One of the things that is most hated by the people is a toothache. This is often the reason why we visit dentists.
While the most common reason for toothache is a deep cavity, toothache does not always due to the tooth itself. There are a lot more reasons causing the tooth pain, it can be as small as a cavity to the pain arising from other parts of the body.
Before we go into possible causes of toothache, let’s have a look at how a cavity is formed and how a cavity causes pain.
How does a cavity form?
A cavity does not form overnight. Bacteria in our mouth, when fed with sugar from our diet, secretes acid. This acid attacks our enamel (outermost layer of the tooth).
The good news is that this acid attack can be neutralized by saliva and by effective brushing. This cycle of acid attack and neutralization repeats every day.
However, things can go bad when a person has a frequent snacking habit, a sugary diet, and ineffective brushing. These activities increase the acid attack to the enamel. Over time, the enamel is broken down and a cavity is formed.
Does a cavity always cause pain?
An initial cavity within enamel (outermost layer of the tooth)
If the cavity continues, it progresses into the deeper layer.
If the cavity is left untreated, the pulp (which contains the nerve) becomes dead.
The infection spreads into the bone surrounding the tooth.
Visit here for different tooth pain symptoms and possible problems.
Can a toothache be something else?
Yes, a toothache can be something else.
It is important to recognize the source of toothache, especially when the pain is not coming from the tooth. This will avoid unnecessary treatment to the tooth.
Not surprisingly, there were cases where the patients suffered from pain and went for the dental treatment. However, the dental treatment provided was not solving the underlying problem. Below are some common causes of “toothache” that is not due to the tooth:
#1 Gum inflammation / food impaction
Many people are not aware that gum inflammation can bring discomfort. Pain from gum disease is usually more of a dull pain compared to the deep decay involving the tooth nerve (this typically has a sharp pain). However, food impaction between the teeth can also give a sharp pain.
#2 Chewing muscle pain
We have several muscles that aid in chewing. These chewing muscles can be tensed especially when they are overused or under stress. Muscle soreness can be confused with toothache.
Hereby, we would like to mention a term called “referred pain”. Not going into depth but for understanding, our brain processes nerve messages from different parts of the body. These nerve messages from different areas may be bundled together and sent for interpretation [1] [2]. The brain may misinterpret the location of the sources that are sending those messages. That is the reason why we feel that pain is from the tooth but the culprit is somewhere else.
#3 Sinusitis
Not only chewing muscles can refer pain to the tooth, but the sinus can refer pain too. The pain from sinusitis is usually dull and it is around the cheekbone. It also commonly feels like multiple toothaches on the upper back teeth.
#4 Neuropathic pain
Neuropathic pain means there is a disease affecting the nerve. In other words, no one is sending the pain messages, not even the tooth. It is the nerve disease that makes a non-painful sensation being interpreted as a painful sensation. (Not to be confused with referred pain which the nerves are perfectly alright).
One of the most heavily studied neuropathic pain in dentistry is trigeminal neuralgia. Patients affected by trigeminal neuralgia may experience severe facial pain from a light touch, a slight movement, or even a breeze. When the pain of trigeminal neuralgia is only around the teeth, it can be confused with multiple toothaches.
#5 Heart pain
Yes, heart pain can be felt as a toothache. It seems to be not logical but the idea behind goes back to referred pain. This could be the most critical source of pain to be differentiated from other pain sources as heart pain can be dangerous.
This does not mean that everyone who is experiencing a toothache is having the possibility of a heart attack. This pain category should be considered in the people who has or had heart disease. This type of pain is felt more intensely during exercising, and it could be relieved by resting. It may also come with other symptoms such as chest pain, arm pain or neck pain [3].
#6 Psychogenic toothache
This pain category is unlikely in patients who experience acute pain (short-term pain), but it has to be considered in chronic pain (long-term pain) patients.
When every other possible cause is ruled out, the psychogenic cause may play a big role in toothache. This statement does not mean that the patient fakes the pain but it is the brain that enhances or even maintains the pain perception. Recognizing this pain is important because its management may involve different disciplines of professionals in treating the patient.
How do I recognize that it is a toothache due to a cavity?
Fever, pain, and swelling with pus are some of the typical signs of ongoing infection. Usually, the presence of a deep cavity would suggest the toothache is linked to the cavity. History of deep filling also suggests there could be infection happening underneath the deep filling.
Visit here for signs of a cavity under the filling.
It is when the tooth looks perfectly fine that may raise our suspicion of a toothache that is not caused by the tooth. However, the decision of diagnosing the tooth pain should be in the dentist’s hand. Visit your dentist for professional advice on your toothache.
How do dentists confirm the source of pain?
Firstly, the pain history has a big role. Different pain symptoms signify different types of disease. From history taking, dentists may have ruled out or confirmed some causes of the toothache.
For patients with long-term toothache, a big hint that the source of pain could be somewhere else is a history of multiple treatments that do not relieve the pain.
Next would be from the examination. Dentists may suspect the toothache is not tooth-related when the local cause does not explain the nature of pain. There could be the presence of a small cavity, but a small cavity that involves only enamel usually does not cause pain since enamel has no nerve supply.
Investigations such as thermal test and dental X-rays are important to rule out the causes. Tapping the tooth or applying the thermal test is to see if we can reproduce the pain of what a patient felt thereby confirming the pain comes from the tooth. Any abnormal investigation result may raise dentist’s suspicion of the source of toothache.
What should I do if I have a toothache?
The answer is straightforward: visit your dentist. A toothache should not be taken for granted. Even if the pain is dull, do not leave it unattained.
Your dentist will diagnose if your pain is tooth-related or non-tooth-related. An appropriate and necessary investigation will be carried out to rule out the cause. They may make referrals to specialists if they feel the pain is most likely not tooth-related.
Conclusion
This article serves as a light-up for you that a toothache can be more than just a cavity. The causes of toothache might not always be straight forward but identifying the true pain source by a professional will help you in managing the pain. Thus, for the best of your oral health, I advise everyone reading this article to take the toothache seriously by seeking help from the dental professionals.
References
- Fukuda K. I. (2016). Diagnosis and treatment of abnormal dental pain. Journal of dental anesthesia and pain medicine, 16(1), 1-8. Link
- Soni, A. (2018). Toothache of Non-Dental Origin: A Review of Its Mechanism and Clinical Characteristics. International Journal of Scientific Study, 6(2).
- Ravikumar, K., & Ramakrishnan, K. (2018). Pain in the face: An overview of pain of nonodontogenic origin. International Journal of Social Rehabilitation, 3, 1-5.
