Toothache

As a toothache refers to a usually strong, continuous pain feeling that emanates from the teeth. Inflammation of the gums / periodontal apparatus or the like are often indirectly added in, which usually go the infested zones and nerve irritation hand in hand. Emanating from the tooth or periodontal ligaments inflammation are referred to as odontogenic infections.

Causes

Despite their seemingly solid, robust structure include teeth to the body parts that can cause severe pain in case of illness or injury. This is due to the rich and sensitive nerve strands, each individual tooth. This is already on the sensitivity of the teeth to hot or cold food at its inclusion in the mouth. Particularly evident and significantly this painful irritation is at exposed tooth necks, since the protective enamel missing. Without enamel may have a specific pressure rise to about a finger nail on the appropriate locations slight stinging irritation, especially if the injury is still relatively fresh.

Causes of tooth pain are, inter alia, lack of enamel caries and inflammatory diseases such as periodontal disease, but of course purely mechanical injury and damage. This includes not only the gnashing of teeth, but also ill-fitting crowns, among whom but also an inflammatory disease may be present. It will foster disease of the teeth and mouth from all other relevant organs by the high level of microorganisms, especially bacteria, which are due to the food -absorbing function in the oral cavity. Food debris, moisture, and the relatively low density of endogenous antibodies ( also in saliva ) provide a favorable natural environment for economic foreign fauna.

In rare cases it may be the only symptom of a heart attack occurring acute dental pain.

Differential Diagnosis

The history of pain quality and pain quantity serves the dentist along with the percussion test, the vitality test and the radiograph for differentiating between caries, pulpitis and apical osteitis.

Caries

When tooth decay (Fig. 1) there are usually a pain provoked, usually by sweet, rarely by sour. Salty solutions are virtually out of the question, even though these just as sweet solutions exert an osmotic pressure and thus can cause pain. However, the human taste only tolerate much lower concentrations of salt solutions (approximately 1 % solution ) than to sugar solutions (approx. 30 % solution or a lot more ). Typical is the lack of spontaneous pain in tooth decay. If it is not eaten, at night for example, then there is no pain. The vitality test is negative. The percussion sample ( knock specimen) is negative. Typical tooth pain after sweet pain triggers sound after a few minutes again.

Pulpitis

When pulpitis (Fig. 2) occurs on spontaneous pain - for example, even at night. The pain attacks typically begin abruptly and last much longer than in the caries. Between the attacks of pain, there are breaks with relative freedom from pain. Initially take this pain-free intervals for several hours, in the course of a few days but they are reduced to a few minutes. In contrast, the duration of pain attacks is initially just a few minutes, then extended but continuous. Often there is also a continuous pain. The typical course of pain of pulpitis are encountered only in 50% of pulpitis. Many variants are possible. A vitality test helps in pulpitis mainly to locate the affected tooth, but less so for the differentiation between caries and pulpitis. In a pulpitis often occur very severe pain, which may radiate, so that the patient's localization can be very difficult. He can often specify only the affected side, but not whether the cause is for the pain in the upper jaw or the lower jaw, and certainly, which tooth is responsible. Who rely solely on the information provided by the practitioner patients, treatment can easily apply a false tooth. He will look especially teeth with carious defects or teeth with large or defective fillings as "suspicious " and may produce an x-ray for detection of hidden caries.

Apical osteitis

Typical of the quality of pain at the apical osteitis (Fig. 3) is the addition of kicking the knock pain. Depending on the pain intensity occurs after the knock sample with a dental instrument (e.g., the handle of the dental probe ), or a history of the patient described as mild or strong Aufbissschmerzen bite discomfort. The tooth may occasionally be so strong touch-sensitive, that can touch it with his tongue, the patient does not even. On a cold stimulus (through the vitality sample ) of the tooth may be unresponsive. It can also react positively (severe pain caused by the cold stimulus ) when the pulp is not completely dead.

There are many smooth transitions between pulpitis and apical osteitis. Especially the percussion sample can already result in pulpitis a slight knock sensitivity, since the first toxins have already reached the apex. A positive percussion test always speaks for an inflammatory process in the bone area around the root tip.

In the apical osteitis then you need to determine the differential diagnosis, in which of the four possible stages ( periapical, endosseous, subperiosteal, submucosal ) it is located. This is done by means of x-ray and scanning the vestibular portion of the jaw bone at the level of the root tip ( in the oral vestibule ).

Gangrene

In a gangrene may possibly any toothache missing. The medical history sometimes turns out that the patient a few months earlier had stronger toothache. Because of the typical, strong, putrid, nauseating odor in the most existing carious cavity, the diagnosis, however, is not difficult. However, if the gangrenous pulp be closed by a cavity intact, then a lot of pressure with corresponding severe pain and symptoms of pulpitis and apical osteitis can build up in the pulp.

Chronic apical osteitis usually runs completely symptom -free and pain-free. Again, there were typically in the history ( a few weeks ago to months ) more pain. In most cases the radiograph confirms the diagnosis.

Atypical toothache

Remains largely unresolved the cause of atypical toothache is ( engl. atypical odontalgia ), in which the pain is not associated with a recognizable physical impairment of tooth or gum. In addition, the painful area may change. Often this pain is accompanied by an increased pressure sensitivity. The duration may vary from a few days to chronic pain.

Buddenbrooks syndrome

The Buddenbrooks syndrome is a very rare but all the more dreaded misdiagnosis in dentistry. Toothache like symptoms in the lower jaw, preferably the left lead to the visit to a dentist. Should actually be found a medical correlate, for example, a pulpitischer or devitalized, purulent tooth, namely the primary cause of coronary heart disease, which can be life-threatening remains undetected. see also

History and symptoms

Toothache, even if they are relate to a tolerable extent lead very quickly to a swelling of the mouth areas that are within range of the source of pain, as evidenced by the typical swollen, " thick " cheek. Furthermore, the pain goes in inflammation with a " rap " accompanied, as the palpable pulse was extended to the painful areas (see also: abscess). This is, as in all cases, pain, in particular in which nerves are particularly affected (see sprains, etc.) to the resulting excited increased blood flow. The cooling of the corresponding region restricts the blood flow and helps to reduce the pain.

Prevention, treatment and cure

Regular and thorough dental care significantly reduces the amount of harmful bacteria in the mouth. Also incipient damage let that stop so or sometimes even regress. Already, however, strongly contested, aching teeth need to be treated by the dentist, depending on the cause by fillings, root canal treatment or treatment of periodontitis. Clove oil is used (only superficially ), antibacterial and anti-inflammatory agent to relieve pain. See also: Pharmacotherapy