Pain is the body’s way of telling us that part of us is damaged and needs to be protected or left alone; it prevents us from using this damaged part whilst healing takes place. The nerve that supplies the teeth is known as the trigeminal nerve and is the largest sensory nerve in the body and causes acute dental pain. Input from this nerve accounts for 50% of the input to the part of the brain that deals with information received from our senses (the sensory cortex). It is little wonder that toothache can be an inescapable pain that drives sufferers to distraction.
Whilst toothache can occasionally present without warning, for most patients who present as an emergency in pain there will have been early warning signs that, if acted upon, could have prevented the whole acute episode.
Teeth that are becoming increasingly sensitive to extremes of temperature (hot or cold) where the discomfort lasts for 30 seconds or more after the stimulus has gone or teeth that are giving spontaneous jolts of pain are, most likely, showing signs of an irreversibly damaged nerve and will almost always continue on to give worse pain.
Pain on biting is usually due to one of two possible causes. If the pain is difficult to locate to one tooth and happens periodically, often when biting on chewy foods then it is most likely due to a cracked tooth whereas pain on biting on one specific tooth that is easy to locate is often due to inflammation around the tip of the root that reflects the presence of a dying nerve within it. In the later stages of dental pain, where the nerve has completely died off and the root canal has become infected then pain on biting may also be due to dental infection or abscess associated with this tooth.
Cracked tooth syndrome refers to a periodic pain on biting that is very difficult for the sufferer to localise. It is caused by a fracture line which undermines a portion of the tooth and causes it to flex or move under chewing pressure. Typically patients will report a sudden jolt of pain under increased load, often when the catch the particular tooth with an unexpected grain or solid lump in their food. It is very difficult to spot the offending tooth in the early stages as they will all look the same and the crack will not show up on any radiograph. Careful examination, by your dentist, of each tooth under load can usually track down the offending portion of the tooth and early treatment will avoid unnecessary pain and suffering from toothache and provide a far better outcome for the tooth.