Dental cavities & dental abscess

The most common cause of a toothache is a dental cavity. The enamel is the outermost white hard surface and the dentin is the yellow layer just beneath the enamel. Both layers together protect the inner living tooth tissue called the pulp, where blood vessels and nerves reside. Certain bacteria in the mouth convert simple sugars into acid. The acid softens and (along with saliva) dissolves the enamel and dentin, creating cavities.

Gum disease

The second most common cause of toothache is gum disease (periodontal disease). Gum disease relates to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds and holds the teeth in place.

Tooth root sensitivities

Toothache can also be caused by exposed tooth roots. Typically, the roots are the lower two-thirds of the teeth that are normally buried in bone. The bacterial toxins dissolve the bone around the roots and cause the gum and the bone to recede, exposing the roots. The condition of exposed roots is called "recession." The exposed roots can become extremely sensitive to cold, hot, and sour foods because they are no longer protected by healthy gum and bone.

Cracked tooth pain

A cracked tooth can trigger a toothache caused by a broken tooth (tooth fracture) without associated cavity or advanced gum disease. Biting with the area of tooth fracture can cause severe sharp pains. Your dentist can usually detect the fracture by painting a special dye on the cracked tooth or shining a special light on the tooth.

Temporomandibular joint (TMJ) disorders

Disorders of the temporomandibular joint(s) can cause pain which usually occurs in or around the ears or lower jaw. The TMJ hinges the lower jaw (mandible) to the skull and is responsible for the ability to chew or talk. TMJ disorders can be caused by different types of problems such as injury (such as a blow to the face), arthritis, or jaw muscle fatigue from habitually clenching or grinding teeth. Habitual clenching or grinding of teeth, a condition called "bruxism," can cause pain in the joints, jaw muscles, and the teeth involved. Bruxism is often due to life "stress," family history of bruxism, and poor bite alignment. Sometimes, muscles around the TMJ used for chewing can go into spasm, causing head and neck pain and difficulty opening the mouth normally. These muscle spasms are aggravated by chewing or by stress, which cause the patients to clench their teeth and further tighten these muscles. Temporary TMJ pain can also result from recent dental work or by the trauma of extracting impacted wisdom tooth.

Impaction & eruption

Dental pain can come from teeth that are erupting or growing out. Pain can also be caused by tooth which has failed to emerge into its proper position and remains under gum or bone. When a molar; the large teeth at the back of the jaw erupts, the surrounding gum can become inflamed and swollen. Impacted teeth cause pain when they put pressure onto other teeth or bone and are inflamed or infected. Treatment for impacted teeth is usually pain medication, antibiotics in case of infections and surgical removal. This most commonly occurs with impacted molar (wisdom) teeth.

Treatment for a toothache depends on the specific causes. If a cavity is causing the toothache, your dentist will fill the cavity or if absolutely needed, extract the tooth. A root canal might be needed if the cause of the toothache is found to be an infection of the tooth's nerve. Bacteria that have worked their way into the inner parts of the tooth cause such an infection. An antibiotic may be prescribed. Phototherapy using a cold laser may also be used to reduce the pain and inflammation associated with the toothache.