The terms tooth pain, toothache, and dental pain are used interchangeably. Toothache is an unpleasant sensation in a tooth that goes beyond a sense of discomfort. According to a recent study, 9.1% of dental office visits associated with pain in teeth or surrounding tissue.
What are the types of dental pain?
Toothache in most cases is categorized as good pain. Yes, good pain because in tells us that a tooth or its surrounding structures has a problem and need attention. However, this type of pain also known as normal pain. Normal pain starts when the nerves inside or surrounding the tooth are irritated. Common sources of nerve irritation include excessive pressure, infection, extreme temperature changes (thermal stimulation) and sweet or acidic products (chemical stimulation).
What is the relation between oral hygiene and dental pain?
Maintaining good oral hygiene is essential to preventing toothache. Thorough and regular brushing and flossing should be a life-time habit for everyone. Regular visits to the dental office for teeth cleaning and check-up exams are necessary for maintaining healthy teeth and gums. Visual oral examination and dental x-rays usually help detect early dental problems and stop dental pain before it starts.
Comprehensive dental and oral evaluations save lives by detecting early signs of life-threatening conditions such as oral cancer. A well-trained dentist can spot early tissue changes associated with disease. Advanced imaging such as CT scans and tissue biopsies may be recommended to reach final diagnosis.
What common conditions are associated with toothache?
Dental pain is usually associated with conditions like cavities, dentine exposure, tooth fracture, tooth cracks (cracked tooth syndrome), defective restorations, gum recession, gum abscess, or infection. Other causes of toothache include microtrauma resulting from teeth clinching and grinding.
Pain after tooth extraction is normal, but severe pain starting the second or third day after tooth extraction might happen. This pain is usually caused by loss of the blood clot inside the healing socket, a condition known as dry socket syndrome. Dry socket is most common in young females but can happen to anyone regardless of gender or age.
What is neuropathic pain?
Normal or physiologic pain should disappear after removing the causing factor and after the wound heals. Pain that stays after healing or starts without a known cause is called pathologic pain or neuropathic pain.
An example of a neuropathic pain is phantom pain syndrome. This syndrome describes pain that is felt in a body part that is no longer there– for example, pain in a leg that has been amputated. In the mouth, neuropathic pain is not unusual. Some examples of neuropathic pain are:
- Atypical toothache in which a tooth starts hurting and the pain continues for an unknown reason.
- Primary burning mouth syndrome or burning tongue syndrome in which patients feel that their mouth is on fire. This condition is one of the hardest to treat. Dr. Khalifeh is an experienced orofacial pain specialist and one of the few dental specialists in this country who is trained and capable of managing burning mouth syndrome.
- Neuralgias, neuropathic conditions associated with severe electric-like pain in the offended nerve. Trigeminal neuralgia and glossopharyngeal neuralgia are two neuralgias affect the oral-facial region.
How are neuropathic pain conditions treated?
Diagnosis and management of neuropathic pain is challenging. Patients with neuropathic pain conditions are treated with medications that are not commonly used for normal pain conditions. Vascular decompression brain surgery and gamma knife surgery may be used to treat patients suffering from neuralgia. Non-conventional treatments such as deep brain stimulation, Botox, acupuncture, and TENS (trans dermal nerve stimulation) devices are among other options used to manage neuropathic pain conditions.
What is referred pain?
Another pain category is known as referred pain, which describes pain originating in one part of the body is felt in a different part. Referred pain is very common in the mouth and face area. The following are some examples of referred pain:
- A toothache or pain in the TMJ (Temporomandibular joint) felt as pain in the ear.
- Pain in the jaw as a symptom of a heart attack or angina.
- Masticatory muscle injury presenting as a toothache. A recent study found that 17% of teeth pain are actually referred muscle pain.
- Sinus infection presenting as a toothache on the upper teeth.
- Headache as a symptom of a tooth problem.
The subject of pain is complex. As much as we hate being in pain, pain is necessary for our survival. If we don’t feel pain, we may not be able to tell when our body is hurt and in need of attention.
Is it a toothache, tooth pain, dental pain or something else?
Most pain cases managed in dental settings fall under in the category of normal pain. Only a well-trained orofacial pain specialist can recognize and manage non-dental pain that is felt as a toothache. Recognizing the pain source can help prevent the wrong treatment and save money, time, and suffering.
If you have a toothache, be sure that your dentist recognizes the type of pain you have before doing any dental treatment.
About the author:
Dr. Mohammad Khalifeh is a renowned Orofacial Pain specialist and TMJ specialist practicing dentistry at his Mid-Wilshire dental office in Miracle Mile district of Los Angeles, California. Dr. Khalifeh has also been an educator at the Herman Ostrow School of Dentistry of the USC for over 25 years. He is the director of the USC board preparation course for the American Board of Orofacial Pain.
Special thanks to Zain Khalifeh for editing this article.