My tooth hurts – what should I do?

Toothache is an unpleasant sensation that can have various causes and manifestations, such as pain when biting down, pain in the gums around the tooth, pain in a dead tooth, toothache caused by increased sensitivity to cold or sweet foods, and dull toothache.

The most common causes of toothache

Tooth decay

The most common cause of toothache. Toothache caused by tooth decay can manifest itself in different ways and with varying intensity depending on the extent and location of the decay. Symptoms may include:

• Sensitivity: The affected tooth may be sensitive to hot, cold, sweet or acidic foods and drinks. This sensitivity can range from mild to severe.
• Short-lived pain: This may be a sharp pain that quickly disappears once the stimulus (such as hot or cold food) is removed.
• Long-lasting pain: Pain that lasts longer than 30 seconds after the stimulus is removed may indicate that the decay has reached closer to the dental pulp, which usually means a more advanced stage of decay.
• Pain when chewing: Cavities can cause pain when chewing, especially if the chewing surface of the tooth is affected.
• Spontaneous pain: Sometimes tooth decay can cause pain that comes on suddenly and for no apparent reason, which may indicate advanced decay or involvement of the dental pulp.
• Visible spots or holes: With advanced tooth decay, you may see black, brown or white spots or even holes in the tooth.

It is important to note that tooth decay does not always cause pain, especially in the early stages. Therefore, regular preventive check-ups are important for early diagnosis and treatment of tooth decay before it reaches the stage where it causes pain or other complications. However, if your teeth already hurt or you suspect tooth decay, you should see your dentist without delay.

Increased tooth sensitivity

The cause of increased tooth sensitivity may be exposed dentine, which is the sub-enamel part of the tooth. This exposure of dentine is usually caused by, for example, receding gums, enamel wear, tooth decay or fillings.

Sometimes teeth may be temporarily sensitive after treatment, such as teeth whitening, tartar removal, new fillings or root canal treatment.

Tooth sensitivity manifests itself as a sharp, short-term pain in response to stimuli such as temperature changes (cold or hot drinks and food), sweet or acidic foods and drinks, or even breathing cold air.

Gum inflammation (gingivitis and periodontitis)

The cause of pain can also be gum inflammation caused by a bacterial infection that has developed as a result of insufficient oral plaque due to poor oral hygiene. Gum inflammation (gingivitis) is the initial stage of gum disease (periodontitis) and is characterised by inflammation and swelling of the gums around the teeth.

Typical symptoms of gingivitis are red and swollen gums and bleeding gums when brushing your teeth or chewing.

Dental abscess

A tooth abscess is a pocket of pus in the tissue around a tooth caused by a bacterial infection. An abscess can cause severe pain and, if not treated immediately, can lead to serious problems.

Damaged tooth or filling

A cracked tooth or lost filling can cause pain when the tooth is exposed to external stimuli such as temperature or pressure.

Inflammation of the dental nerve

Inflammation of the dental nerve (pulpitis) is an inflammatory disease affecting the dental pulp, which is the soft tissue inside the tooth containing nerves and blood vessels. It is most often caused by untreated tooth decay. Pulpitis can cause pain, sensitivity to temperature stimuli and sometimes swelling in the surrounding area. It is important to treat the inflammation as soon as possible to prevent further complications, such as an abscess or the need for root canal treatment.

Wisdom teeth

Toothache is often associated with wisdom teeth and their eruption, which can cause the following problems:

• Pain and swelling in the area of eruption: Infection of the gums around a partially erupted tooth.
• Teeth crowding: Lack of space in the jaw, which can lead to shifting and crookedness of surrounding teeth.
• Tooth decay: If a wisdom tooth remains partially erupted, it may be prone to tooth decay.
• Cyst: Cysts can form around wisdom teeth, damaging surrounding tissue and bone.
• Complications with cleaning: Wisdom teeth can be difficult to reach when cleaning.

Pain from a dead tooth

A dead tooth, which is a tooth with a dead or removed pulp, can cause pain for several reasons, the most common of which is infection. Bacteria can penetrate the area around the root of the dead tooth and cause an abscess, leading to intense pain. In addition, the pus that forms as a result of the infection can put pressure on the surrounding tissue, increasing discomfort. In addition, inflammation of the periapical tissue, which is the area at the end of the tooth root, may occur. Even though the pulp inside the tooth is dead, the tissues around the tooth root remain alive and are sensitive to infectious and inflammatory processes.

Tooth enamel erosion

Excessive consumption of acidic foods and beverages can gradually damage tooth enamel. This condition is called tooth enamel erosion and leads to increased sensitivity and tooth pain. In general, calcium, which occurs naturally in saliva, helps neutralise the acid in food and thus protects tooth enamel from erosion. However, if you consume large amounts of very acidic foods or drinks, the calcium in your saliva is often not enough. Pure fruit juice and carbonated drinks of any kind (even diet sodas) are highly acidic, so drinking large amounts of these drinks can increase your risk of developing tooth erosion.

Other possible causes of toothache

• Toothache after drilling or extraction.
• A lost tooth or filling.
• Tooth injury due to an accident.

If you have toothache, it is important to see your dentist as soon as possible so that they can determine the exact cause of the pain, prevent further complications and start the appropriate treatment.

What to do if you have toothache?

When a tooth starts to hurt, the pain usually does not improve on its own and tends to intensify. It is important to visit your dentist or dental emergency service as soon as possible, as acute toothache can be a symptom of a more serious problem that requires treatment. If the pain persists, is severe or is accompanied by swelling, rashes, fever or other symptoms, seek medical help as soon as possible.

Here are a few measures that can help temporarily relieve the pain until you see your dentist:

• Pain medication: Over-the-counter pain medication such as paracetamol (acetaminophen) or ibuprofen can be taken as recommended in the package insert.
• Cold compresses: Apply a cold compress or ice wrapped in a thin towel to the painful area for 15 minutes. A cold compress can help reduce inflammation and pain.
• Thoroughly clean your mouth: Rinse your mouth with warm (not hot) water to remove any food debris. Use dental floss to gently remove food debris between your teeth. However, avoid using sharp objects to remove foreign objects.
• Salt rinses: Rinse your mouth with a weak solution of warm water and salt. Salt rinses can help reduce swelling and remove bacteria from the oral cavity.
• Keep your head upright: When sleeping, try to keep your head propped up slightly to reduce blood pressure in the mouth area, which may help relieve pain.
• Avoid certain foods and drinks: Limit your consumption of foods and drinks that are too hot, cold, sweet or acidic, as these can increase sensitivity and thus tooth pain. Eat soft foods to avoid further irritation.
• Do not smoke: Smoking can worsen tooth pain and cause further complications.

How is toothache diagnosed?

Toothache is usually diagnosed as follows:

Taking a medical history

The doctor will ask you about the nature of the pain, its duration, triggers and any other related symptoms.

Clinical examination

• Visual inspection: The dentist will examine the patient's mouth, looking for signs of tooth decay, cracks, wear or infection.
• Palpation: The dentist may use palpation to detect swelling, abscesses, or areas of sensitivity.
• Percussion: Lightly tapping on a tooth can reveal which tooth is the source of the pain.

X-ray examination

Panoramic images or images of individual teeth can reveal problems beneath the surface, such as infections in the root tips, impacted teeth or decay between the teeth.

Thermal tests

Applying heat or cold can help determine whether the dental pulp is alive and how it responds to temperature stimuli.

Electrical test

A device that emits a low-intensity electrical current can be used to test the response of the dental pulp.

Hydrogen peroxide test

Applying a 3% hydrogen peroxide solution can help identify which tooth is the source of the pain.

Referral to a specialist

In some cases, an examination by an endodontist (root canal specialist) or another specialist may be recommended, depending on the nature of the problem.

Solving toothache

After examination and diagnosis, we will proceed to eliminate the problem that is causing the toothache.

Treatment of tooth decay: If the cause is tooth decay, the affected part of the tooth must be removed and the tooth then sealed with a filling.

Endodontic treatment: In the case of infection or damage to the dental pulp, root canal treatment may be necessary.

Antibiotics: Antibiotics are usually necessary to treat bacterial infections.

Tooth extraction: In some cases, especially if the tooth is severely damaged or impacted, it may be necessary to remove the tooth.

Pain management recommendations: To relieve pain, your dentist may recommend analgesics or non-steroidal anti-inflammatory drugs. It always depends on the specific findings.

Referral to a specialist: In more complicated cases, the dentist may refer the patient to a specialist – an endodontist or oral surgeon. (These specialists are part of the medical team at our clinic.)

What can happen if toothache is not treated in time?

We consider it necessary to emphasise once again that it is important to visit the dentist in time when experiencing toothache, as prompt treatment can prevent the problem from worsening, the infection from spreading and more serious complications from developing, which could lead to tooth loss or more serious health problems.

Failure to treat toothache can cause:

• Worsening of tooth decay and spread of tooth damage.
• Infection of the dental pulp with possible development of an abscess.
• Spread of infection to surrounding tissues or the bloodstream.
• Loss of the affected tooth.
• Complications such as osteomyelitis, an infectious purulent disease of the bone and bone marrow caused by bacteria or mycobacteria, etc.
• Greater pain and more expensive treatment in the future.

No need to worry about pain

Our aim is to either completely eliminate or at least significantly reduce the pain of the entire procedure.

• We use modern anaesthetics.
• We emphasise a gentle procedure.
• We take client feedback into account.
• We create a pleasant and harmonious environment for the procedure.