Tooth nerve pain can range from mildly annoying to physically debilitating. Working in a range of low-income, rural, suburban, and university clinics, I have seen my fair share of serious complications related to tooth pain.
In areas with low access to dental care it can be nearly impossible for people to have their dental needs met.
Depending on the severity of the pain and its associated symptoms, it can be a quick fix with over-the-counter products like toothpastes and mouth rinses.
Often, however, tooth pain represents some deeper underlying dental problems that may warrant more comprehensive treatment and ongoing care.
Needless to say tooth pain should not be ignored. Generally speaking, pain is a red flag that something has gone wrong. While a little gum recession can cause aching teeth and sensitivity to hot and cold, most severe tooth pain stems from more serious problems like fractures, dental abscesses, or cavities.
Tooth nerve pain is generally caused by inflammation or irritation of the central portion of the tooth, called the dental pulp. The dental pulp contains very sensitive nerve endings that are usually protected by other layers of the tooth, namely the dentin, cementum, and enamel. When these barriers are eroded or damaged, the nerve endings in the pulp of the tooth are exposed to stimulus, causing tooth pain.
Sometimes nerve signals come from areas other than the mouth and "feel" like tooth pain; this is called referred pain. Multiple systems share the facial nerves and can pass a pain signal onto the teeth. This referred dental pain is most common with TMJ issues, chronic ear infections, sinus infections, and heart problems. Conversely, many people with tooth pain actually feel it as ear aches, headaches, or jaw pain instead of as tooth pain.
Sensitivity to hot or cold generally represents more mild conditions such as gum recession or exposed roots. If the pain persists 15-20 seconds after exposure to hot or cold, a more serious issue is likely the cause.
Mild sensitivity to hot or cold should not persist longer than 15-20 seconds after the source of stimulus has been removed. For example, if you are sensitive to cold water but the pain goes away rapidly after exposure, this is a sign of mild sensitivity. Generally this type of pain is due to gum recession and exposed roots (dentin.) Over-the-counter products like Sensodyne toothpaste usually alleviate these symptoms. Generally no further treatment is needed.
If you are sensitive to hot, cold, or pressure and the pain persists long after the stimulus has been removed, this usually represents a more serious condition. Aching teeth that show signs of infection (swelling, pus/exudate, etc.) should always be looked at by a dentist or dental specialist. Even if you don't see obvious signs of tooth or gum infection, ongoing serious tooth nerve pain should be handled by trained dental professionals.
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