Dental pain is an abnormal sensation caused by problems involving the teeth.

Toothache pain can be caused by various reasons, a few of which are decribed below.

An exposed tooth neck, for example, can cause dental pain

The transition zone of enamel into cementum (cementoenamel junction) is not always seamless, and sometimes a bit of the inner dentin gets exposed. The cementoenamel junction refers to the area where enamel merges into cementum. Enamel is built like a crystal, and its prisms are arranged in a certain geometric pattern, making it the hardest substance in our body. At the junction of enamel and cementum, however, this geometry dissolves, forming weak points in the enamel.
Normally, however, the cementoenamel junction is well protected by the gingival sulcus. If anatomical deviations lead to dentin exposure at the neck of the tooth as well as exposure of the cementoenamel junction, then cold air and/or hot or cold food may cause the individual to feel pain.
How does the cementoenamel junction come to be exposed? By periodontitis, for example, or by tooth movements and/or anatomical peculiarities. Surgical procedures such as wisdom tooth removal may also expose the cementoenamel junction. During wisdom tooth removal, the bone is drilled and the wisdom tooth is eventually levered out. The wound heals but the surgery causes some tissue damage; the gums behind the preceding tooth sink a little, thus exposing the tooth neck and causing pain. A brace can also cause change in the position of the junction in relation to the gums. Also Tooth neck defectes can cause Tooth pain! Tooth neck defects refer to damage in the area of the tooth neck. This may occur because of abnormal tooth anatomy or incorrect brushing techniques.
Furthermore the cementoenamel junction is frequently exposed to strain during chewing motions. If the strain is too much because of tooth malalignment and/or the enamel itself is very weak because of an individual enamel prism anomaly, parts of the tooth surface can chip or break off from the neck area. A small wedge-shaped defect is the consequence.
Wedge-shaped defects can often reveal information about the kind of trauma that has been suffered. Wide, extensive defects are usually the consequence of incorrect brushing techniques, whereas small, irregular, slit-shaped defects tend to indicate tooth structure anomalies with abnormal axial strain. If the two factors are combined, wider slit-shaped defects are the consequence after a number of years. Although using a toothbrush is essential for oral hygiene, it can also cause damage if not handled correctly. Another cause for tooth neck defects and tooth neck pain may be incorrect flossing. If floss is placed around the tooth and moved back and forth, it will cut into the tooth after a while. The result is a smooth slit. Tooth neck defects should be treated by smoothening the broken or chipped enamel and filling the defect with special materials. In extreme cases, root canal treatment may be required. Additionally, the triggering cause must also be treated; e.g., the brushing technique should be changed or the bite should be corrected.

Remedies for tooth neck pain

The use of fluoride-containing toothpastes can give ongoing protection to the exposed dentin; however, if the patient consumes too much of acidic food or beverages or neglects his/her oral hygiene, then this protection can be lost and hot and cold items will once again cause pain. This type of pain is a sharp, shooting pain that disappears when a lot of saliva gathers in the oral cavity. There are many other reasons for pain in the neck region of a tooth. Nevertheless, the dentist can alleviate this pain by sealing the sensitive tooth neck, irrespective of the cause of pain.

Another reason for dental pain is exposure of the dental nerve (pulp) by caries, leading to inflammation (pulpitis) and, eventually, death (necrosis).

Caries, which is a Latin term for decay, is a bacterial disease involving teeth. Numerous bacteria are present in human bodies. Bacterial colonization usually starts immediately after birth because of contact with other individuals and the environment. Not all bacteria are harmful; eg., the bacterial flora in our intestinal tract are crucial for our survival; these are called symbiotic bacteria. Other bacteria simply settle in niches; these are called commensal bacteria. We do not benefit from them directly. However, the formation of such niches by commensal bacteria, such as in the skin, prevents these areas from being inhabited by other harmful bacteria. Sometimes, bacteria and hosts struggle for dominance. Doctors call such bacteria opportunists. When the host is damaged by bacterial dominance, meaning that the bacteria are winning the fight, the bacteria are called pathogens. There are a number of bacteria in our oral cavities. Some live in essential niches and prevent other aggressive forms from settling in, while others simply live alongside us. This means that humans have symbiotic as well as commensal bacteria in their oral cavities. However, bacterial flora can change instantly with changes in life circumstances. Commensal bacteria can suddenly transform into pathogens, resulting in caries formation. Caries develops when certain factors come together, the most important ones being certain host factors, plaque, and time. Host factors encompass all the factors related to the host, such as tooth anatomy, saliva composition, and cleaning habits. The formation of mature plaque usually takes about 24 hours, which is originally the time  taken by commensal and symbiotic bacteria to become pathogenic. Disorganized mouth bacteria are not harmful. Only mature plaque can cause caries and periodontitis. Therefore, it is very important to remove plaque efficiently with the help of a toothbrush, dental water jets, and floss. By doing so, the bacteria are deprived of their habitat. Without a suitable habitat, they cannot cause any more harm. Plaque, which is a layer of saliva components, bacteria, and carbohydrates, forms on tooth surfaces when they are not cleaned properly. When all these factors; i.e., bad cleaning habits, plaque, and time come together, they lead to the formation of caries. Plaque is organized like a little city. There are bacteria that are specialized in just holding on to the teeth. Other bacteria transport nutrients by forming transport tubes. Streptococcus mutans bacteria, for example, produce nutrients from organic acids, which then attack the tooth by removing existing minerals from the tooth substance. These bacterial products within the plaque dissolve the enamel. Furthermore, the dentin (depicted in yellow) becomes colonized by bacteria as soon as caries reaches it because it contains proteins that supply the bacteria with a food source. Once this occurs, caries progression cannot be stopped even if plaque is removed thoroughly, and the disease gains it owns momentum. Toothache usually only occurs when caries reaches the tooth nerve. In this case, a root canal treatment becomes necessary because the tooth nerve is infected by bacteria.
In addition to caries, drilling of a tooth and/or chemicals used by the dentist while restoring a tooth may also cause pulp exposure and necrosis. The patient will feel a dull throbbing pain that may be pretty strong and linger for a few days. As a rule, however, it generally disappears after a few days. If root canal treatment is not performed on time, then the pain may disappears as the pulp necroses completely; however, the focus of infection still remains. The infection then spreads to the bone, the tooth becomes sensitive to tapping (percussion), and it becomes impossible to bite with that tooth. Infection of the bone may take days, weeks, months, or even years to develop.

An Abscess can, but must not cause pain!

An abscess is defined as an isolated collection of pus - remnants of blood, cells, and bacteria. Untreated abscesses in the jaw can lead to life-threatening conditions. Symptoms may include pain, fever, and restricted mouth opening. However, abscesses can also be painless. In such cases, the patient feels a swelling that is painful only when pressure is applied. Abscesses in the jaw, mouth, and face area are frequently caused by teeth with treated roots, retained wisdom teeth, untreated periodontitis, and/or dead teeth and untreated root problems.Incision and drainage of an abscess are necessary for successful treatment. In this procedure, the abscess is cut open to allow pus to be removed. A drain is often installed to permit the pus to flow out before the wound heals; normally an Iodoform strip is used as drainage system. The strip is usually removed within one or two days. Although this procedure alleviates the symptoms of the abscess, the actual cause remains to be treated. In this case, the tooth roots, which caused the abscess after being injured, must be treated by a root canal therapy, once the worst symptoms have subsided. If not, a new abscess, or a fistula will eventually form.

What is a Fistula?

A fistula is an unnatural tube or tube-like connection between an organ or an inflammatory focus and the body interior or the body surface. A fistula is the body’s reaction to chronic inflammation. When one suffers from chronic inflammation with pus formation in a certain location, a pus canal may develop. Pus flows from the inflamed area through this pus canal, which eventually arrives at the body surface or the body interior. A dental fistula is usually felt as a small elevation on the gums. When this elevation ruptures, pus empties out into the oral cavity and the elevation disappears, only to quickly fill up again. This process repeats itself, occasionally resulting in scarring of the existing pus canal. The walls around the pus canal get coated with special cells, following which the body isolates it. With time, the lesion became more organized, and a fistula course is formed from the bone infection to the mucosa. Although the patient still does not experience any acute discomfort, the infection has literally eaten up the bone, causing the bone defect to grow larger. Possible treatment options include either a root canal treatment or, if the focus is too large, root canal treatment with subsequent root tip resection. The fistula canal is usually removed during the surgery; if not, it normally heals by itself after the causative factor is removed.

Gingivitis - another possible reason for Tooth ache

Gingivitis is the Latin term for acute or chronic inflammation of the gums, technically called the gingiva. Healthy gingiva is pale pink, tightly attached to the teeth, and, when looked at closely, has a characteristic appearance; an orange-peel appearance. This pattern is usually lost in inflamed gums, which swell up, bleed easily, and turn dark red. Generally moderate gingivitis is not painful. Nontreated gingivitis can progress to periodontitis. In principle, all the bacteria found in the oral cavity can cause gingivitis. Overall, the most common cause of gingivitis is plaque. Consequently, it is important to remove plaque thoroughly from tooth surfaces. In order to prevent gingivitis, the patient has to thoroughly clean the teeth. During the inflammation persists, the gingiva can bleed quite heavily for a short time. However, brushing should not be discontinued at any point of time. Many patients stop cleaning their teeth because they are afraid of the blood. However, this causes the buildup of more plaque, marking the beginning of a vicious cycle. Hence, good oral hygiene represents both treatment and prophylaxis against gingivitis.

However, good oral hygiene will not be possible if the following are present:

  • overhanging fillings
  • leaking fillings
  • overhanging bridge or crown edges
  • overlapping or crowded teeth
  • and other Micro-Gaps

Why do Micro-Gaps cause Tooth Pain?

Micro-gap is the term used to describe the very small gap between two bodies joined firmly together.
The term has acquired a special meaning in the field of dentistry when it is associated with root canal treatments, fillings, and implants. Wherever there are small gaps between fillings or there are cracked or loose fillings, the danger of bacterial invasion and subsequent inflammation such as periodontitis and/or secondary caries increases. What does micro-gap mean in regard to implants? Implants are artificial roots that are anchored to the bone by an abutment, a connecting element between the implant and the crown. The currently used connection between an implant and its abutment is a push-fit type of connection that leaves a virtually imperceptible gap, called a micro-gap, between the implant and the abutment. This micro-gap plays a key role in implantology. The gap may be occupied by bacteria, and the dentist can detect this only by an unpleasant smell evident while cleaning the abutment. In order to keep bacteria at bay, some dentists apply one of various antibiotic ointments to the implant before fixing the abutment.
Tight sealing of a tooth also plays an important role in root canal treatments. But the best root canal treatment is useless if the tooth receives a filling that is not tight, because this can lead to bone inflammation after several years. Every good filling should prevent bacterial invasion and the consequent possibility of secondary caries; therefore, there should always be a tight seal between the tooth and the filling. This happens only to a certain extent because many factors such as pressure, temperature changes, and saliva cause microscopic cracks and gaps in most materials soon after placement. The patient first feels the pain when the caries reaches the dental nerve (pulp); root canal treatment is required at this stage as it is too late for a filling. Fillings should therefore be checked regularly. If one wants to perfect his/her cleaning technique, it is worth investing in dental materials that hardly or never alter in the oral cavity, such as gold, titanium, and/or ceramics. In order to avoid worse complications, it is best to have every painful tooth investigated.

Pain after Tooth Extraction

The term alveolitis refers to inflammation of the bone socket, which usually occurs after tooth extraction. This condition occurs primarily in the posterior region of the lower jaw, and is more often seen in smokers. However, improper handling of the wound can also cause alveolitis (for example smoking). The pain typically appears two to four days after extraction, and is caused by disintegration and/or the lack of a blood clot. In order to prevent this complication, it is important to ensure that the bone socket fills up completely with blood. After tooth extraction the tooth socket (alveoli) often don’t fill up with blood right away, therefore, the dentist clean and curette the socket with a sharp spoon, following which the bone socket fills with blood. This blood clot protects the alveolus from the intrusion of germs from the oral cavity until the wound surface is covered with a mucous membrane. If the patient is educated regarding appropriate handling of the situation, alveolitis can very easily be avoided. Basically, alveolitis is an acute bone infection, also known as osteomyelitis, and is thus treated accordingly. Treatment comprises surgical curettage under local anesthesia to remove infected bone from the wound, with subsequent tight wound closure. As a rule, systemic administration of antibiotics is considered inappropriate.

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