Why do teeth hurt?

Man with toothache
 Why do teeth hurt?

Sometimes it is helpful to understand what is going on in your body.  Knowledge can give you a sense of control over the situation. I find this to be true for my patients who have tooth pain. 

The problem is that most people try to cover up the pain with medication in order to delay treatment.  This only makes things worse.

The purpose of medication is not to mask pain but to facilitate treatment so it isn’t such a bad experience.  Drugs themselves can also be therapeutic allowing and helping the body to heal.  In addition they can lessen pain.

Over the counter medications can definitely help pain, but sometimes the body will give you even more pain when you are not paying attention to a lower level of pain.

Tooth pain is this way.  Teeth are alive with blood supply and nerves.  Unfortunately the only nerve in a tooth is a pain nerve.  Any stimulation of a tooth will feel painful.

We feel pain in our teeth because this pain nerve is awakened.  This can be caused by extreme temperatures, bacterial decay, or trauma.  This is the body telling you that you need to take action. 

Sometimes the pain is extreme and lasts a long period of time.  This is different than sensitivity which is more a dull ache that is not spontaneous and goes away quickly.  In this publication I will discuss severe pain and not sensitivity (I will write again on sensitivity in the future) that wakes you up at night.

Pain is motivating.  If infection is allowed to continue without pain, death or permanent damage to the body is a possibility.  That is why pain is good.

But wait a minute doc!  I don’t like pain.  It hurts after all!!!  What are you going to do about it?   Pain that is no longer helpful can and should be treated, once the cause is indentified and cured.

Teeth that are dying cause the most pain.  This is because pressure builds inside the tooth where the nerve is enclosed, much like your brain is encased in your skull.  This greatly stimulated the pain nerves inside teeth

Pressure is caused by gases created by bacteria that invade the living part of the tooth.  We remove the entire living part during a root canal and replace it with filling material to stop and prevent infection.

But what about biting pain?  Chewing pain can be caused by trauma or infection outside of the tooth about the gums and ligaments that line the bony socket where the tooth lives. 

Usually, the cause of the infection is the tooth itself which leaks bacteria into the surrounding ligament and bone.  This is what happens when a tooth dies.  The now dead tissue rots and is very dangerous. 

At this point the tooth does not hurt at all because the nerve inside the tooth is dead.  However, there are plenty of nerves outside the tooth in the ligament and bone that will also feel the pressure of the infection.

Pain is caused by anything touching the tooth.  It can even be spontaneous and keep you up all night.  When this happens, don’t wait another minute, go right to the dentist.

Sometimes root canals don’t get started until this point.  Antibiotics are critical here as well as pain medication.  There are two important places for antibiotics to go: inside and outside the tooth.

Pill antibiotics will travel through the blood stream to the bone and ligaments, and medicine is placed directly into the tooth once the tooth is opened with a root canal.

I usually have my patients take pill antibiotics before and several days after to first root canal appointment.  During the root canal I place antibiotic in the now empty canal and let it sit for two weeks.

Once the body shows signs of healing without pain, I determine that the root canal can be treated and remove the medicine and place the final root canal filling.

That’s fine doc but what if it takes me some time to get to you.  What over-the-counter medications can I take to help?

1.  Oral topical anesthetics are useful for gum pain but won’t get inside a tooth or bone in a more significant infection.  Examples are Orajel and Anbesol. 

2.  If there is a missing filling you can use over-the-counter temporary fillings to cover the hold which will usually lessen the tooth pain. Cloves are a natural tooth pain reliever and are a part of most temporary fillings.

3. If you can take Motrin or Advil which are both made from the drug ibuprofen, I recommend taking 800mg three times a day for adults.  If you have stomach problems use Tylenol XS or generic acetaminophen 500mg instead.

Do not take more than 8 Tylenol a day as this can harm your liver.  Do not take more than 3200mg of Motrin a day either as this can harm you digestive system.

I hope this helps!  Please be aware that I keep my cell phone on me all the time and I can respond to after-hour emergencies.  Please call me at 972-800-2312 if you are have extreme tooth pain. 

If you have never been seen by me, I will not be able to prescribe medications but will make you an appointment early the next day.  If you are a patient of record who I have seen in the last year, I can call in medications after-hours and on weekends.

God’s blessings to you,

Dr. Philip N. R. Estes