The most common causes of toothache are cavities, pulpitis, periodontitis and pericoronitis. And each disease has its own symptoms.
Caries
This is a disease of the hard tissues of the tooth, leading to the destruction of enamel and dentin. Caries primarily affects the natural cavities of the teeth (fissures), but also the areas where a lot of plaque accumulates – these are the interdental spaces and the periodontal area. Caries causes the dental hard tissue to demineralize and soften, subsequently creating a cavity-like defect in the tooth.
Caries has several stages; the process is initial, superficial, intermediate, and deep. At the beginning, dental caries is almost asymptomatic: the main discomfort a person experiences is due to the food stuck in the cavity. Another symptom of decay that is usually not paid much attention to is short-term pain from chemical, mechanical and temperature stimuli. Simply put, the damaged enamel no longer protects the tooth from hot tea or icy water or from mechanical action, and we experience pain at that moment. But because it only lasts a few seconds, we usually don’t take it seriously.
But when the process reaches the final stage, advanced caries, it becomes difficult to ignore the discomfort. With deep caries the patient experiences pain when food and liquid get into the damaged area, pain when brushing teeth (irritation by the toothpaste and toothbrush), pain from any external stimuli, thermal, chemical, mechanical. After the irritant is removed, the pain subsides – until the next episode. At this stage the quality of life is already significantly reduced. If a person continues to be patient and doesn’t go to the doctor, the tooth nerve (pulp) is gradually drawn into the inflammatory process, and the pulpitis begins.
Mayo Clinic mentions that if cavities aren’t treated, they get larger and affect deeper layers of your teeth. They can lead to a severe toothache, infection and tooth loss.
Mayo Clinic
Pulpitis
It is an inflammation of the pulp (the nerve) of the tooth, and the process is usually accompanied by severe pain. The pulpitis occurs as a response to constant irritants that attack the pulp cavity, but also due to the effect of microorganisms and toxins on the dental nerve. Irritation of the pulp leads to changes in blood flow, which provokes increased pressure on the nerve fibers.
At the initial stage, pulpitis is manifested by mild pain, which goes away when the irritant is removed. At this stage, the inflammation recedes on its own if the irritant is removed – i.e. if the caries is cured and the tooth is sealed, isolating the pulp from external influences.
If nothing is done, the inflammation gradually gets worse and the pain increases. The stage of acute pulpitis occurs, and irreversible changes take place in the pulp. The pain can be easily caused by any irritant. The option of “don’t eat, don’t drink, keep your mouth closed” does not save the pain. Very often the toothache worsens at night.
Pain with acute pulpitis can be very different:
- Sharp or dull
- Pulsatile or constant
- Localized or diffuse
- Transient or prolonged
If you continue to ignore your condition and don’t see a dentist, the next step is the complications that are likely to develop with acute pulpitis, including purulent pulpitis.
Purulent pulpitis
This is the most severe form of pulpitis, most often ending in pulp necrosis. With purulent pulpitis, the pain is especially intolerable and sharp, and often worse at night. The pain goes to the temporal lobe, to the ear, to the eye cavity, to other teeth – often in this condition, it feels like all the teeth already hurt.
Chronic Pulpitis
In the most patient patients, acute pulpitis can progress to chronic. The pain becomes less acute and constant, sometimes subsiding for a long time. If the carious cavity is difficult to reach for irritants, chronic pulpitis can run almost painless.
Symptoms of chronic pulpitis
- Pain on cold
- Pain when eating hot food
- Pain from changes in temperature (e.g., when leaving the house on a cold street)
- Prolonged nagging pain if the cavity is clogged with food debris
Chronic pulpitis can worsen at any time and give you all the unforgettable sensations of acute pulpitis.
If chronic pulpitis is left untreated, it can progress to periodontitis.
Acute Periodontitis
Periodontitis is an inflammatory process in the periodontal (perio-tooth) tissues at the apex of the tooth root. Inflammation often involves the cement and dentin of the tooth root, as well as the alveolar bone. Periodontitis in most cases is caused by damage to the pulp, i.e. pulpitis.
Symptoms:
- Constant, throbbing pain, with clear localization
- The pain is increased by any touching of the tooth, including chewing
- The pain may spread to part of the face
- Headache
- General weakness
- Fever
- Swelling of the cheek
- Gum pain, redness, and swelling in the gum
- Submandibular and chin lymph nodes become enlarged
- Pus may be secreted from the root canal.
Chronic Periodontitis
Chronic periodontitis is sometimes asymptomatic or acute periodontitis may progress to this stage. Chronic periodontitis develops when the pulp dies and the tooth provides a favorable environment for microorganisms to develop. Sometimes chronic periodontitis can occur after an injury to the tooth.
Symptoms:
- Discoloration of tooth enamel
- A fistula on the gum
- Painful sensation when chewing hard food
Chronic periodontitis can have many very serious complications: granuloma, root cyst, pathological fracture of the lower jaw, periapical abscess, phlegmon and others.
Pericoronitis
This is the difficult eruption of wisdom teeth (octogenes). When a tooth cannot erupt normally, it causes inflammation of the surrounding soft tissue and periosteum behind the dental fossa. The inflamed gums are constantly traumatized during chewing, making the process even worse.
The inflammatory process can gradually lead to the development of purulent pericoronitis.
Symptoms:
- Constant pain that worsens with chewing
- Pain radiates to the ear and temporal region
- Painfulness when opening the mouth
- Enlarged and painful submandibular lymph nodes
- If you press on the gum, it hurts suddenly, and may lead to purulent discharge
- Increase in body temperature
The pain continues to increase, and the body temperature continues to rise. The patient’s well-being worsens considerably, and posteromolar periostitis may develop.
How to Avoid Toothache?
In fact, everything is very simple.
The overall condition of the teeth is affected by the general state of the body and the person’s lifestyle. If a person leads a healthy lifestyle, eats a balanced diet, and pays attention to oral hygiene, their chances of keeping their teeth in good condition are much higher.
Visit your dentist regularly – preventive care visits once or twice a year, ideally combined with professional dental hygiene followed by fluoridation and enamel strengthening.
Your doctor will help you find the right toothpaste and toothbrush, and show you how to brush your teeth properly. Be sure to floss and use mouthwash.
Please note: Some very serious dental diseases can be completely asymptomatic! And they can be detected only at a stage when it is no longer possible to save a tooth. Therefore, regular preventive visits to the dentist are essential for everyone!