A toothache is the most common reason for a visit to the dentist. This pain can be caused by many different factors. The first and most common one is dental caries, followed by gum disease, dental trauma, hypersensitivity, alveolar osteitis, temporomandibular disorders and much more. But not every dental pain is the same. The characteristics of the pain may vary and that is how dentists set up diagnosis for a specific case. Pain is definitely not a good symptom. No matter the cause of the pain, every single time you feel it, you should schedule a visit to the dentist.
Sharp, intermittent pain
Sharp pain can be short and intermittent or prolonged. Short and sharp pain can be a result of dental hypersensitivity. Tooth sensitivity may be caused by cavity lesions, gingival recession, erosions, pain right after tooth scaling and root planning, after dental procedures such as crowns and bridges, after tooth bleaching and more. The pain is stimulated by hot or cold drinks and food and it lasts for a short time.
Another reason for short and sharp pain is reversible pulpitis. If caries has reached the dental pulp and the pulp is inflamed than it reacts with pain. If the pulpitis is reversible, that means that the pulp still has the ability to fight the inflammation. Teeth with reversible pulpitis are very sensitive to cold, and the pain only lasts for as long as the trigger is in touch with the tooth. Once the cold stimulus is gone, the pain stops. Deep cavity lesions are the number one cause for a reversible pulpitis, while dental trauma is the second one.
Tooth fillings that are improperly made can also cause a sharp, intermittent pain. If there is space between the tooth and the filling, or the filling is too high that the patient will feel pain every time he bites on that tooth. Those fillings should be removed and restored with new ones.
Sharp, prolonged pain
Irreversible pulpitis is characterized by sharp a pain that lasts long. Once the bacteria have caused irreparable damage to the pulp that condition is called irreversible pulpitis. Caries lesions that haven’t been taken care of lead to this. The patient feels extreme pain, and in most of the cases, he cannot locate the tooth from which the pain originates. After some time (usually days) the pain stops because of necrosis of the pulp. If the tooth is not treated the infection will spread to the periapical tissues.
An acute apical periodontitis causes prolonged, sharp pain and it is one of the most intense and painful situations in dentistry. The pain is deep and throbbing, spontaneous, and it gets worse with time. The patient sometimes can locate the tooth, while other times the pain can irradiate. The gums around the tooth are usually red and swollen. The patient might feel like his tooth is high, and the pain gets worse while biting. The apical periodontitis requires immediate visit to the dentist.
Acute pericoronitis causes prolonged severe pain that is combined with trismus (difficulty in opening the mouth), swelling and sometimes fever. Pericoronitis is actually an inflammation of the soft tissues that surround a tooth that is partially erupted. Pericironitis is most common with third molars. The pain might also irradiate towards the ear, head and neck.
Sharp pain only when you eat
The most likely reason for a sharp pain when you bite down on food is decay. When you bite on the decayed tooth, the food puts pressure on the dentine tubules that have been exposed by bacteria and you feel a painful sensation. The best thing to do is visit a dentist as soon as possible, before the caries gets to the pulp and causes irreparable damage. Also fillings that are high, chipped or broken might cause that feeling when you bite. Those fillings need to be replaced.
Another condition that might cause pain when you eat is the syndrome of cracked tooth. It is usually presented as a sharp pain that happens when you bite down, because of the pressure on the tooth. Tooth cracks can be very difficult to diagnose.
Alveolar osteitis or alveolitis is a complication that happens after a tooth extraction and causes a dull, throbbing pain. If after the extraction, the tooth socket stays dry, and there is no blood clot formed then there might be an infection in the socket. The pain is usually located in the socket but it might also irradiate to the head and neck. It requires a visit to the dentist.
A tooth with chronic apical periodontitis might cause dull pain. These type of teeth are asymptomatic in most cases, but some patients might feel a dull pain from time to time, or when they bite on food. The apical periodontitis happens when a tooth is not treated in time, the pulpal tissue is not vital anymore and the infection has spread into the periapical tissues. It can be seen only on an x-ray.
Temporomandibular disorders cause a dull pain, that appears in the area of the temporomandibular joint, but it can spread to the neck, head, and jaws. People with TMD wake up with headaches, earaches, and pain in the masticating muscles. The opening and closing of the mouth are painful and difficult. Patients can hear clicking and popping sounds when they chew, open or close their mouth.