Causes of Tooth Pain and Treatment Options

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 doctor will consider several potential diagnoses based on your medical history, dental exam, and sometimes an imaging test, usually an X-ray.

Here is a summary of the most common causes of a toothache, ranging from tooth sensitivity and decay to serious infections, like abscess formation.

Causes

Among all the things that might cause a toothache, the most common are tooth decay, inflammation of the tooth pulp, an abscess, a cracked or impacted tooth, gum disease, and sensitive teeth.

Common

Let's look at each of these potential causes individually.

Gum Disease

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.

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

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.

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.

Sensitive Teeth

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.

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).

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

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.

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).

It's important to mention there are two types of pulpitis—reversible pulpitis and irreversible pulpitis.

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.

Cracked Tooth

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.

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:

• 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.

Abscess

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.

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.

Impacted Tooth

Teeth can become impacted when they are prevented from moving into their proper position in the mouth by other teeth, gums, or bone.

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.

Rare

There are a couple of potential, though rare medical emergencies that may cause tooth pain or result from untreated tooth conditions.

Ludwig's Angina

Very rarely, a submandibular space infection, also called Ludwig's angina can cause tooth and mouth pain. This very serious, life-threatening infection of the submandibular space—an area deep within the floor of your mouth—usually occurs as a result of an infected second or third mandibular molar tooth.

A submandibular space infection is very serious and quickly spreads, causing fever, chills, mouth pain, stiff neck, drooling, a muffled voice, and difficulty swallowing. If the infection spreads to a person's airway, breathing can become difficult.

Cavernous Sinus Thrombosis

Very rarely, a condition called cavernous sinus thrombosis—where a clot forms in the cavernous sinus, located at the base of the skull—may develop from an untreated facial, sinus, ear, or dental infection. In addition to a high fever, other symptoms of cavernous sinus thrombosis include a severe headache, often located behind the eyes, as well as eyelid edema and weakness of the eye muscles.

When to See a Doctor

If you haven't had a tooth cleaning in the last year, be sure to schedule an appointment with your dentist. Regular, professional dental cleanings will optimize your teeth health.

In addition, make an appointment with your dentist if you are experiencing any tooth discomfort, dental sensitivity, persistent bad breath, loosening teeth, widening spaces between your teeth, or notice your gums are bleeding, swelling, or receding.

Diagnosis

In order to determine the cause of your tooth pain, your doctor will proceed in a step-wise fashion, beginning with a medical history.

Medical History

In order to narrow down the possible causes of your tooth discomfort, your doctor will ask you several questions regarding the types of symptoms you are having.

Some of these questions may entail the following:

• How long has your tooth pain been going on?
• Is the pain constant or does it occur only after a trigger (for example, drinking a cold beverage)?
• Is your tooth sensitive to cold or heat, sweet food, chewing, and/or brushing?
• Has your tooth pain woken you up in the middle of the night?
• Are you experiencing any associated symptoms (e.g., face pain or swelling, pain with bending forward, headache, fever, or vision problems)?
• Have you experienced any tooth or mouth trauma?
• Have you undergone any recent dental procedures?

Physical Examination

After a medical history, your dentist will examine your face and mouth for swelling and tenderness. During the oral exam, your dentist will inspect the inside of your mouth, including your gums, for inflammation. He will also inspect your teeth for decay or signs of infection (e.g., swelling at the base of the tooth).

Using a tongue depressor, your doctor may "percuss" or tap teeth within the area of identified pain and/or apply an ice cube or blow cold air on different areas of the tooth to figure out where the sensitivity is coming from. He may also perform a biting pressure test, using a “biting stick” or cotton tip applicator, to determine what area of the tooth is causing the pain.

For people with more unusual or worrisome associated symptoms, like a fever or vision problems, your dentist may perform a cranial nerve exam.

Imaging and Other Tests

After the physical examination, your dentist may want to take an X-ray of the bothersome tooth to check for abscesses, cavities, or any other hidden problems.

A computed tomography (CT) scan or magnetic resonance imaging (MRI) test is generally reserved for diagnosing very serious, rare diagnoses, like Ludwig's angina or cavernous sinus thrombosis.

Differential Diagnoses

Believe it or not, there are times when tooth pain or sensitivity has nothing to do with your teeth at all.

For example, if you have a sinus infection, you may notice that your teeth feel more sensitive than usual. You may even have pain or discomfort that seems to be coming from several teeth. This is especially true of your upper teeth because they are located directly under your sinus cavities. Any pressure or pain from your sinuses can affect these teeth.

Another disorder that a person may describe as a toothache is temporomandibular joint (TMJ) disorder. This disorder refers to dysfunction of the jaw joint, located in front of your ear. Symptoms usually entail a dull pain or tenderness near the ear that worsens with jaw movement and chewing. Jaw clicking when opening and closing the mouth is also common, along with headache, earache, and neck pain.

Treatment

Once your dentist has diagnosed the cause of your toothache, he will explain to you what is involved in fixing the problem.

Medication

Depending on your underlying diagnosis, your dentist may recommend or prescribe various medications.

Pain Control

For pain relief, your dentist may recommend taking Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID). For severe pain, your doctor may prescribe an opioid. Local nerve block injections may also be given for severe pain or during a dental procedure.

Antibiotics

If you have an abscess, pulpitis, gingivitis, or periodontitis your doctor may prescribe an antibiotic, like amoxicillin. Antibiotics will also be prescribed for bacterial sinusitis.

Oral Rinses and Topical Fluoride

Chlorhexidine oral rinses may be administered by your dentist to treat gingivitis. Fluoride rinses or topical fluoride treatments may also be given by your dentist to prevent or treat tooth decay.

For tooth sensitivity, in addition to brushing your teeth with a special toothpaste made for teeth sensitivity, such as Sensodyne, your dentist may apply fluoride to your teeth (especially the parts of your teeth that meet the gum).

Oral Devices

If you have sleep-related bruxism, your dentist may recommend wearing a mouthguard at nighttime.

Keep in mind, while a mouthguard will protect your teeth from damage, it won't decrease the number of bruxism episodes. This is why addressing your underlying bruxism triggers—stress or drinking alcohol or caffeine at night—will also be an essential part of your treatment plan.

Dental Procedures

Sometimes, various dental procedures are warranted to treat your diagnosis. For instance, for tooth decay and cavity formation, the primary treatment is restorative therapy, which entails removal of the decay by drilling, followed by filling of the removed area with a strong material (called a filling).

For irreversible pulpitis, your dentist will need to perform a root canal. For an abscess, incision and drainage of the infected pocket is the primary therapy.

Lastly, for a cracked tooth, treatment depends on the location and direction of the crack, as well as the extent of the damage.

For instance, for a fractured cusp, your dentist may simply place a new filling or crown over the cracked tooth to protect it. Likewise, for a cracked tooth that does not extend below the gum line, your dentist may perform a root canal and place a crown to prevent the crack from spreading further.

For more serious cracks, like a crack that extends below the gum line or for a fractured root with an associated infection, tooth extraction may be necessary.

Prevention

The key to good oral health is preventing problems before they arise. For example, to prevent cracked teeth, it's important to wear a mouthguard during contact sports and to avoid biting hard candies or ice.

To prevent cavities, gum disease, and tooth sensitivity, try following these preventive strategies:

• Brush your teeth gently twice daily using soft-bristle toothbrush and a fluoridated toothpaste
• Floss daily
• Drink fluoridated water
• Undergo regular professional dental cleanings
• Replace your toothbrush every three to four months or sooner
• Avoid smoking
• Eat a regular, balanced diet rich in fruits, vegetables, protein, and fatty fish and minimize ingestion of sugar-rich foods or drinks

A Word From Verywell

Due to the fact that most causes of tooth pain require the expert care of a dentist, be sure to contact your dentist's office with any new tooth pain. This holds true even for tooth pain that is mild or intermittent. If left untreated, you may develop a serious complication and/or require a more invasive dental procedure.