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What Causes a Toothache?

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Updated July 03, 2014

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

When you have a toothache, every movement, thought, sound -- even touch -- is overshadowed by throbbing pain of a toothache. If you have a toothache and are not sure what could be causing it, continue reading.

Tooth Decay

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Untreated tooth decay is a gateway to a host of serious dental problems that may result in a toothache. While a cavity may not cause significant tooth pain, the consequences of untreated tooth decay leads to potentially painful bouts of tooth pain.

Small cavities that only involve the enamel are usually painless, and generally go undetected by the patient. Once the decay penetrates through the enamel, it invades the dentin layer of the tooth. At this point the cavity is likely just cold- and sweet-sensitive. As the decay progresses deeper into the tooth, the pain intensifies. Pain from a toothache caused by a cavity is best described as sharp and intermittent.

Tooth Abscess

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An abscess forms when an infection develops just below the root of the tooth, when the pulp of the tooth has become infected. An abscess is comprised of pus, which is essentially white blood cells, dead tissue, and bacteria. When an abscess appears on a dental x-ray, it looks like a small, round, bulb. This pocket of infection, along with the inflammation of the tissues inside of the tooth, causes a very painful type of toothache -- often described as throbbing and pulsating, with intermittent sharp pains. Many people with an abscessed tooth have a difficult time identifying the exact tooth that is causing the pain, and it doesn't always show up on x-rays

Untreated tooth decay and advanced gum disease are common causes of tooth abscess.

Gum Disease

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Gum disease doesn't necessarily cause a toothache, although advanced gum disease may cause pain in the mouth that may be interpreted as a toothache.

When the early stages of gum disease, known as gingivitis, begin to progress, the bacteria responsible for the infection causes inflammation of the tissues. This inflammation may cause a dull pain in the area where the gums are infected. In serious cases of gum disease, known as periodontitis, a gum abscess may occur. This abscess is similar to an abscessed tooth, only the pocket of infection is on the outer tissues in the mouth. Pain from advanced gum disease, and a gum abscess may be described as a throbbing, dull pain, that increases in severity when the area is stimulated.

Wisdom Teeth

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A toothache caused by the wisdom teeth is very common. In fact, the development of a toothache in the area of the wisdom teeth generally indicates the need to have your wisdom teeth extracted.

An impacted wisdom tooth may cause a toothache that is described as throbbing, with bouts of sharp pain. The pain is generally because the tooth is trying to erupt into the mouth, but it is unable to because there isn't enough room, or because it's in an undesirable position. A tooth that is cutting through the gum may also cause a toothache -- similar to when a child is teething.

Cracked or Broken Tooth

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A cracked or broken tooth is often responsible for a severe toothache. How the tooth is cracked or broken also affects the type of toothache you may develop.

When there is a small crack or break in either the natural tooth or a filling, bacteria is able to enter the tooth and cause decay to form. When a tooth has a substantial break, it is possible that the nerve of the tooth has become exposed. A dull, persistent pain is often the outcome. When a tooth has a cracked root, a toothache is inevitable. Similar to a cracked or broken filling, the toothache is usually described as a dull, aching pain that has intermittent bouts of sharp, painful jabs in the gum area of the tooth.

TMJ and Malocclusion

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Temporomandibular Joint disorders, and/or a misaligned bite, known as malocclusion, often cause toothaches in teeth that appear to be healthy.

When your jaw or teeth are misaligned, the forces exerted on the teeth are not distributed evenly. The extra forces on the teeth may cause inflammation in the nerve of the tooth, which in turn may cause a toothache.

TMJ disorders and misaligned bites also cause patients to clench or grind their teeth. Grinding the teeth wears away the enamel surface of the tooth, exposing the dentin layer, which causes pain from sensitivity to temperature. Grinding and clenching the teeth may also cause teeth to fracture, which may result in the loss of natural tooth structures, or cause restorations to break. Clenching and grinding aches may be felt more during the night or you wake up, and tend to get worse during stressful periods in your life.

Sinus Cold or Infection

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Sinus colds and infections, known as sinusitis, are notorious for causing a toothache on a otherwise healthy tooth.

Your sinus cavity sits just above your upper jaw. The roots of your maxillary teeth come within millimeters of your sinuses. When you have a sinus cold or sinus infection, the pressure from your sinuses is often referred to one or more upper teeth. A dull aching pain that may be sensitive to pressure often occurs. Keep in mind that once your sinus infection subsides, the toothache will go away as well, and there will not be any permanent damage to the tooth or teeth in question. Sinus infections that mimic toothaches should clear up within 48 hours of taking antibiotics. If the tooth remains painful, see your dentist.

Dental Treament

Having dental work completed, such as a root canal, may leave you with a toothache. This may sound contradictory to what dental treatment is intended to do, but there are many dental procedures that may leave you with a small toothache for a day to two after the treatment has been completed. Many patients feel varying degrees of pain or discomfort after dental treatment and, understandably, often feel disappointed -- because they spend a great deal of money to treat a toothache, not create a new one. If the pain doesn't subside, see your dentist.

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