Dental pain

Dental pain can vary in intensity from mild to severe. It can also range from dull-aching pain to sharp-shooting pain based on the causative factors. A range of symptoms can be seen with dental pain, including:

• Dull-aching toothache that may radiate to the gums or jaws.
• Pain that worsens while biting or chewing food.
• Pain exacerbated by excessively hot or cold foods or sweets.
• Pain accompanied by bleeding or discharge from the gums.
• Swelling of the gums or face, which may be accompanied by a fever.
• Occasionally, a bad mouth odor and bad taste in the mouth may be present, along with toothache.

• Fracture of the tooth
• Dental caries or tooth decay causing cavities and infection in the tooth
• Periodontal or gum infections
• A dental abscess, which is a collection of pus or fluid near the tooth, occurring in tooth infections
• Erosion of tooth enamel and gum recession
• Lack of space for the eruption of wisdom teeth
• Accumulation of food particles and debris between the teeth
• Repetitive clenching or grinding of teeth
• Loose or fractured old filling or a cracked tooth cap
• Ill-fitted dentures or braces

Dental pain is most commonly seen in children and adolescents, with a prevalence rate around 9.4%. It is more frequent in lower socio-economic populations who have limited access to quality healthcare. Dental pain is also prevalent in the elderly population and is the primary reason for dental procedures among them.

Additionally, the risk of dental problems is often associated with the following:

• Poor oral hygiene
• Excessive consumption of sweets, starchy or acidic foods and drinks
• Smoking
• Diabetes
• Weak immune system due to certain medications (such as chemotherapy for cancer) or diseases (such as HIV)
• Xerostomia or dry mouth due to inadequate salivation, which can occur after head or neck injury, radiation therapy, or as a side effect of certain drugs
• Heartburn or gastroesophageal reflux disease (GERD), which can cause stomach acid to flow into the mouth, leading to enamel dissolution and tooth damage
• Eating disorders like Anorexia and Bulimia, which can lead to tooth wear and cavities, as well as affect saliva production

When you visit your dentist for dental pain, they will perform a thorough oral examination and obtain a detailed history of symptoms.

Some of the common tests used to diagnose dental pain include:

• A tooth percussion test, which involves gently tapping the tooth with the end of a mouth mirror to check the response.
• A tooth mobility test, where the dentist carefully attempts to move your tooth to determine if it is loose.
• A tooth sensitivity test, which checks the response of the tooth to hot or cold stimuli.

Additional investigations may be needed to evaluate the condition further, which include:

• Imaging studies: Dental X-Ray and X-Ray TM Joints help visualize the teeth and jaws to identify potential abnormalities causing the pain. A detailed visualization is possible with CBCT (Cone Beam Computed Tomography), which is used when individual x-rays of teeth alone are insufficient to identify the cause of dental pain.
• Laboratory tests: Lab tests such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), and diabetes screening may assist in diagnosis and treatment planning.

Since most toothaches occur due to poor oral hygiene, good dental hygiene practices can largely prevent dental pain. You can keep your teeth and gums healthy by:

• Brushing gently with fluoride-containing toothpaste at least twice a day.
• Flossing regularly to clean the spaces between the teeth.
• Rinsing and gargling after meals to prevent food particles and debris from lodging between the teeth.
• Avoiding excessive sugar, starch, or acidic foods and beverages in your diet.
• Reducing the consumption of sticky foods like caramel or chocolate that can remain in the grooves and pits of teeth for an extended period.
• Consuming sweet foods with meals rather than as snacks.
• Avoiding frequent snacking, as eating or drinking beverages other than water allows bacteria in the mouth to create acids that can dissolve tooth enamel. Frequent snacking throughout the day can keep your teeth under constant attack.
• Avoiding extremely hot or cold foods if you have sensitivity issues.
• Avoiding chewing on very hard foods like ice or sugarcane, which can cause tooth fractures. Using teeth to open food packets or crack open nutshells can also increase the risk of a tooth fracture.
• Scheduling regular appointments with the dentist for professional cleaning and examinations.
• Considering the application of dental sealants or protective coatings on teeth and fluoride treatment if advised by the dentist.

The treatment for dental pain is broadly divided into providing pain relief and treating the underlying cause.

1. Medicines for Dental Pain Relief

• NSAID painkillers are prescribed to provide relief from mild to moderate dental pain.
• Opioid painkillers or combination medicines are prescribed to treat severe dental pain.
• Anti-sensitivity toothpastes can provide some relief from sensitivity of teeth.

2. Treatment of Underlying Cause

• Antibiotics are prescribed by dentists to treat dental infections.
• Mouthwashes are also recommended to combat infections.

3. Dental Procedures

These procedures can be advised if needed and may include:

• Scaling and Planing: In cases of plaque accumulation and gum infection, the dentist may carry out professional cleaning or scaling of teeth or numb the gums to remove plaque buildup below the gum line.
• Cavity Filling: For a shallow cavity in the tooth, the dentist will remove the decay and seal the tooth with a filling.
• Root Canal Treatment (RCT): In cases of a deep cavity that infects the pulp of the tooth, the dentist will perform a root canal treatment. In this procedure, all the vital contents of the tooth (nerves and blood vessels) are removed, and the root canal system is sealed with an inert filling material. RCT is usually followed by a dental cap or crown.
• Tooth Extraction: If the tooth is badly damaged and cannot be saved, it may be advised to get it extracted.

If you have mild dental pain, home remedies may provide considerable relief. Home remedies are also useful in alleviating symptoms of severe disease. You can do the following at home to help ease dental pain:

• Rinse your mouth with lukewarm saline water, an effective first-line treatment. Saline water acts as a natural disinfectant, reducing inflammation and easing pain or swelling. Mix 1/2 teaspoon of salt in a glass of lukewarm water and use it as a mouthwash.
• Apply an ice pack or cold compress externally to help reduce inflammation and swelling, providing relief from pain.
• Avoid eating foods that are hard to chew and refrain from chewing on the painful side.
• Apply clove oil or peppermint oil to the affected area, as these are known to help with pain relief from toothaches.
• Avoid consuming excessively hot or cold foods or sweets, as these may worsen sensitivity and increase your pain.
• Gently brush your teeth at least twice a day. Rinse and gargle after every meal to prevent food particles from getting stuck between your teeth.

A toothache on its own does not cause severe complications, and in most cases, tooth infections can be easily treated. However, a tooth infection can sometimes lead to an abscess, where pus collects inside the tooth or gums. In very rare cases, a delay in treatment can cause this infection to spread to other areas of the body, resulting in the following complications:

• Sinusitis: Can occur rarely from untreated upper teeth infection.
• Osteomyelitis: Infection of the bone surrounding the tooth.
• Ludwig angina: Submandibular space infection.
• Cavernous sinus thrombosis: Infection of the blood vessels within the sinuses.
• Cellulitis: An infection of the skin and fat directly beneath the skin.
• Parapharyngeal abscess: An abscess at the back of the mouth.
• Septicemia: A medical condition in which the immune system overreacts to an infection in the blood.

These conditions can be life-threatening and require immediate attention and intervention. The following signs and symptoms may indicate a possible spread of infection to other parts of the body:

• High fever
• Chills
• Swelling of the face or jaw
• Foul-smelling discharge from the tooth
• Nausea
• Vomiting
• Severe headache
• Itching or burning sensation on the skin
• Drooping eyelids
• Double vision
• Confusion

1. Ayurveda: Dental or oral health is referred to as ‘Danta Swasthya’ in Ayurveda. Various Ayurvedic practices can be adopted for good oral health, including:

• Chewing sticks from medicinal trees, such as Neem and Meswak, serve as an alternative to conventional brushing techniques. When chewed, these sticks release medicinal extracts that help promote and maintain healthy teeth and gums.
• Oil pulling is an ancient practice that involves swishing oils inside the mouth. Sunflower oil, sesame oil, or coconut oil can be used for oil pulling, which is a traditional remedy to prevent teeth and gum diseases.
• Medicinal condiments and herbs like clove, garlic, vanilla extract, peppermint, wheatgrass, and thyme are useful in relieving dental pain and are commonly used as home remedies for toothaches.

2. Homeopathy: Homeopathy is an alternative form of medicine based on the principle of ‘like kills like’. Homeopathic practitioners prescribe diluted tinctures that elicit symptoms similar to those the patient is experiencing.

• Tinctures of Belladonna and Arnica Montana are effective in relieving toothaches.
• Other remedies such as Calcarea carbonica, Chamomilla, and Antimonium crudum are also beneficial in alleviating dental pain.
• Arsenicum album is effective for treating gum diseases, including bleeding gums.

To prevent tooth pain, maintain basic oral hygiene by brushing and flossing twice a day and visiting your dentist regularly. If you experience a toothache, consider trying these simple home remedies for natural relief.

Dental Pain or Toothache is one of the most common pains experienced by patients worldwide. It is normal to occasionally battle with tooth pain due to sensitive teeth, gum infections, or dental cavities. Although good and consistent oral hygiene measures help prevent many dental problems, sometimes, despite efforts to brush twice a day, floss daily, and maintain a healthy diet, individuals may still suffer from dental issues.

Some factors that may contribute to dental pain include:

• Genetic predisposition to brittle or sensitive teeth
• More acidic saliva
• Accidents resulting in tooth fractures

Dental pain can be quite annoying and irritating. Continuous pain may lead to avoidance of food, causing nutritional deficiencies or weight loss. Heightened dental sensitivity can prevent patients from enjoying their favorite sweets or ice cream. Additionally, patients with dental infections may experience bad breath or foul odor, leading to social embarrassment or isolation.

Prevention of dental diseases is always better than treatment. Good oral hygiene practices and routine visits to the dentist are essential for maintaining healthy teeth and gums throughout life. In cases where dental problems occur despite precautions, one should not be disheartened, as most dental issues are easily treatable and have a positive outlook. Home remedies and a prompt visit to the dentist can significantly alleviate toothache.