while awake and/or asleep
• A cracked tooth due to mouth trauma
• A tooth abscess, which is an infection in the center of the tooth
• An impacted tooth, which is a tooth that does not break through the gums or only breaks through a bit
• Tooth pulp inflammation, also known as pulpitis, which can trigger pain in the center of the tooth
  

Gum Disease

Gum disease, or periodontitis, is characterized by an infection of the gums.

More specifically, with gingivitis, which is the early stage of gum disease, the gums become inflamed and hot, red, and swollen.

Both gingivitis and periodontitis can cause mild or intense pain. Typically, the worse the pain, the more advanced the infection is.

Tooth Decay

Tooth decay refers to the gradual destruction and cavity formation in the outer surface, or enamel, of the tooth.

Plaque, a sticky layer of bacteria that forms on the tooth enamel, 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.

As the decay spreads inward toward the middle layer of the tooth, known as the dentin, it can cause pain and sensitivity.

Sensitive Teeth

Teeth sensitivity develops from exposed dentin. This can happen as a result of cavities, worn fillings, receding gums, or cracked teeth.

Teeth sensitivity is associated with quick, sharp pain when exposed to a triggering situation, such as teeth brushing or cold air exposure.

Bruxism

Bruxism, which is characterized by clenching and teeth grinding, can occur while sleeping or while awake.

Over time, it may cause tooth sensitivity, as well as tooth or facial pain.

Inflammation of the Tooth Pulp

Pulpitis is a condition that occurs when the tissue in the center of the tooth, also known as the pulp, becomes inflamed and irritated. This can lead to pain and an intense sensitivity to various things, such as temperature.

Conditions that may trigger pulpitis include:

• Tooth decay
• Trauma to a tooth
• Multiple procedures done on a tooth

Cracked Tooth

A cracked tooth may be caused by trauma to the mouth, severe teeth grinding, or biting down on something hard.

Symptoms of a cracked tooth may include a sharp pain when biting or chewing, as well as temperature and food sensitivity.

The five types of cracks in teeth include:

• Craze lines, which are shallow, tiny cracks on the outer enamel
• Fractured cusp, which occurs when a piece of the tooth's chewing surface breaks off, usually around a filling
• Cracked tooth, which is when a crack goes from the chewing surface of your tooth to the root of the tooth
• Split tooth, which is when the tooth splits into two parts
• Vertical root fracture, which is when a crack forms in the root of the tooth and may go unnoticed until an infection develops

Abscess

A dental abscess, which may result from an untreated cavity or pulpitis, is caused by the buildup of bacteria inside the pulp chamber.

The infected pulp chamber tries to drain itself out of the very tip of the tooth root, which is located beneath the pulp. This can cause intense pain and swelling.

Impacted Tooth

Teeth can become impacted when they are prevented from moving into their proper position in the mouth.

Wisdom teeth commonly get impacted because they are usually the last to break through. Impaction can cause pressure, pain, and swelling.

Ludwig's Angina

Ludwig's angina, also called submandibular space infection, is a rare infection in the part of the mouth beneath the tongue. It may be caused by mouth trauma or a tooth abscess.

This infection is very serious and can quickly spread. If the infection spreads to a person's airway, breathing can become difficult.

When Should I See a Doctor for Tooth Pain?

Make an appointment with your dentist if:

• Your toothache is causing intense pain
• You have a fever
• Your face and/or mouth are swollen
• Your toothache won't go away

How Is Tooth Pain Diagnosed?

In order to determine the cause of your tooth pain, your healthcare provider may take a medical history, give you a physical exam, have you undergo an imaging test, such as an X-ray.

Medical History

In order to narrow down the possible causes of your tooth discomfort, your healthcare provider will ask you questions regarding your symptoms.

These questions may focus on the location of the pain, possible triggers, and how long you've experienced this discomfort. They may also ask you if you have any other symptoms, such as swelling or a fever.

Physical Examination

After taking your medical history, your dentist will check your mouth and face for swelling. During the oral exam, your dentist will look at the inside of your mouth, including your gums, for inflammation. They will also check for signs of an infection.

For more potentially worrisome symptoms, like a fever or vision problems, your dentist may perform a cranial nerve exam, which focuses on the head.

Imaging and Other Tests

After the physical examination, your doctor may want to take a dental X-ray to check for abscesses, cavities, or any other problems.

A computed tomography (CT) scan or magnetic resonance imaging (MRI) test may be used to diagnose rare conditions, like Ludwig's angina.

What Else Can Cause a Toothache?

There are times when tooth pain or sensitivity has nothing to do with your teeth at all. Other conditions that can cause a toothache include:

• A sinus infection, which can cause pain or make your teeth feel sensitive
• Temporomandibular joint disorder, or TMJ, which refers to dysfunction of the jaw joint, and may lead to pain or tenderness that worsens with jaw movement and chewing

If your symptoms point to one of these, or a dental issues has already been ruled out, you may be referred to an ear, nose, and throat specialist called an ENT for an evaluation.

How Do You Treat Tooth Pain?

There are many ways to treat tooth pain depending on the underlying cause. Treatment may include medication, oral rinses, oral devices, and medical procedures.

Most conditions that cause tooth pain can worsen or cause additional concerns if not addressed early on, so it's best to be evaluated and start treatment as soon as possible.

Medication

Your dentist may recommend or prescribe various medications:

• For pain relief, your dentist may recommend taking Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID) such as Motrin (ibuprofen).
• For severe pain, your healthcare provider may prescribe an opioid pain reliever.
• If you have an abscess, pulpitis, gingivitis, or periodontitis your healthcare provider may prescribe an antibiotic, like amoxicillin.

Oral Rinses and Topical Fluoride

Oral rinses include:

• Chlorhexidine, which reduces bacteria in the mouth, and may be used to treat gingivitis
• Fluoride rinses, which may be used to prevent or treat tooth decay and gum disease

For sensitivity and pain, your dentist may apply fluoride to your teeth and recommend a fluoride toothpaste designed for sensitive teeth.

Oral Devices

If you have sleep-related bruxism, your dentist may recommend wearing an oral device, like a mouth guard, at night. Over-the-counter options that mold to your teeth are the most affordable, but custom guards made from molds of your teeth are typically more comfortable and durable.

While a mouth guard will protect your teeth from damage, it won't decrease the number of bruxism episodes. With this in mind, you may want to also work to address your underlying bruxism triggers, which can include stress, anxiety, and anger.

Dental Procedures

Various dental procedures may be needed to treat certain conditions.

• For tooth decay and cavities, the primary treatment is removal of the decay by drilling. The removed area is then restored with a strong material, known as a filling.
• For irreversible pulpitis, your dentist may perform a root canal, where the infected pulp of the tooth is removed.
• For an abscess, your doctor may make a small cut and drain the infected pocket.
• Depending on the extent of the damage, a cracked tooth may need a filling, a root canal, or to be removed and replaced.

How Do I Prevent Tooth Pain?

To prevent cavities, gum disease, and tooth sensitivity, try to practice good oral hygiene by:

• Brushing your teeth gently twice a day and using a toothpaste with fluoride
• Flossing daily
• Drinking fluoridated water
• Getting regular professional dental cleanings
• Not smoking
• Avoiding habits like biting down on pencils or forks

Summary

Tooth pain may be caused by an infection or disease, mouth trauma, general sensitivity, or inflammation. Be sure to reach out to your doctor if your toothache is incredibly painful, you have a fever, or you have face or mouth swelling.

Tooth pain treatment will vary depending on your diagnosis. But whether you need medication, an oral device, or something else, the sooner you are treated, the better.