The following observations are intended as general information for the public based on over one hundred thousand individual cases over thirty years. This is not intended to serve as a guide for self-diagnosis or as a substitute for an examination by a dentist.
Dental decay is usually painless as it goes thru the enamel, the outer layer of the tooth.
The tooth can become “sensitive” as decay moves into the “live” dentin (inner layer) of the tooth…. sensitivity to sweet and sour as well as hot and cold is common but the tooth should not be continuously“sore” or “throb”. As the decay process gets near the nerve of the tooth , the intensity and frequency of the symptoms usually increase.
Once the decay process has reached the nerve of the tooth, extreme pain can occur at any time…the intensity can range from moderate to a very severe…extreme throbbing pain can be continuous and can resist oral pain medication. This kind of pain could subside during thedaylight hours but is typically much worse during the evening and night. Once a toothache wakes you from sleep it is often relentless .
By definition, a dental abscess is a localized collection of “pus”or infected material in the area surrounding the root end of the offending tooth…pressure built up in this area can cause severe pain that can be referred to other teeth as well as other areas of the mouth and face. Its not unusual for the patient not to know for sure where the pain is coming from or which tooth is the problem. This abscess can enlarge and extend to surrounding teeth…if the infection goes through the bone, rapid swelling of the gum and cheek can occur.
Cracked Tooth Syndrome
A very common problem with “root canal teeth” and teeth with large fillings .
Toothache due to a crack will start when you chew or put pressure on the tooth … it will get worse as the crack continues to enlarge. …the fractured piece may feel loose or actually fall off and an abscess can develop at any time. Its easy to visualize the mechanics of the problem – picture an ice cube or piece of glass with a crack…….every time you apply pressure or tap on top of the ice or glass, the crack will get bigger until the crack goes completely through. Pain from a cracked tooth can start as an occasional” twinge” or “zinger” or it can be sudden and severe and continuous from the very start.
P-Cor ( Pericoronitis )
This very common and painful condition is usually seen with a partly erupted wisdom tooth. Because there is not enough room for the tooth to come in completely, it becomes “stuck” or “wedged”. A pocket or sack develops in the gum tissue around and behind this tooth. This pocket quickly fills with bacteria and food debris. Because the mouth is moist, warm and dark (it’s a perfect incubator) an abscess can form rapidly. This pain can be very severe and continuous, and is commonly sent to (referred to) the area around the ear. Pain when opening or even severe limitation when trying to open the mouth in common. We often see patients coming from an ear doctor when their real problem was a wisdom tooth .
Wisdom teeth are the last molars to develop and usually start to erupt in the late teens. Because they are the very last teeth, they very commonly become impacted (stuck or wedged between jaw bone, gum and the adjacent tooth) . Toothache or pain from the wisdom tooth area is one of the most common emergency problems that we see.
Over 90% of the population has “wisdom tooth”problems due to lack of room for proper eruption. Wisdom Tooth Problems encompass many issues including:
Pain Constant pressure in this sensitive area frequently causes neuralgia-like pain that can radiate to the ear, side of the face and upper teeth and spread to the other lower teeth as well. Headaches are commonly associated with impacted or partially erupted wisdom teeth.
Destruction of the Next Tooth -pressure from the wisdom teeth frequently erodes or dissolves away healthy tooth structure, resulting in pain and tooth loss
Cysts...fluid -filled sacks can form and enlarge around impacted wisdom teeth. These cysts can dissolve jawbone and teeth-they commonly become infected and cause serious pain
Crowding. Impacted wisdom teeth can quietly and painlessly push other teeth out of alignment and ruin years of orthodontic treatment. Cosmetic correction could require involved orthodontic work.
Gum Abscess (Periodontal Abscess – Perio Abscess)
This infected tooth may be completely free from decay and have no filling…it may feel loose and the surrounding gum can feel swollen ….a bad taste is a common feature . A defect in the supporting bone along one or more sides of the tooth forms a “pocket” with the gum that becomes filled with food and bacterial debris….an abscess can develop “overnight”. Mild sensitivity in the area can escalate to severe pain and swelling involving several teeth.
Overloaded/Over-stressed Tooth (Hyper Occlusion or Traumatic Occlusion)
Moderate to sharp discomfort to touch or pressure most commonly seen after placement of a dental filling or crown that is too “high”…. can be easily corrected by adjusting the offending filling or crown and bite.