Toothaches are a sign that there may be more to worry about then just a little pain. The causes of toothache are several but the major causes are, dental cavity, a cracked tooth, exposed tooth root, gum disease, disease of the jaw joint or spasms of the muscles used for chewing. It is possible for the cause of a toothache to originate from an entirely different problem such as heart attack or angina but this is quite rare. It can be noted however that some patients suffering angina will show toothache or jaw pain as the only symptoms so it is always best to let your dentist or doctor evaluate you.
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Dental Cavities
The most common cause of a toothache is a dental cavity. Dental cavities (caries) are holes in the two outer layers of a tooth called the enamel and the dentin. The enamel is the outermost white hard surface and the dentin is the yellow layer just beneath the enamel. Both layers serve to protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. Certain bacteria i n the mouth convert simple sugars into acid. The acid softens and (along with saliva) dissolves the enamel and dentin, creating cavities. Small shallow cavities may not cause pain and may be unnoticed by the patient. The larger deeper cavities can collect food debris. The inner living pulp of the affected tooth can become irritated by bacterial toxins or by foods that are cold, hot, sour, or sweet-causing toothache. Toothache from these larger cavities is the most common reason for visits to dentists.
Treatment of a small and shallow cavity usually involves a dental filling. Treatment of a larger cavity involves an onlay or crown. Treatment of a cavity that has penetrated and injured the pulp requires either a root canal procedure or extraction of the affected tooth. Injury to the pulp can lead to death of pulp tissue, resulting in tooth infection (dental abscess). The treatment of an infected tooth is either removal of the tooth or a root canal procedure. The root canal procedure involves removing the dying pulp tissue (thus avoiding or removing tooth infection) and replacing it with an inert material.
The procedure is used in an attempt to save the dying tooth from extraction.
Tooth Root Sensitivities
Chronic gum disease also contributes to toothache due to root sensitivities. The roots are the lower 2/3 of the teeth that are normally buried in bone. The bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The exposed roots can become sensitive to cold, hot, and sour foods because they are no longer protected by healthy gum and bone. The sensitivities may be so severe that the patient avoids any cold or sour foods.
Early stages of root exposure can be treated with topical fluoride gels applied by the dentist or with special toothpastes (such as Sensodyne or Denquel) which contain fluorides and other minerals. These minerals are absorbed by the surface layer of the roots to make the roots stronger and less sensitive to the oral environment. If the root exposure causes injury and death of the inner living pulp tissue of the tooth, then a root canal procedure or tooth extraction may be necessary.
Cracked Tooth Syndrome
"Cracked Tooth Syndrome" refers to toothache caused by a broken tooth (tooth fracture) without associated cavity or advanced gum disease. Biting on the area of tooth fracture can cause severe sharp pains. These fractures are usually due to chewing or biting hard objects such as hard candies, pencils, nuts, etc. Sometimes, the fracture can be seen by painting a special dye on the cracked tooth. Treatment usually involves protecting the tooth with a full-coverage gold or porcelain-fused-to-metal crown. However, if placing a crown does not relieve pain symptoms, a root canal procedure may be necessary.
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