Toothache

Toothache: Excerpt from In a Page: Signs and Symptoms

Toothache or tooth pain is caused when the nerve root of a tooth becomes irritated. Tooth infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction (removal of a tooth). Pain sometimes originates from other areas and radiates to the jaw, thus being perceived as tooth pain, most commonly from the temporomandibular joint, ear, and even occasionally cardiac problems.

Differential Diagnosis

• Pulp pain (pulpalgia) secondary to dental caries
• Traumatic tooth injury (e.g., tooth fracture, restoration fracture, avulsion)
• Traumatic occlusion
  –Secondary to a new restoration or bruxing
  –Galvanic “shock” due to contact by two dissimilar metals (e.g., gold crown with amalgam filling)
• Periradicular or periapical pain due to infection of the tooth root or abscess formation
• Referred pain from a tooth in the opposing arch
• Sinusitis
  –Maxillary sinusitis is the most common extraoral source of tooth pain
  –All or most teeth in the upper arch may become sensitive secondary to sinusitis

Workup and Diagnosis

• History and ear, nose, throat, neck, and cardiac exam and intraoral exam should include mobility tests, percussion, electric pulp test, and thermal tests (ice)
  –Tooth mobility is tested by using the back ends of two mouth mirrors on both sides of the tooth
  –Reversible pulpitis pain is sharp, intermittent pain of short duration that is provoked by hot, cold, sweets, or biting; the pain does not linger more than a few seconds when the stimulus is removed
  –Irreversible pulpitis pain lasts more than 30 seconds upon withdrawal of the stimulus and may occur spontaneously, such as when sleeping
  –If an abscess is present, the tooth may be slightly elevated in its socket and mobile
  –Periapical abscesses may have systemic findings such as lymphadenopathy or fever
  –Toothache or TMJ pain in the morning may occur due to bruxing at night
• Transillumination may show fracture lines in teeth
• Pulp necrosis will not have any response to stimulation or via the electrical pulp tester
• Dental radiographs
• Consider sinus X-rays or CT scan if sinusitis likely
• Consider referral to dentist (e.g., tooth decay, abscess) or otolaryngologist (e.g., mastoiditis)

Treatment

• Reversible pulpitis from tooth decay can be treated with a restoration (e.g., filling or crown)
• Irreversible pulpitis requires root canal or tooth extraction if the tooth is not salvageable
• Incision and drainage of an abscess will often result in instant relief of pain
• Penicillin for oral infections (clindamycin if severe)
• Appropriate oral antibiotics (e.g. amoxicillin, trimethoprim-sulfamethoxazole) for sinusitis or otitis
• TMJ: avoidance of gum chewing and bruxing, bite block, NSAIDs, topical ice massage
• Migraine: pain relievers (e.g., acetaminophen, NSAIDs) migraine specific medications (e.g., triptans) and preventative therapy (e.g., gabapentin, riboflavin)

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Tooth abscess

• Back to disease: Tooth abscess: Introduction
• Next Book Extract About Tooth abscess: Jaw Pain/Swelling (In a Page: Signs and Symptoms)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Jaw Pain/Swelling (In a Page: Signs and Symptoms)

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