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In addition to caries and an inflamed tooth nerve, exposed necks of teeth or sensitive teeth are also possible triggers. Furthermore, gum inflammation can also be accompanied by pain.
One thing is certain: If toothache is very pronounced or recurs repeatedly, waiting is the wrong strategy. A visit to the dentist is then necessary so that a precise diagnosis can be made and appropriate treatment initiated.
For many people, toothache is a horror – severe, pulsating pain, a thick, reddened cheek, problems opening the mouth. In most cases, a bad tooth is to blame – but not always. For example, an inflammation of the sinuses or a heart attack can also trigger toothache. You can find out more about the causes of the symptoms and helpful home remedies for toothache here.
In the majority of cases, toothache originates directly from the teeth. Sometimes, however, health problems or diseases affecting other parts of the body are behind it.
Toothache due to dental problems
- Mainly the following triggers come into question (mostly as a result of poor oral hygiene): Caries (tooth decay): The tooth surface is covered with a thin biofilm (plaque), which is colonized by bacteria (especially Streptococcus mutans). These decompose sugar molecules from food residues into acid, which attacks the tooth enamel. If plaque is not removed regularly, the enamel is slowly destroyed – a cavity develops. This allows food residues and bacteria to penetrate the tooth, possibly reaching the pulp and causing painful irritation. The affected tooth is particularly sensitive to sweet, sour, cold and heat.
- Tooth root inflammation: If caries is not treated or is treated too late, the acid-producing bacteria can trigger pulpitis and also penetrate into the tooth nerve and damage it. In addition, the swollen pulp presses on the nerve. Persistent, pulsating toothache is the result. In extreme cases, the nerve dies. The toothache then subsides, but the inflammation can spread to the root tip and the jawbone (apical ostitis). Then the affected tooth hurts when pressure is applied from above, for example when chewing. Rarely, toothache is caused by bacterial inflammation of the tooth root when the jawbone has been injured or a root canal treatment has failed.
- Abscess: Tooth root inflammation can spread to the surrounding tissue and jawbone, where it can form pus accumulations (abscesses). Typical signs are pronounced, heated swellings as well as persistent toothache.
- Gingivitis: This acute or chronic inflammation is usually caused by bacteria. The affected gums are swollen and reddened. In addition, the gums often bleed and hurt when brushing.
- Inflammation of the periodontium (periodontitis): The periodontium includes the gums, root cementum, root membrane and jawbone. When these structures are inflamed, bleeding gums may occur and the gums may be swollen and reddened. It gradually recedes, exposing the pain-sensitive necks of the teeth. The inflammation itself is also noticeable as dull pain that is difficult to localize. Periodontitis destroys the jawbone in the medium term.
- Tooth eruption: When milk teeth break through in babies or wisdom teeth in adults, this can also be associated with pain.
- Tooth fracture: Teeth can also break, for example as a result of an accident or when you bite down on something hard. This can be very painful – just like a broken arm or leg – painful.
- Fallen-out fillings, crowns and temporaries: Dental restorations can fall out, for example, when you eat. Then the abraded tooth underneath is exposed and reacts painfully to external stimuli such as food particles, liquid, pressure (when brushing teeth) and air.
- Barotrauma: Cavities, for example as a result of caries or under leaking fillings and crowns, often react painfully to pressure differences. Divers are often affected by this; at high altitudes or when flying, the phenomenon occurs less frequently.
- Dental treatment: Grinding down teeth in preparation for fillings or crowns irritates the tooth nerve and can temporarily trigger pain after treatment.
How does a toothache actually develop?
Teeth are by no means lifeless. On the contrary, each individual tooth contains blood vessels as well as nerve fibers. These penetrate the tooth root from below through openings in the jawbone and lie in the middle of the pulp. The nerve fibers react very sensitively to even the smallest stimuli. A protective mantle of dentin (tooth bone) and enamel surrounds the pulp, protecting it from irritation caused by heat or food particles. In the case of dental diseases such as caries or periodontitis, however, this natural barrier is destroyed, so that irritants can reach the inside of the tooth unhindered - toothache results.
Other causes of toothache
Diseases in other parts of the body can also be the cause of toothache:
- Myocardial infarction and angina pectoris: both are typically characterized by severe pain behind the breastbone, which can radiate to the left shoulder, left arm and lower jaw. In the so-called Buddenbrook syndrome, a diseased tooth in the left lower jaw can cause the actual trigger of the toothache – a heart attack or angina pectoris attack – to be overlooked.
- Sinusitis: The upper molars and the sinuses are close together. If the latter are inflamed, the inflammation can therefore spread to the root of the tooth and cause pain.
- Shingles (herpes zoster): the rash associated with this viral disease can also appear on the face and in the oral cavity, where it can cause severe pain on the skin, mucosa and teeth.
- Headache and migraine: Sometimes headache is accompanied by toothache. Migraine, which usually occurs on one side of the head, can also cause this, since it usually affects only one side of the head, can cause teeth to ache on that side. In addition, migraine patients often suffer from phantom toothache. This is pain that occurs even though a diseased tooth has already been extracted.
- Trigeminal neuralgia: The trigeminal nerve is a facial nerve that also supplies the teeth. If it is inflamed, this also leads to severe toothache.
- Earache: Diseases of the ears such as a middle ear infection often radiate to the jaw and teeth.
Cysts: cysts in the jaw area can also trigger toothache.
- Medication and radiation: Inflammation caused by certain medications (bisphosphonates) and radiation to the jawbone are other possible causes of toothache.