toothache

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Definition

A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection.

Description

A toothache may feel like a sharp pain or a dull ache. The tooth may be sensitive to pressure, heat, cold, or sweets. In cases of severe pain, identifying the problem tooth is often difficult. Any patient with a toothache should see a dentist for diagnosis and treatment. Most toothaches get worse if left untreated.

Demographics

Toothaches are common. Yet people have fewer cavities on average in the early 2000s than they did in the nineteenth or twentieth century, in part because in the late 1900s many towns added fluoride to the drinking water and many dentists began prescribing fluoride tablets as a preventative measure. Fewer cavities and better tooth health have reduced the number of toothaches.

Causes and Symptoms

Toothaches may result from any of a number of causes:

• tooth decay (dental caries)
• inflammation of the tooth pulp (pulpitis)
• abscesses
• gum disease, including periodontitis
• loose or broken filling
• cracked or impacted tooth
• exposed tooth root
• food wedged between teeth or trapped below the gum line
• tooth nerve irritated by clenching or grinding of teeth (bruxism)
• pressure from congested sinuses
• traumatic injury

When to Call the Doctor

If the toothache lasts for more than 24 hours an appointment with the dentist should be made. If there is fever, swelling, intense pain, or bleeding in addition to the toothache the dentist should be seen right away.

Diagnosis

Diagnosis includes identifying the location of the toothache, as well as the cause. The dentist begins by asking the patient specific questions about the toothache, including the types of foods that make the pain worse, whether the tooth is sensitive to temperature or biting, and whether the pain is worse at night. The dentist then examines the patient's mouth for signs of swelling, redness, and obvious tooth damage. The presence of pus indicates an abscess or gum disease. The dentist may flush the sore area with warm water to dislodge any food particles and to test for sensitivity to heat. The dentist may then dry the area with gauze to determine sensitivity to touch and pressure. The dentist may probe tooth crevices and the edges of fillings with a sharp instrument, looking for areas of tooth decay. Finally, the dentist may take x rays, looking for evidence of decay between teeth, a cracked or impacted tooth, or a disorder of the underlying bone.

Treatment

Treatment depends on the underlying cause of the toothache. If the pain is due to tooth decay, the dentist will remove the decayed area and restore the tooth with a filling of silver amalgam or composite resin. Loose or broken fillings are removed, new decay cleaned out, and a new filling is placed. If the pulp of the tooth is damaged, root canal therapy is needed. The dentist or a specialist called an endodontist removes the decayed pulp, fills the space left behind with a soothing paste, and covers the tooth with a crown to protect and seal it. If the damage cannot be treated by these methods, or if the tooth is impacted, the tooth must be extracted. If the dentist finds an infection, antibiotics are given to treat it.

Toothaches should always be professionally treated by a dentist. Some methods of self-treatment, however, may help manage the pain until professional care is available:

• rinsing with warm salt water
• using dental floss to remove any food particles
• taking acetaminophen (Tylenol) or ibuprofen (Advil) to relieve pain (Aspirin is not recommended for children because of the risk of Reye's syndrome.)
• applying a cold compress against the outside of the cheek
• using clove oil (Syzygium aromaticum) to numb the gums (The oil may be rubbed directly on the sore area or used to soak a small piece of cotton and applied to the sore tooth. Clove oil should not be put on the tongue because it often burns or stings.)

Alternative Treatment

Toothaches caused by infection or tooth decay must be treated by a dentist. Several alternative therapies may be helpful for pain relief until dental treatment is available. Clove oil (Syzygium aromaticum) may be rubbed on sensitive gums to numb them or added to a small cotton pellet that is then placed into or over a hole in the tooth. The herb corydalis (Corydalis yanhusuo) may also help relieve toothache pain. Pain also may be reduced by using acupressure, acupuncture, or reiki.

Prognosis

Prompt dental treatment provides a positive outcome for toothache. In the absence of active infection, fillings, root canal treatments, or extractions may be performed with minimal discomfort to the patient. When a toothache is left untreated, a severe infection may develop and spread to the sinuses or jawbone, and eventually cause blood poisoning.

Prevention

Maintaining proper oral hygiene is the key to preventing toothaches. The best way to prevent tooth decay is to brush at least twice a day, preferably after every meal and snack. Flossing once a day also helps prevent gum disease by removing food particles and bacteria at and below the gum line, as well as between teeth. Children should visit the dentist at least every six months for oral examinations and professional cleaning. Dentists often recommend that children see the dentist for the first time before they are one year old. Parents should help young children brush their teeth. Fluoride is also very helpful in preventing tooth decay. If the town's water is not fluoridated, the parent should ask the dentist for fluoride supplements.

Parental Concerns

Toothaches are most often caused by cavities. If not treated promptly an infection could begin or spread. If infection spreads to the blood, serious complications can result.

Resources

Books

Bagley, Katie. Brush Well: A Look at Dental Care. Decatur, IL: Capstone Press Inc., 2001.

Diamond, Richard. Dental First Aid for Families. Ravensdale, WA: Idyll Arbor Inc., 2000.

Keller, Laurie. Open Wide: Tooth School Inside. New York: Henry Holt & Co., 2003.

McDonald, Ralph E., et al. Dentistry for the Child and Adolescent. St. Louis, MO: Mosby, 2004.

Periodicals

Goldstein, Laura. "Two Ways to Soothe Sensitive Teeth." Prevention 52, i.11 (November 2000): 161.

Organizations

American Dental Association. 211 East Chicago Ave. Chicago, IL 60611–2678. Web site: www.ada.org.

Web Sites

"Understanding a Toothache." Available online at www.floss.com/understanding_a_toothache.htm (accessed October 15, 2004).

[Article by: Tish Davidson, A.M. Bethany Thivierge]

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The following charm was collected by M. A. Denham in the north of England in the 1840s (Denham, 1895: 9-10):

Peter was sitting on a marble stone
And Jesus passed by
Peter said, ‘My Lord! My God!
How my tooth doth ache!’
Jesus said, ‘Peter art whole!
And whoever keeps these words for my sake,
Shall never have the toothache!’ Amen.

Others report similar stories, adding that to be effective the words should be written on a piece of paper and worn round the neck. Opie and Tatem reprint a Latin version from c.1000 AD, and an East Anglian version from 1957. Aubrey (1686/1880: 164-5) reports a more gruesome cure: ‘I remember at Bristow (when I was a boy) it was common fashion for the woemen, to get a Tooth out of a Sckull in ye churchyard, wch they wore as a preservative against the Tooth-ach’, and more prosaically, the use of ginger at the same period (he was born in 1626).

See also TEETH, TOOTH FAIRY.

Bibliography
The full bibliography list is available here.

• Opie and Tatem, 1989: 411-12
• Forbes, 1971: 293-316

IN BRIEF: A pain making it hard to chew or bite.

Love conquers all things except poverty and toothache. — Mae West (1892-1980)

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n

Pain located in the tooth or its surrounding supporting tissues. Dental pain may have a halo effect, making location of the precise source or location of the pain difficult. Determining the location may require several diagnostic tests.

For a list of words related to toothache, see:

• Signs and Symptoms - toothache: pain associated with teeth, gums, and surrounding tissue, usu. due to tooth decay or caries

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See words rhyming with "toothache."

  See crossword solutions for the clue Toothache.

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - tandpine

Nederlands (Dutch)
tandpijn, kiespijn

Français (French)
n. - mal de dents, rage de dents

Deutsch (German)
n. - Zahnschmerz

Ελληνική (Greek)
n. - πονόδοντος

Italiano (Italian)
mal di denti

Português (Portuguese)
n. - dor de dentes (f)

Русский (Russian)
зубная боль

Español (Spanish)
n. - dolor de muelas

Svenska (Swedish)
n. - tandvärk

中文（简体）(Chinese (Simplified))
牙痛

中文（繁體）(Chinese (Traditional))
n. - 牙痛

한국어 (Korean)
n. - 치통

日本語 (Japanese)
n. - 歯痛

العربيه (Arabic)
‏(الاسم) وجع ألسن أو ألاسنان‏

עברית (Hebrew)
n. - ‮כאב-שיניים‬

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