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Symptoms, Their Causes & Cures: Toothache

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Toothache

WHEN TO SEE YOUR DOCTOR

* You feel a sharp or recurring pain in one or more teeth.

* A tooth hurts when you eat or drink something hot.

* A painful tooth suddenly stops hurting.

What Your Symptom Is Telling You

In the old movies, if you had a toothache, they'd tie one end of a string to the bothersome bicuspid and the other end to a doorknob. And sooner than you could say "see ya later," the door would slam into the jamb and you were out of your jam.

Fortunately, in real life you can rely on better diagnosis and treatment. In fact, when your tooth aches, there are only a few likely causes.

Something as simple as a popcorn kernel lodged between two teeth could be causing your pain. More likely, though, the pulp inside your tooth has become infected and inflamed, according to J. Frank Collins, D.D.S., a dentist in private practice in Jacksonville, Florida. The inflammation either squeezes the tooth nerve or pushes against the periodontal ligament that holds the tooth inside your mouth, and that causes the pain, he explains.

A number of things can cause inflammation, including long-time neglect of brushing and flossing, a broken or loose filling, recent dental work, a cracked tooth or blows to the mouth. Usually the pulp darkens, and the discoloration shines through the outer layer of the tooth. The pain may rise up gradually or smack you in the face all of a sudden. It could feel like an electrical jolt, as with cracked teeth, or it may erupt and linger after you've eaten or drunk something hot or cold.

Even an old injury that you thought was relatively minor can come back to haunt you. You may never have realized that you damaged the nerve in a tooth during that fall you had when you were a kid, according to Lisa P. Germain, D.D.S., M.Sc.D., an endodontist in private practice in New Orleans. "But 30 years down the line, you could develop the symptoms." (Endodontists specialize in root canals.)

A tooth could also—on its own and with no forewarning—just decide to become inflamed, hurt and die, Dr. Germain says. "Like appendicitis, there's no way to predict when it will happen," she says, "but it's painful, and you have to have it taken care of by a dentist or orthodontist."

An overall dull ache in your teeth might be because you gnash and grind them while you sleep. And problems with how your jaw works may transfer pain to your teeth. Toothache could also be a symp-tom of a sinus problem. "If you can't figure out which tooth it is, it could be sinuses," says Van B. Haywood, D.M.D., an associate professor in the Department of Operative Dentistry at the University of North Carolina School of Dentistry in Chapel Hill. Because the roots of your upper teeth extend into the sinuses, any pressure up there pinches tooth nerves. "It's like sitting on your foot and it falls asleep," Dr. Haywood explains. (For more information, see Sinus Problems on page 458.)

Symptom Relief

If you're unwilling to try the string-tied-to-the-doorknob approach for the ultimate in toothache relief, there's not much you can do other than see your dentist. Here's what to do before your appointment.

Reach for the ibuprofen. Whether the tooth is dead or not, you're still feeling inflammatory pain, Dr. Germain says. And ibuprofen is an excellent anti-inflammatory drug that you can get over-the-counter. "I prescribe 600 milligrams of Motrin (a prescription brand of ibuprofen) for my patients, and that really does help a toothache," she says. "But you could take 400 milligrams of over-the-counter ibuprofen four times a day. The dosage is different, but the drug is the same."

Save aspirin for headaches. Aspirin and acetaminophen don't seem to have as great an effect on tooth pain, according to Dr. Germain. You certainly don't want to try the old cure of putting an aspirin directly on the throbbing molar. "Aspirin will burn your gums and the soft tissue inside your mouth," she cautions. "Don't do it."

Don't try to ignore it. Even if the toothache goes away, it will come back and torment you with a vengeance. If you ignore a pulsating toothache and the pain eventually vanishes, that probably indicates that decay or trauma has killed the nerve, Dr. Germain says. From there it's only a short step to a pus-filled abscess. "One day you'll wake up in severe pain with a huge swelling on your face," she says. "Don't assume that when the pain is gone the tooth has healed."

Don't munch on ice. Or unpopped popcorn, either. "They're the greatest ways to crack teeth and give you a toothache—more than automobile accidents or football or anything," Dr. Haywood says. Those hard popcorn seeds can hide in a handful scooped from the bottom of the bowl, he points out, and ice puts a brittle freeze on your teeth just before you bite down.

Put aside your fear. Contrary to how horribly anguishing everyone thinks they are, today's root canals, in which the dentist or endodontist removes the damaged tooth nerve and pulp, are painless, Dr. Germain says. "We're so good at making patients numb now that it doesn't hurt any more than the regular soreness of getting a filling," Dr. Germain says. "It only takes three seconds to remove the nerve inside the tooth, and then from there, we're working in an empty space."

See also Jaw Problems; Tooth Grinding

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