A toothache can start suddenly and catch you by surprise. The severity of pain can vary from a mild, dull ache to severe throbbing that radiates to the other areas of the face. The pain can be constant or intermittent, spontaneous or triggered by chewing, cold and/or hot drinks and foods.
What causes toothaches?
In the absence of obvious trauma such as a blow to the mouth that damages the teeth, a toothache is usually caused by decay. When decay is advanced, the tooth starts causing pain. Decay is essentially bacteria breaking into the tooth and eating away at the tooth substance. As the bacteria get deeper into the tooth, they trigger an inflammatory response within the tooth pulp. The pulp resides deep in the middle of the tooth and consists of microscopic nerve fibres and blood vessels that supply the tooth. As the pulp becomes inflamed, the tooth starts getting more sensitive to cold and hot temperatures. For example, a cold drink might trigger a sharp pain from the tooth that subsides after a while. As the pulp gets more inflamed however, the pain might not subside but instead linger as a dull ache. The ache can increase in severity leading to a throbbing sensation. As the inflammation spreads to the immediate areas around the tooth, the pain can radiate to the face and the tooth can be very painful on chewing and application of pressure. As bacteria within the tooth pulp multiply, they can start spreading from the tooth into the surrounding bone and gum tissues, leading to a spreading infection. This can lead to a localised swelling in the gum around the tooth initially but as the infection spreads further, the swelling can extend to the face and jaw and can interfere with mouth-opening and breathing leading to a medical emergency.
There are also other less common causes of toothaches such as severe gum disease and infection, tooth grinding (bruxism) and acute sinusitis. In these cases, the cause is not the tooth itself but the symptoms can feel like a toothache. Some other soft tissue and bone pathologies can also cause toothache symptoms. In the absence of any decay, cavity, crack or fracture in any tooth, these causes cannot be disregarded. It is important to seek professional help from your dentist to properly diagnose the cause of a toothache and hence provide the appropriate treatment.
Can painkillers help for a toothache?
When the toothache is still mild and the inflammation of the pulp not as severe, painkillers can help. A combination of paracetamol and nurofen can be quite effective in relieving the pain. Nurofen is also an anti-inflammatory and will reduce the level of inflammation thus helping alleviate the pain further. However, as the inflammation becomes more severe and spreads, paracetamol and nurofen may no longer be effective. Opiod analgesics such as oxycodone can help but these must be prescribed by a health professional. Opiods can have undesirable side effects such as drowsiness, constipation and addiction. It is not recommended to use opiods unless absolutely necessary.
Painkillers can be helpful as long as they are being taken. They are not a final solution and must only be used as a temporary measure. They do not address the root cause of the pain, which is advanced decay in a tooth. To only way to resolve a toothache is dental treatment. Hence, it is advisable to see your dentist as soon as possible.
Do I need antibiotics for a toothache?
A toothache alone does not indicate that antibiotics are necessary. If there is no swelling inside the mouth or on the face, antibiotics are not indicated. Seek dental treatment as soon as possible.
If there is a swelling in the gum only and dental treatment can be accessed within 24 hours, antibiotics are not necessary. However, if dental treatment cannot be accessed within 24 hours, antibiotic therapy may be prescribed.
Antibiotics are only indicated when the infection from the tooth is starting to spread to the adjoining tissues, leading to swelling of the face. However, antibiotic therapy is NOT a substitute for dental treatment when there is an infected tooth. Seek dental treatment as soon as possible.
If the infection has spread extensively, is accompanied by a fever, and the swelling is severe enough to affect mouth opening and breathing, this is a medical emergency and urgent transfer to a hospital is required where surgical treatment can be provided by an oral-maxillofacial surgeon along with Intravenous antibiotic therapy.
What kind of dental treatment is required for a toothache?
This depends of the type and the cause of the toothache. If the toothache is short and sharp and only triggered with cold foods and drinks, it possibly indicates a cavity and decay in the tooth that has not yet advanced too deeply. In this case, a filling might be sufficient to fix the issue. However, if the pain is constant and severe, with throbbing and aggravated by chewing on the tooth, it could mean that the decay has advanced too deeply into the tooth leading to an infection within the pulp. This would indicate that a filling alone will not work. The tooth might need root canal treatment, or if too heavily decayed, extraction of the tooth might be the only solution.
If you have any questions regarding a dental issue, Dr Yew at the Melbourne Smile Clinic is your dentist in Northcote. For any dental emergencies, give us a call on (03) 90784471 for an appointment and we will do our best to help.
For after hours, in case of dental emergency, we recommend you contact the Royal Dental Hospital on (03) 93411000.
Reference: Oral and Dental Therapeutic Guidelines Version 3 - Independent Evaluation of the Evidence