Excruciating Tooth Pain Causes – What Can Be Done?

Tooth pain is often unpleasant, distracting and sometimes excruciating. For many people, it develops slowly and for others, the onset can be rapid and confronting. A true toothache differs from what dentists define as sensitivity because in the majority of cases it involves the presence of infection.

Sensitivity is where a tooth reacts to cold, or sometimes hot stimulus in foods or drinks and fades very quickly with no lingering pain. The main cause is where the gum has receded from the outside of the tooth due to heavy brushing or gum disease. In this situation, the root surface of the tooth is exposed which carries the cold sensation through to the nerve of the tooth. Once the stimulus is removed, the sensation fades quickly. The use of desensitizing toothpaste, or in some cases, professional application of fillings or glazes by a dentist typically resolve the issue.

What If The Problem Is More Serious?

Inside your tooth is the pulp which is more commonly known as the nerve. The outside layers of your tooth are typically very strong, but there are situations when they can be breached.

If the nerve of the tooth becomes exposed to the bacteria inside our mouths there is a high chance it becomes infected. An infected nerve leads to internal swelling which results in tooth pain. An infected nerve also becomes increasingly reactive to hot and cold much like a sensitive tooth. The main difference is the reaction tends to last longer, with lingering pain that continues for several seconds to a few minutes.

In some cases, the stimulus can “set the tooth off” where a throbbing or dull background pain can be felt. Excruciating tooth pain causes loss of sleep and the inability to eat when it is at extreme levels. In some cases, painkillers are not effective. It should also be noted that painkillers and antibiotics are never a true cure for the vast majority of dental infections.  In the case of antibiotics, they only moderately suppress an infection but do not remove it at the source which means it usually comes back.

Tooth pain when biting, or chewing can also be an indicator of infection. If the nerve inside the tooth becomes infected, there is an increase in blood flow to the bone and tissue that support it. This can become very sore or tender when pressure is applied resulting in people favoring the opposite side while chewing.

What Happens When A Nerve Dies?

When the nerve inside your tooth becomes infected, it has a poor chance of survival. In certain situations, the initial pain may not be particularly bad, as some of the nerve tissue dies, while some remains alive. Dead nerve tissue can result in the development of pus which can lead to an abscess or a cyst. These generally form underneath the tooth as the bacteria spread into the jaw bone and in some cases can lead to very dangerous facial swellings which can require hospitalization. There are also occasions where the infection can progress without obvious pain or symptoms. These situations are sometimes picked up during routine dental x-rays and may require treatment due to the higher chance of them developing into a more severe acute infection. Dentists are often asked, “So if the nerve is dead then why do I feel pain?”

The answer is that in most situations there is some living nerve tissue still alive within the tooth, or that the pain is actually coming from the surrounding gum and bone.

Another cause of tooth pain can be gum disease. For the most part, gum disease progresses slowly and silently over many years and leads to loss of supporting gum and bone tissue. It is most common in situations of inadequate brushing and flossing and is made worse by smoking and uncontrolled diabetes. There are certainly some situations where excruciating tooth pain can be caused by significant and acute gum infections, or by food particles or debris pushed deep into the space between the tooth and the gum.

So How Does The Infection Get Into The Tooth?

Tooth decay, cracks or trauma are the most likely reasons you develop tooth pain and dental infection. Our mouths are filled with bacteria that are essentially impossible to eradicate completely no matter how much we brush or floss. If the surface of the tooth is damaged enough, there is a higher chance of these bacteria to be able to reach the nerve. Whilst tooth decay can occur slowly, cracks or trauma may be more instantaneous.

Cracks tend to occur more in teeth that already have large fillings, or in cases where people clench or grind excessively. If a crack leads to the nerve, the resulting tooth pain is typically quite intense. Trauma to a tooth can occur as the result of an accident, or by chewing and contacting hard and unexpected items such as seed or pips in food. Procedures such as crowns can be done preventive to strengthen a tooth that is showing signs of fatigue or early cracking.

How To Prevent Tooth Pain?

Having your teeth regularly inspected by a dentist is a great way to have any potential problems identified and treated before they become more severe. There are always situations that can be difficult to predict, however for the most part prevention and early intervention is the key. Practicing regular and thorough dental hygiene is also the cornerstone of good outcomes and minimizing tooth pain.


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