Anyone who has experienced a toothache will tell you it is one of the worst pains they have ever had.  I’ve had numerous women tell me they would rather experience childbirth than have a toothache!  In the past we have talked about sensitivity, but this week I will discuss a different kind of pain – one that lasts and is often unbearable.  There are a lot of things that can cause a tooth to hurt.  The two most common causes are decay and gum disease.  The good news is that with preventive care most of these toothaches can be avoided, the bad news is that most people often wait until it is too late.  By the time you feel pain, permanent damage to your tooth or supporting structures has already occurred.  Wouldn’t it be nicer to have a quick, tiny filling now than a root canal, crown or extraction later?  I thought so!

Dental Abscess

We all have bacteria in our mouths that show up in the form of plaque.  If not removed, the bacteria can erode the surface of a tooth creating a cavity.  The decay will eventually progress to a point that it involves the nerve of the tooth and an abscess will ultimately occur.  An abscess is an infection caused by the “death” of the nerve and blood vessels that supply the tooth.  As the tissue dies it creates an infection that is forced out the end of the root.  The infection causes pressure to build at the end of the root and then comes the pain.  It’s common for the pain to come and go a few times until it eventually hurts and doesn’t go away.  As an abscess progresses, it erodes the supporting bone at the end of the root creating a “hole” that shows up on a radiograph (x-ray).  Left alone, the infection will either cause swelling of the face or create a drain hole in the bone called a fistula.  A root canal or extraction are the treatment choices when the disease has progressed to this point.

Periodontal (Gum) Abscess

The bacteria in our mouths are also responsible for a painful abscess of the gums.  Most people think a tooth is fused directly to the bone, but it isn’t.  All teeth have a ligament that attaches it to bone.  Think of it as a sock that covers the root of a tooth.  The sock attaches between the tooth and the bone.  It’s a wonderful system the good Lord created because it acts like a “shock absorber” that can protect the teeth.  The gums we see in our mouth don’t intimately attach all of the way up a tooth.  At the very top it lies next to the tooth and creates a “pocket” just above the supporting ligament (sock).  A way to visualize it is to think of the lower part of the sock as being glued to the tooth, while the upper part (where the elastic of a sock would be) hugs to the tooth, but isn’t attached.  Plaque (bacteria) collects in the pocket and secretes acids and toxins that erode the ligament (glue) and dissolves bone creating a deeper pocket that is difficult to clean.  It usually isn’t painful in the early to moderate stages of the disease but as the pocket deepens it progresses into a painful infection of the gums.  By the time you have pain from an abscess of the gums, typically the only treatment alternatives are periodontal (gum) surgery or extraction.  Having your teeth professionally cleaned and examined on a regular basis is crucial to prevention of the disease and avoidance of pain.

Next week, I will cover other causes for a painful tooth.