Dear Dr. Mady: I am a person who rarely goes to the dentist but I have been having a toothache off and on for three weeks. What causes a toothache and what should I do? - Jamie in River Canard
Dear Jamie: There are several possible causes for a toothache. It generally is caused when the pulp (nerve) of a tooth becomes inflamed or irritated by some stimulus.
Most often this irritation is from decay but may be a result of trauma, periodontal (gum) disease or some other causative factor. If your tooth has a cavity that is very deep, it may be encroaching on the pulp or the nerve of the tooth. As the cavity progresses it will eventually work its way to the pulp through the enamel and the dentin layers of your tooth. Cavities in enamel tend to progress at a slower rate but once they penetrate the next layer (dentin), it is much softer and allows quicker access to the nerve.
The pulp of a tooth is basically made up of nerve fibers and blood and once it is contaminated by a cavity or some other source, it first becomes very irritated and inflamed from this assault. This creates pressure within the tooth. Often, if untreated, this pain may eventually decrease over time as the pulp becomes necrotic or dies.
So your tooth is actually a living part of your body. The bacteria from decay that can attack your tooth and its pulp may often cause no pain and even go unnoticed, or the tooth may just be sensitive to temperature and sweets. If this is the case, a restoration or filling alone may cure the problem and allow the sensitivity to disappear.
If the cavity is left untreated, which is probably the situation here, it will eventually reach the center of the tooth with or without symptoms. The result at some point will be an abscess forming at the end of the root of the tooth in question (this is because the bacteria infects the pulp). The appropriate treatment at this stage is root canal therapy or extraction. The toothache you are feeling is from the pressure in the nerve of the tooth from either an infection or inflammation.
Many feel that a simple filling will solve their problem. The truth is that if a tooth aches with or without a stimulus, and if the pain persists for any period of time, then there usually is irreversible nerve damage to the tooth.
A root canal procedure is a more optimal treatment option for you, assuming your dental health is stable, structurally and periodontally. This involves removal of the nerve and blood supply, irrigation and disinfection of the canal that they sat in and then filling that canal with a rubber-like material. Then usually a crown (sometimes called a cap) or a covering made of metal, porcelain, or both is placed over the tooth to restore and preserve some of the strength lost from the root canal.
At other times, toothaches may be caused by gum problems around a tooth, or from spaces between teeth where food impaction can occur. Periodontal disease, periodontal abscesses and pericornitis cab cause and mimic toothaches also. Pericornitis is a soreness (from inflammation or infection) of the gum tissue over wisdom teeth as they try to erupt. It is commonly an intermittent problem. Take a trip to your dentist to determine the exact cause and get all your treatment options.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5