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Toothache (Dental Neuralgia)


1. What is toothache? 

Toothache, also known as dental neuralgia, is an intense, stabbing pain in the teeth, often described as a burning or electric shock. It is often very difficult to bear.

It may or may not be dental in origin and is usually caused by a compression, lesion or inflammation of one of the many nerves present in the oral sphere, which then send a pain signal to the brain:

  • caries, pulpitis, dental necrosis,

  • dental trauma, broken or cracked tooth, dental wear

  • abscess,

  • gum infection ie. periodontal disease (gingivitis, periodontitis), gum recession, 

  • painful oral lesions e.g. mouth ulcers

  • aliment compaction

  • growing wisdom teeth,

  • desmodontitis (bruxism - teeth grinding),

  • sinusitis.

The pain may be acute and localized to a particular tooth, or it may be diffuse and spread to other teeth, the jaw or the face. The pain may be intensified by factors such as cold, heat, chewing or even speech, and it may persist over time.

2. Toothache and cavities

Tooth decay is the most common cause of toothache. 

Tooth decay is a cavity that forms in the tooth enamel due to the accumulation of bacteria and sugars in the mouth. If not treated in time, the bacteria can penetrate deep into the tooth, reaching the dental pulp which contains nerves and blood vessels, easily causing toothache. 

3. Toothache and pulpitis

Pulpitis is an inflammation of the dental pulp, which is the central part of the tooth that contains nerves and blood vessels. The dental pulp is confined in a small space. When the tooth becomes infected or if the temperature rises, the blood vessels dilate, which increases the blood supply and compresses the nerves causing intense, stabbing pain in the tooth, called toothache.

As mentioned above, the most common cause of pulpitis is untreated tooth decay. However, there are other triggers such as

  • dental trauma where an injury or impact to the tooth can damage the dental pulp and lead to inflammation.

  • a broken tooth that can expose the dental pulp to bacteria and cause an infection.

  • excessive tooth wear of the tooth enamel that can expose the dental pulp to bacteria and cause inflammation.

4. Toothache and abscess

A dental abscess is a bacterial infection of the gum or tooth, especially at the root of a tooth. It causes swelling and the production of pus.

The possible causes of this infection can be multiple

  • untreated periodontal disease (gingival or periodontal abscess),

  • a crack or fracture of the root of the tooth (apical or periapical abscess),

  • pulp necrosis (apical or periapical abscess),

  • a badly performed root canal treatment (apical or periapical abscess). 

5. Toothache and periodontal disease (gingivitis / periodontitis)

Periodontal disease is a bacterial inflammation of the periodontium (gum, alveolar bone, cementum, ligament) related to an accumulation of pathogenic bacteria on the surface of the tooth (dental plaque/tartar), between the teeth and/or under the gum.

The first stage of the disease is gingivitis which can later evolve into periodontitis. In the case of acute gingivitis, the gums become red, swollen and sensitive, to the point of hindering chewing. 

6. Toothache and desmodontitis

Desmodontitis, also known as dental arthritis, is a painful condition caused by inflammation of the desmodont, the ligament that connects the tooth to the jawbone.

This inflammation can be caused by infectious causes (e.g. pulp infection, untimely inoculations such as fish bones), physical causes (e.g. bruxism, bite problems, traumatic shock), chemical causes.

For example, during a problem of occlusion or bruxism, a premature or non-axial contact between the teeth has repercussions on the nerve.

7. Toothache and food compaction

Food impaction, also called food blockage, is caused by food residues stuck in the space between two neighboring tooth roots. 

The prolonged contact of this food residue with the gum creates a compression of the nerve, as well as an inflammation: this can trigger a toothache.

8.  Toothache and sinusitis

In the case of a maxillary sinus infection (sinusitis), the pressure caused by the mucus build-up on the roots and nerves of the teeth can cause pain in the teeth of the upper jaw. It is this nerve irritation, not the teeth themselves, that causes dental pain. These pains can be diffuse on the whole upper jaw or more localized; their intensity and localization can evolve.

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