Tooth Pain and Oral Pain

tooth pain You are having tooth pain... what can you do? It depends on what type you are having. Is it very sensitive to cold or hot? Is it only sensitive to direct pressure when you chew on it? Is it a constant dull throbbing tooth ache that worsens when you bend down or lie down at night? Let's break it down and start with the most serious condition.

Abscessed/Infected Tooth Pain

This is a very serious condition because it involves an infection that in some cases can worsen and threaten your life. Tooth infections are dangerous because of the close proximity to the brain. Before the advent of antibiotics, it was not unusual for someone to die from a tooth abscess. Although that extreme is not that common now, it is still a condition that needs effective management.

An abscessed tooth can cause unprovoked, severe, constant pain. Cold temperatures and pressure may set it off initially, but hot temperature causes the most pain as it progresses. It hurts when you lie down at night or it may wake you up in the middle of the night. This means that the nerve in the middle of the tooth has died and become infected. Fluid pressure builds up around the root of the tooth and puts pressure on the surrounding bone.

This is what causes constant tooth ache. The oral pain level can vary as this pressure ebbs and flows from day to day. Sometimes the tooth pain will lessen if the fluid drains. This does not always happen and the swelling increases as the infection spreads out. This is called cellulitis and is particularly dangerous. You should be prescribed antibiotics immediately and treatment should be performed as soon as possible.

The only treatment options are tooth extraction or root canal therapy. The tooth can be saved by the root canal treatment only if there is enough tooth structure left to rebuild the tooth. Root canal therapy involves removing the infected nerve tissue from the middle of the tooth and replacing it with a filler/sealer. A General Dentist may perform this treatment or refer you to a specialist called an Endodontist.

Home treatment for a tooth ache can involve icing the area with external ice pack to reduce pressure and inflammation. Some find it helpful to keep ice chips in the mouth directly around the painful tooth. Avoid heating pads or getting any hot food or drink anywhere near the tooth. Don't chew on that side. Do not put an aspirin in the mouth next to the tooth. It will only burn the gum tissue and lead to a different type of oral pain.

Over the counter pain medications may be helpful but are sometimes not strong enough to control this severe form of tooth ache. Ibuprofen is a good anti-inflammatory and may be more effective than other over the counter products. The bottom line is you need professional treatment so please see your Dentist.

Pain From Wisdom Tooth Infection / Periodontal Abscess

These are also infections but usually not quite as painful as the tooth pain from a nerve abscess. This can occur when food debris is trapped between two teeth or around a partially erupted wisdom tooth. An infection caused by food impaction between two teeth will resolve quickly when the food debris is dislodged and cleared. Relief of oral pain is almost immediate.

Take a piece of dental floss and put one knot in it. Place the floss between the 2 offending teeth and pull back and forth sideways between the teeth. The knot will often catch the debris and pull it out the side rather than trying to force it back out through the top biting surface contacts.

An infected wisdom tooth can be treated with antibiotics but will usually need to be removed if it is in a bad position. Try to clean around the infected gum tissue to dislodge any debris. Use a Q-tip soaked with hydrogen peroxide (3%) and paint it around the swollen gum tissue. Try to encourage it between the gum tissue and the tooth. Do this 2 to 3 times per day for two days. Rinsing with warm salt water is often helpful.

See your Dentist for an antibiotic prescription and a possible referral to an Oral Surgeon to have the offending wisdom tooth removed. The recommendation is usually to have all 4 wisdom teeth removed at the same time.

A dry socket refers to a post operative infection that occurs after surgery. The blood clot that fills the socket is damaged and deteriorates which leaves exposed bone. This leads to a very high level of oral pain. The Oral Surgeon will keep you on antibiotics and place a special medicated cream into the socket every couple of days until it feels better. Please avoid smoking, rinsing or spitting, over cleaning or doing anything that might disturb the blood clot in the socket. This will greatly reduce the possibility of a dry socket.

Oral Pain of Periodontal Disease / Gum Disease

Periodontal Disease is a chronic condition that ultimately leads to loose teeth or loss of teeth. 30 percent of the human population is predisposed to have Periodontal Disease.

Gingivitis is the mildest form of this disease. It refers to inflammation of the gum tissue without resulting bone loss. These conditions are caused by the harmful acidic effects from the build up of plaque and tartar. It is usually a slow progressing condition with a low level of tooth or oral pain that many people are not aware of. Warning signs include swollen gums that bleed easily and persistent bad breath. Loose teeth are an advanced sign of this disease. Damage to the supporting bone can be so complete that many or all teeth are eventually lost.

Contributing factors include the presence of rheumatoid arthritis, hormonal changes during puberty or pregnancy, and damage from stress related clenching and grinding. Recent studies are finding significant links between chronic periodontitis and the risk of coronary heart disease. Prevention includes a healthy diet rich in fruits and vegetables, avoiding smoking and chewing tobacco, and seeing your Dentist regularly.

Home care must include a thorough oral care routine including brushing twice a day and flossing daily. Antimicrobial mouth rinses can be helpful. Perio Therapy used in a Hydro Floss Oral Irrigator, make a nice combination. See Best Toothbrushes and other Home Care Products here on our website.

At your Dental Office, your Dentist or Dental Hygienist will perform preventative teeth cleanings. Root Planing refers to deep cleanings in the presence of heavy tartar and bone loss. Advanced cases can need gum surgery performed by a Periodontist. The key to success is committing to a long term maintenance program with dental cleanings every 3 to 4 months.

Cracked Tooth Pain Syndrome

A cracked tooth will feel sensitive to pressure and cold temperature. Tooth pain occurs when the crack is deep enough to allow the two pieces of tooth to flex apart during chewing. This pressure pulls on the nerve tissue in the middle of the tooth. If a piece of the tooth breaks off, it is usually less sensitive because you no longer have the internal pressure caused by the 2 pieces rubbing together.

A cracked tooth needs a dental crown to prevent it from cracking further. A cracked tooth in an early stage will only hurt to direct pressure or temperature. If the crack gets deep enough, it will invade the nerve chamber and cause the nerve to abscess. This will lead to a more severe constant tooth ache.

Sometimes the crack goes so deep, it damages the root and the tooth must be extracted. The goal of treatment would be to get to it soon enough before a root canal or extraction was necessary. Home care would involve avoiding putting any chewing pressure on the tooth, and keeping cold things away from it.

DenTek makes an over the counter temporary filling material you can use to fill a void if part of the tooth breaks away. Fixodent Denture Adhesive Cream also comes in handy to temporarily recement a loose crown(cap). Please see your Dentist as soon as possible.

Teeth Grinding Pain / Bruxism / TMJ Pain

Bruxism is the term for clenching or grinding your teeth. This becomes a habit related to high stress levels. Most of us will clench or grind our teeth at times. Bruxism while we sleep is most damaging because it is something that we cannot monitor or control. It can lead to moderate tooth pain and wear, muscle pain, headaches, joint (TMJ) pain, and tooth sensitivity that can mimic cracked tooth syndrome.

A stressful event may trigger the onset of bruxism. The level of oral pain can be slight to moderate. It may continue for a number of weeks until symptoms gradually subside. It will usually resolve on its own with or without treatment.

Early intervention, though, can greatly reduce the severity and duration of painful symptoms. I recommend icing the joint the first 2 days if you have a sudden onset of oral pain from some type of trauma. Over the counter Ibuprofen is helpful because it is a good anti-inflammatory. Use it a couple of times per day, as directed for 2 days. After 48 hours, switch to moist heat over the sore joint area to relax the muscles and improve circulation. Avoid chewing hard things and any unnecessary jaw movements like chewing gum. Let the joint heal before trying any stretching or rehabilitation exercises.

Once symptoms of oral pain have disappeared, it is helpful to do stretching exercises by holding open the mouth like an isometric exercise. This will keep the muscles more relaxed and help prevent new spasms.

Some people clench or grind their teeth chronically and need to wear a special appliance, called a night guard, to protect their teeth and TMJ. Night guards should be custom made and adjusted by your Dentist. If you are not sure you can sleep with an appliance in your mouth, you can purchase a low cost over the counter DenTek Night Guard for a trial run. If you find you are able to tolerate it, please have your Dentist fabricate a better fitting custom night guard. The balance of the biting surface is very important for long term success with this type of appliance. Your Dentist will carefully adjust the bite for you.

For those who continue to have persistent symptoms of more severe oral pain, an Oral Surgeon can take special x-rays to screen for physical damage of the Temporal Mandibular Joint.

Pain of Oral Ulcerations

Canker sore - this is thought to be caused by a strep bacteria. It is found inside the mouth on flexible tissues like the tongue or inside of cheek. It is non-contagious. Use tooth pastes without SLS, like Rembrandt Canker Sore Toothpaste or TheraBreath Toothpaste. An over the counter medicated gel, Zilactin-B , can be used to coat the ulceration and reduce the oral pain. L-Lysine is a popular supplement used to help prevent canker sores.

Cold sore - this is caused by the Herpes virus. It occurs on the outer lips or inside the mouth on tissues that overlie bone like the hard palate or gum tissue. These are contagious and can be spread to other people or other parts of the body. These will usually recur in the same location repeatedly because the virus resides in the nerve endings that supply the area. This proximity to nerve endings can lead to a moderate level of oral pain. Although very common during cold and flu season, these cold sores can be activated by trauma to the area or too much sun on the lips. Zilactin-L Early Relief Liquid is very effective on the outer lips if used during early itching stage. You can also ice the lip as soon as you feel the itching and this may reduce the severity.

Cracks in corners of mouth (Angular Cheilitis) - If you have persistent cracks in the corners of your mouth that are resistant to healing, you have a fungal infection. Please see your Dentist for a prescription for Mycolog Cream. This will quickly clear up the problem. The oral pain level is slight but very annoying.

Conclusions About Oral Pain

Tooth pain, tooth ache, oral pain can be just annoying or so severe that it is debilitating. Try to identify the problem early using the guidelines above. When in doubt, see your Dentist before you are miserable! Early intervention of most forms of tooth and oral pain will greatly reduce the severity and duration of the pain.

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