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How to Manage a Toothache?


That first bite of ice cream was supposed to feel sweet, cold, pleasant, and yummy. But it turned out to be painful as if your gums and teeth were stabbed! Most of us have experienced a toothache at some point in life.

Toothache is defined as a condition where there is pain around the teeth and jaw. Clinically, the toothache is caused by inflammation of the dental pulp, most caused by decay or dental caries. Here let’s take a look at some causes of toothache, its prevention, and treatment.

Causes of toothache

A toothache may be caused by the following conditions:

  • Infection arising from the presence of dental caries close to the pulp
  • Chemical or thermal dental treatments
  • Abscess or Inflammation
  • Visceral toothache
  • Grinding or clenching teeth

In addition to toothache caused by caries and infection, pain that occurs in the organs can also trigger pain in the teeth. That is known as a visceral toothache. Toothache can also be a real symptom of angina pectoris (chest pain due to coronary heart disease). The thing that distinguishes a toothache due to heart disease from a regular toothache is the tooth pain that radiates to the jaw.

Toothache can be classified according to the type of pain felt. Firstly, a sharp pain is due to inner layers of cementum or pulp getting exposed. You may feel a stabbing pain when you eat or drink something that has a sour or sweet taste and/or something hot or cold. High pressure such as brushing, or biting can also trigger a toothache. Sharp pain in the teeth in a short duration may be due to the cracks or cavities in the teeth and exposed tooth roots. Pain in the tooth is influenced by the nerve of the tooth (pulp) and blood supply.

Second, a dull, throbbing pain may occur in the teeth in or around the mouth and jaw. This pain is usually persistent and lasts longer. This type of toothache is usually caused by an infection.

Prevention

Small changes can make a difference when it comes to preventing toothache. The simplest way is to maintain the health and hygiene of your mouth and teeth. The American Dental Association recommends brushing teeth at least twice a day regularly. The best time to brush your teeth is in the morning and at night before bed. Rinse your mouth after every meal. Avoid brushing your teeth after consuming acidic drinks or foods as this can erode tooth enamel and dentin.

Dental caries and periodontal disease which can cause toothache can be prevented by proper brushing techniques. The horizontal brushing method is the most popular technique for brushing the surface of the teeth in a horizontal motion such as back and forth.

Next, is the roller brushing method recommended by the World Health Organization. This technique is a sweeping movement of the surface of the teeth from top to bottom with a rolling motion of the wrist on the upper teeth. If you have periodontal problems, then the bass brushing technique is the most recommended method. This brushing technique requires a soft toothbrush with two vibrating paths that move quickly and lightly.

The next step you can take is choosing the right toothpaste. The American Dental Association (ADA) recommends toothpaste that contains fluoride. Toothpaste products with the ADA “Seal of Acceptance” may also contain other safe ingredients to improve oral health such as reducing tartar formation, reducing gingivitis, preventing enamel erosion, whitening teeth, or improving bad breath. Other products such as mouthwash and oral rinse should be used as necessary.

Treatment

Toothache treatment can be done based on the type of pain experienced. Sharp, aching pain may be stimulated by enamel damage including cracked, chipped, or teeth cavities. Treatment for this toothache may include filling the cavity or doing a root canal and replacing it with a new artificial tooth crown.

If there is damage to the cementum of the tooth that causes the dentin to be exposed, a filling solution can be given which will harden and close the dentin. Treatment of a throbbing toothache can be done based on the dentist's diagnosis. If the pain is caused by an infection, the infected tissue can be removed.

The key to the success of toothache treatment is a good history and oral examination. Dentists may also advise x-ray to identify the exact problem. Dentists do these investigations to be able to differentiate between odontogenic and non-odontogenic causes of tooth pain. Depending upon the cause, the treatment will differ for toothaches.

For instance, you can use anti-inflammatory drugs such as ibuprofen which have been proven to be safe, efficacious, and cost-effective for the treatment of odontogenic pain. If the toothache is caused by an infection, antibiotics (such as amoxicillin, penicillin, azithromycin, cephalexin, clindamycin, and metronidazole) may be prescribed by the dentist.

If the pain is muscular in origin, then the patient may be advised gentle stretching of muscles, including muscles of the neck. Additionally, trigger point massage or release of trigger points may be advised. For visceral toothaches, a primary care provider (physician) may need to evaluate and provide treatment.

In addition to chemical drugs, medicinal plants can also be used for the treatment of toothache. Various species of medicinal plants have been used for the treatment of toothache for a long time. Medicinal plants such as Acmella caulirhiza, garlic (Allium sativum), horsewood (Clausena anisate), thorn apple (Datura stramonium), and bitter apple (Solanum incanum) are among the plant species that are often used for the treatment of toothaches. The content of secondary metabolites such as (flavonoids, alkaloids, tannins, saponins, and steroids) can be used as antiseptic, antioxidant, and analgesic agents. Clove oil can also offer temporary relief from toothache.

Toothache can be bothersome, but it can be prevented with proper oral hygiene. If you are experiencing a toothache, consult your dentist and/or primary care provider soon.

References

ADA, 'Toothpastes', American Dental Association, (2021) <https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/toothpastes> [Accessed 18th May 2022].

H.J. Bok, and C.H. Lee, 'Proper Tooth-Brushing Technique According to Patient’s Age and Oral Status', Int J Clin Prev Dent, 16 (2020), 149-53. K. I. Fukuda, 'Diagnosis and Treatment of Abnormal Dental Pain', J Dent Anesth Pain Med, 16 (2016), 1-8.

S. W. C. Koh, C. F. Li, J. S. P. Loh, M. L. Wong, and V. W. K. Loh, 'Managing Tooth Pain in General Practice', Singapore Med J, 60 (2019), 224-28.

S. Kumar, J. Tadakamadla, and N.W. Johnson, 'Effect of Toothbrushing Frequency on Incidence and Increment of Dental Caries:A Systematic Review and Meta-Analysis', Journal of Dental Research, 95 (2016), 1230-36.

Anita M. Mark, 'Dealing with Tooth Pain', The Journal of the American Dental Association, 150 (2019), 812.

Moa Megersa, Tilahun Tolossa Jima, and Kabaye Kumela Goro, 'The Use of Medicinal Plants for the Treatment of Toothache in Ethiopia', Evidence-Based Complementary and Alternative Medicine, 2019 (2019), 2645174.

T. Renton, 'Dental (Odontogenic) Pain', Rev Pain, 5 (2011), 2-7.

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