Toothache

Toothache

Toothache is noted in caries, pulpitis, periodontal and periodontal diseases, purulent-inflammatory processes in the periosteum, bone and surrounding soft tissues. It can be observed with bruxism, TMJ dysfunction, hypersensitivity of teeth, some neuralgias. It can be dull, acute, constant, periodic, jerking, bursting, aching. It is often provoked by temperature, chemical and mechanical influences. It is diagnosed according to dental examination and additional studies. Treatment includes local activities, drug therapy. Sometimes operations are shown.

Why does toothache occur
Caries
Pulpitis
Periodontal diseases
Periodontal diseases
Bone lesion
Abscess and phlegmon
Dental injuries
Other dental pathologies
Neurological diseases
Other reasons
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why does toothache occur
Caries
Caries is understood as a condition in which the hard tissues of the tooth are destroyed, a cavity of various depths is formed. Painful sensations are aching, there is a reaction to hot, cold, sweet, sour. Clinical manifestations depend on the stage of the disease:

Superficial. The soreness is short-term, mild or moderate, quickly disappears when contact with the irritant ceases.
Average. The intensity of the toothache is the same as in the previous case, but the unpleasant sensations are observed a little longer.
Deep. The pain syndrome becomes severe. Mechanical stimuli (pressure, chewing) are added to temperature and chemical stimuli. When pieces of food accumulate in the hollow, the symptom persists until they are extracted. With multiple lesions, halitosis is possible.
Secondary caries is formed in a previously treated tooth. The manifestations become noticeable no earlier than 3-6 months after the completion of treatment, correspond to the usual caries. Swelling and bleeding of the gums are possible. The cervical variant differs in its localization, sometimes circularly covers the neck, is prone to rapid progression. Root caries may initially be asymptomatic, sometimes the spot is barely noticeable, hidden under plaque or tartar. Subsequently, the clinic is the same as in other forms.

Pulpitis
Acute pulpitis lasts from 2 days to 2 weeks. Toothache appears without connection with irritants, increases with temperature influences, persists after the trigger disappears. Localized, paroxysmal, lasts 10-20 minutes. After 1-2 days, pain sensations become pulsating, paroxysms become more frequent and lengthen. The decrease in the severity of the symptom is due to the destruction of the nerve. Chronic pulpitis can occur in the following variants:

Fibrous. A delayed painful reaction to cold with a gradual subsiding after the cessation of exposure is characteristic. The rest of the time, there may be a feeling of heaviness in the area of the affected tooth. With exacerbation, spontaneous toothache is possible, giving off along the branches of the trigeminal nerve.
Hypertrophic. It often proceeds painlessly. Sometimes mild pain is detected when chewing or pressure.
Gangrenous. Pain appears after contact with chemical agents. A typical sign is a bright reaction to hot. The symptom persists for a long time, supplemented by a putrid smell from the mouth.
Pulp necrosis develops with dental injuries, complicated caries. It often proceeds asymptomatically, sometimes accompanied by toothache in contact with hot food, due to the formation of gases in the affected area. The soreness slowly increases and also slowly decreases.

Periodontal diseases
Apical periodontitis is an inflammation of the tissues surrounding the tip of the tooth root. Serous periodontitis is characterized by an acute course, pain when biting and chewing, which increases with pressure, vertical tapping. The general condition is satisfactory. With the development of purulent periodontitis, painful sensations become strong, pulsating, prevent food intake, radiate into the ear, temple, eye. The tooth feels like “grown up”. There is general hyperthermia, intoxication syndrome. Chronic periodontitis occurs in the following variants:

Granulating. Remissions are often replaced by exacerbations. Toothache is paroxysmal, which increases with contact with cold and hot food, chewing, pressing. Regional lymph nodes are enlarged, slightly painful. After the formation of a fistula and the expiration of accumulated pus, the condition normalizes, sometimes soreness is disturbed by ingestion of food and temperature influences.
Granulomatous. Accompanied by the formation of granuloma, which may be asymptomatic or manifest discomfort when eating. During the period of exacerbation, the clinical picture resembles acute periodontitis.
Fibrous. In most cases, there are no symptoms, sometimes there is discomfort with vertical percussion. In the acute phase, minor or moderate pain may occur when pressing and chewing.
Acute traumatic periodontitis develops against the background of trauma, is characterized by local pain, bleeding, pathological mobility. With a chronic course, the signs are absent or poorly expressed. Acute marginal periodontitis is rare, characterized by cervical lesions. Toothache is aching, constant, increases with the action of irritants. After the transition to a chronic form, the symptoms disappear. Teeth become loose over time, the roots become exposed, become sensitive.

Toothache
Toothache
Periodontal diseases
This group includes gingivitis, periodontitis and periodontal disease. Gingivitis is an inflammation of the gums, including the following types of disease:

Catarrhal. The acute form is manifested by pain and burning sensation, which increases during meals. The affected part of the gum is swollen, hyperemic. The general condition, as a rule, does not suffer. In the chronic variant, soreness decreases, a feeling of bursting prevails, constant bleeding.
Ulcerative. In the vast majority of cases, it has an acute character. It is quite rare. Manifests insomnia, subfebrility, cephalgia, dyspepsia. Gums are painful, itchy. Then ulcers form, pronounced halitosis appears. The pain is so strong that it prevents chewing, talking, and carrying out hygienic measures.
Hypertrophic. It flows chronically. Soreness, burning, bleeding and bright red gum color are detected.
Pericoronaritis – inflammation of the gums during eruption (more often – wisdom tooth). Toothache is intense, often gives in the ear or temple, sometimes prevents mouth opening, chewing and swallowing. The symptom is especially pronounced when the tooth is in the wrong position. Local hyperthermia is detected, less often – lymphadenitis, an increase in body temperature.

Periodontitis develops with the progression of gingivitis, affects the dental joint. There is pain when pressing, mobility of teeth, unpleasant odor. With a prolonged course, the teeth become loose and fall out. Generalized periodontitis is considered to be the main cause of adentia in patients of the older age group. With periodontal disease, gingival pockets are formed. Constant soreness and hypersensitivity of the gums are determined, which negatively affect the emotional state.

Bone lesion
Purulent periostitis (flux) is a common complication of dental diseases. Occurs with periodontitis, pericoronitis, improper treatment, the development of infection in the well after extraction. It is more often detected in the area of molars. It is accompanied by severe, sometimes pulsating toothache, which can give to the eye, ear, temporal zone. Painful sensations increase with thermal effects, decrease with cold ones. There is subfebrility, a violation of the general condition, swelling of soft tissues with facial asymmetry.

When the infection spreads from the periosteum to the underlying bone, osteomyelitis of the jaw occurs. The pain increases, becomes diffuse, spreads to the entire half of the face. Body temperature rises to febrile numbers. There is mobility of the teeth, swelling of the gums, the outflow of pus from the gingival pockets, a putrid smell. There may be difficulties when swallowing and chewing. When the lower jaw is affected, sensitivity disorders are detected in the chin area. The face is asymmetrical, the regional lymph nodes are enlarged.

Abscess and phlegmon
Parotid abscess is provoked by dental diseases, soft tissue injuries, and general infections. With the odontogenic nature of the disease, toothache develops, resembling that of periodontitis. The symptom increases with biting. A painful seal is formed with facial asymmetry or protrusion of the mucous membrane in the oral cavity. General intoxication manifestations are determined. With spontaneous autopsy, the condition normalizes, however, there is a high probability of chronicling the process.

Unlike an abscess, the parotid phlegmon has no clear boundaries. More often odontogenic. Manifests weakness, weakness, rapid deterioration, fever. Toothache is combined with cephalgia, muscle pain. The symptom increases with talking and chewing, there may be limited mobility of the jaw, difficulty breathing. The seal is diffuse, painful. The face is asymmetrical.

Dental injuries
Toothache accompanies all dental injuries. The features of the clinical picture are determined by the type and severity of the injury:

Bruise. Painful sensations are aching, constant, moderately pronounced. They are amplified by pressure and tapping. There is swelling, sometimes mobility, a pinkish tinge of the crown.
Dislocation. With partial dislocation, the tooth changes its position, but remains connected to the underlying tissues. There is a displacement of the crown, mobility, toothache. With complete dislocation, the tooth falls out.
Fracture of the crown. Part of the tooth breaks off, a defect with sharp edges is formed. Periodontitis or traumatic pulpitis may develop.
Root fracture. The patient complains of soreness during percussion and biting. The crown is movable, but the defect is not visually determined.
Other dental pathologies
A sharp, but rapidly disappearing toothache worries people with dental hyperesthesia. It is often supplemented by a feeling of discomfort, a snarl. Provoked by the reception of cold, hot, salty, sweet and sour, hygienic procedures. It occurs due to enamel hypoplasia, erosion formation, mechanical damage.

Patients with bruxism suffer from involuntary contractions of the masticatory muscles and strong compression of the jaws. Episodes occur in a dream, last for several seconds, repeat repeatedly. Overstrain of the muscles and excessive pressure cause toothache, prosopalgia and cephalgia in the daytime. Dizziness, drowsiness are noted. The formation of enamel cracks and wedge-shaped defects, the development of hyperesthesia, periodontitis and other dental complications is possible.

With TMJ dysfunction, dental, facial and headaches, soreness and pressure in the eyes are bothering. The widespread nature of the pain syndrome may cause the similarity of the clinical picture with osteochondrosis, trigeminal neuralgia and other pathologies. The damage to the joint is indicated by clicks during jaw movements, episodes of blocking (jamming) of the TMJ.

Neurological diseases
The main manifestation of ganglionitis of the wing node is spontaneous attacks of prosopalgia in combination with vegetative disorders. Pain is most pronounced in the hard palate, the base of the nose, the upper jaw, and the eye. Toothaches are possible. There is irradiation in the temple, neck, ear, nape. With trigeminal nerve neuralgia, prosopalgia feels like an “electric shock”. When the lower branches of the nerve trunk are affected, pain impulses pass through the lower jaw, which may be accompanied by a feeling of toothache.

Other reasons
Toothaches of an irradiating nature are sometimes detected in the following diseases:

Primary cephalgia: cluster headache, migraine. They proceed paroxysmally, are accompanied by photophobia, intolerance to loud sounds.
Otolaryngological pathologies: otitis media, sinusitis. Pain in the affected area, signs of intoxication, discharge from the ear or nose are determined.
Heart damage: heart attack, angina attack. With an atypical clinical picture, painful sensations sometimes occur not in the heart area (or not only in this area), but in the left half of the lower jaw, which can be interpreted as a toothache.
Mental disorders: hysteria, GTR, neurasthenia, chronic stress conditions. The unusual nature of pain, which does not fit into the picture of a certain disease, and the absence of objective changes are considered typical.
Dental examination
Dental examination
Diagnostics
Diagnostic measures are carried out by a dentist. Patients with nerve damage are referred to a neurologist. If there are indications, consultations of an otolaryngologist, cardiologist, and other specialists are prescribed. As part of the survey, they find out the anamnesis of life and illness. Particular attention is paid to the nature, intensity, time of occurrence, localization and duration of toothache, the relationship with external factors.

As part of the examination, the symmetry of the face, the condition of the skin, the smile line and the closing of the lips are evaluated, edema and hyperemia are detected. Palpate the TMJ, masticatory muscles, lymph nodes. Then the oral cavity is examined (vestibule, bottom, hard and soft palate). Teeth and periodontal are examined to detect mobility, chips, cracks, carious spots, cavities, bleeding, dentoalveolar pockets, and other changes. Vertical and horizontal percussion is performed, the cavities are examined with a probe. The following additional methods are used:

Thermometry. Thermal and cold tests allow to differentiate caries, pulpitis and periodontitis, to determine the reversibility of pathological processes in the pulp.
Electrodontodiagnostics. The effect of electric current on the receptors in the pulp is used in the diagnosis of pulpitis, deep caries, periodontitis, periodontitis, traumatic injuries, osteomyelitis, neuralgia.
Electrometry. It is carried out to determine the length of the root canal. Allows you to clarify the therapeutic tactics for periodontitis and pulpitis when radiography is unavailable or reduce the number of X-rays.
X-ray diagnostics. Targeted radiography is performed to study the structure of the tooth. Radiovisiography makes it possible to obtain data with a reduced radiation load. Orthopantomogram provides information about the state of the dental system.
During the examination, rheodentography, chewing test, rheoparodontography, and other functional techniques can also be used. According to the indications, luminescent diagnostics, TMJ axiography, and other procedures are performed. If necessary, a neurological examination is performed, laboratory tests are prescribed.

Treatment
Conservative therapy
Emergency measures are carried out without prior preparation. Before planned treatment, in most cases, removal of tartar and professional hygiene are recommended. Taking into account the nature of the pathology , the following procedures are shown:

Caries. Sanitation of the carious cavity by dissection using a drill or laser. Disinfection, possibly with the installation of a temporary seal. With deep caries, a therapeutic pad is applied to the bottom. At the final stage, permanent sealing is performed.
Pulpitis. Use pastes and medicinal dressings, remove the pulp completely or partially. The treatment option for pulpitis is chosen depending on the type of pathology, the number of root canals, and the age of the patient.
Periodontitis. At the initial stage, the contents of the root canal are removed, a turunda with a drug is placed in the cavity. In the presence of exudate, drainage is carried out. With severe intoxication, antibiotics are prescribed. In case of chronic course, special pastes are used for resorption of granulomas.
Periodontitis. The application of therapeutic bandages, medical treatment of periodontal pockets, splinting, selective grinding, laser treatment is practiced.
Purulent processes. Patients are indicated for antibiotic therapy. In the postoperative period, UHF, electrophoresis, and laser therapy are performed to eliminate inflammatory phenomena. Osteomyelitis may require infusion therapy, immunomodulators, desensitizing agents, autohemotherapy, hemosorption, plasmapheresis, hyperbaric oxygenation.
Injuries. It is recommended to reduce the chewing load on the diseased side. Physiotherapy and drug therapy are used. The restoration of the crown part of the tooth is carried out, crowns or fixed tabs are installed.
Neuralgia. Anticonvulsants are used to eliminate seizures, antihistamines are used to reduce swelling, antispasmodics are used to relieve pain, and microcirculation correctors are used to improve local metabolic processes. If necessary, therapeutic blockades are performed. Diadynamic currents, ultraphonophoresis, galvanization are effective.
Surgical treatment
In case of toothache, the following operations can be performed:

Periodontitis: root apical resection.
Periodontal diseases: gingivotomy, curettage of periodontal pockets, with pronounced mobility – tooth extraction followed by prosthetics.
Purulent processes: periostotomy, sequestrectomy, removal of a bone defect with the help of osteoplastic material, opening of abscesses and phlegmon.
Injuries: reposition, fixation with a wire splint, replantation, prosthetics

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