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Why Does My Tooth Hurt?

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Updated May 29, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

A toothache is no fun at all and can even be scary when you don't know what is causing it. A toothache is described as any pain, soreness or ache in and/or around a tooth. The tooth may be sensitive to temperature, painful when chewing or biting, sensitive to sweets, or it may even have a sharp pain or dull ache.

Diagnosing the Problem

Your dentist has several methods he will use to determine the cause of the pain. First, he will ask you several questions regarding the types of symptoms you are having. Is it sensitive to cold or heat? Does it hurt to eat? Has it woken you up in the middle of the night? These questions will help your dentist narrow down the possible causes for your discomfort.

Your dentist may also want to take an x-ray of the offending tooth to check for abscesses, cavities, or any other hidden problems. There are other tests a dentist sometimes performs to help diagnose a toothache. Such tests include a percussion test where the dentist will gently tap on areas of the tooth or surrounding teeth to help identify the precise location of the pain. A biting pressure test, using a “biting stick” or cotton tip applicator, may be used to determine what area of the tooth is causing the pain. The cold air test uses a gentle stream of cold air blown directly on the different areas of the tooth to figure out where the sensitivity is coming from.

Once your dentist has diagnosed the cause of your toothache, they will explain to you what is involved to fix the problem and possibly prescribe you medication to help alleviate the symptoms in the meantime. In cases of severe pain, it is often difficult to determine the exact cause. Of course, if left untreated, your symptoms will only worsen over time.

The Most Common Causes of Toothaches Are:

Tooth Decay

Also known as cavities, this condition refers to the decay of the outer surface (enamel) of the tooth. When plaque sticks to the tooth enamel, it feeds on the sugars and starches from food particles in your mouth. This produces an acid that eats away at the enamel, causing weak areas and holes. As the decay spreads inward toward the middle layer of the tooth (dentin), it can create symptoms such as sensitivity to temperature and touch.

Inflammation of the Tooth Pulp

Also called pulpitis, this condition means that the tissue in the center of the tooth (nerve/tooth pulp) has become inflamed and irritated. This inflammation causes pressure to build inside the tooth and puts pressure on the surrounding tissue. Symptoms of an inflamed tooth pulp can be mild to extreme, depending on the severity of the inflammation. Treatment for pulpitis is essential because the pain will only worsen.

Abscess

A dental abscess is caused by the buildup of bacteria inside the pulp chamber that becomes infected. This infection then tries to drain itself out of the very tip of the tooth root. The pressure from the draining infection causes a pain that can become severe with swelling if left untreated. Most abscesses can be seen visually on a dental x-ray.

Cracked Tooth

Your teeth can be weakened over time due to the amount of pressure from biting and chewing. The force from biting down on a hard object like ice or a popcorn kernel can sometimes cause a tooth to crack. Symptoms of a cracked tooth may include pain when biting or chewing, and sensitivity to hot and cold temperatures or to sweet and sour foods. Treatment for this condition will depend on the location and direction of the crack as well as the extent of the damage.

Impacted Tooth

Teeth can become impacted when they are prevented from moving into their proper position in the mouth by other teeth, gums or bone. The most common teeth to become impacted are the wisdom teeth because they are usually the last to erupt. When the jawbone cannot accommodate for these extra teeth, the teeth remain stuck under the gum. This impaction can create pressure pain and even jaw soreness.

Gum Disease

Also known as gingivitis and periodontitis, gum disease is characterized as an infection of the gums that surround the teeth. This infection eventually causes bone loss and deterioration of the gums. Gums become detached from the teeth, forming pockets that fill with more bacteria. Tooth roots are then exposed to plaque and become susceptible to decay and sensitive to cold and touch.

Sensitive Teeth

Sometimes you may notice that your teeth or a specific tooth is sensitive to cold air, liquids and foods. There are people who simply have what is known as "sensitive teeth," meaning your teeth may have developed a sensitivity linked to cold temperatures. Your dentist may have you start brushing your teeth with a special toothpaste made for teeth sensitivity, such as Sensodyne, to help alleviate your symptoms. He may also apply fluoride to your teeth (especially the parts of your teeth that meet the gum). Always let your dentist know when you are experiencing dental sensitivity of any kind.

Non-Dental Causes

Believe it or not, there are times when tooth pain or sensitivity has nothing to do with your teeth at all. For example, if you have a sinus infection or have sinus congestion, you may notice your teeth feeling more sensitive than usual. You may even have pain or discomfort that seems to be coming from several teeth, when in fact, the pain is caused by a sinus infection. This is especially true of your upper teeth, because they are located directly under your sinus cavities, and any pressure or pain from your sinuses can affect these teeth. If your dentist feels that this may be a possibility, he may have you try taking a decongestant to see if symptoms are alleviated or lessened.

Sources:

Academy of General Dentistry. The endodontic diagnostic puzzle. January 9, 2012. http://www.agd.org/support/articles/?ArtID=6515

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