Toothache

and Sabine Schrör, medical journalist

Hanna Rutkowski is a freelance writer for the medical team.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

For many people, a toothache is a horror - intense, throbbing pain, a thick, flushed cheek, difficulty opening the mouth. Usually a sick tooth is to blame - but not always. For example, sinus inflammation or a heart attack can also trigger toothache. You can find out more about the causes of the symptoms and helpful home remedies for toothache here.

Brief overview

Causes: e.g. tooth decay, tooth root inflammation, gingivitis, periodontitis, abscess, tooth eruption, tooth fracture, fallen out fillings, crowns and temporaries, barotrauma (due to pressure differences painful tooth cavities), heart attack, angosterina pectoris, sinusitis (herpes zoster), herpes zoster , Headaches and migraines, trigeminal neuralgia, ear infections, jaw cysts, inflammation caused by drugs (bisphosphonates) and radiation of the jawbone, teeth that are sensitive to pain.
When to the doctor Always consult a doctor if you have a toothache. Self-treatment only as a first aid measure.
Treatment: depending on the cause, e.g. treatment of caries, root treatment, cleaning of the gum pockets, pain relievers, treatment of other underlying diseases (heart attack, sinusitis, etc.).
Home remedies for toothache: Emergency measures if a visit to the dentist is not possible: biting into a clove, rubbing the painful area with clove oil, placing a damp cloth or towel with an ice pack on the cheek, tea made from peppermint, St. John's wort, lemon balm, quendel and valerian, mouthwashes with sage tea, highly concentrated, lukewarm salt water rinse.
Prevention: thorough oral care (brushing your teeth twice a day with toothpaste containing fluoride, cleaning spaces between the teeth once a day), restricting your consumption of sugar, checking your teeth twice a year, tips for over-sensitive teeth: when brushing your teeth do not scrub and exert little pressure, sealing the dentinal tubules, Crowning the teeth as a last resort.

Toothache: causes

In the majority of cases, toothache comes directly from the teeth. Sometimes, however, there are also health problems or illnesses behind it that affect other parts of the body.

Toothache from dental problems

The following triggers in particular (mostly as a result of poor oral hygiene):

Caries (tooth decay): The tooth surface is covered with a thin biofilm (plaque) that is colonized by bacteria (especially Streptococcus mutans). These break down sugar molecules from food residues into acid, which attacks the tooth enamel. If the plaque is not removed regularly, the enamel is slowly destroyed - a hole is created. In addition, food residues and bacteria can penetrate the tooth, possibly penetrate into the pulp and irritate it painfully. The affected tooth is particularly sensitive to sweet, sour, cold and warmth.
Root inflammation: If tooth decay is not treated or treated too late, the acid-producing bacteria can trigger an inflammation of the tooth pulp (pulpitis) and also penetrate into the tooth nerve and damage it. In addition, the swollen pulp presses on the nerve. Persistent, pulsating toothache is the result. In extreme cases, the nerve dies. The toothache will then subside, but the inflammation can spread to the tip of the root and the jawbone (apical ostitis). Then the affected tooth hurts when pressure is applied from above, for example when chewing. Toothache is rarely caused by bacterial tooth root inflammation, when the jawbone has been injured or a root canal treatment has failed.
Abscess: A tooth root inflammation can spread to the surrounding tissue and the jawbone and form pus collections (abscesses) there. Typical signs of this are pronounced, heated swellings and persistent toothache.
Inflammation of the gums (gingivitis): This acute or chronic inflammation is usually caused by bacteria. The affected gums are swollen and reddened. In addition, the gums often bleed and hurt when you brush your teeth.
Inflammation of the periodontal system (periodontitis): The periodontal system includes gums, root cement, periodontal membrane and jawbones. If these structures become inflamed, the gums may bleed and the gums may be swollen and red. It gradually withdraws, exposing the painful necks of the teeth. The inflammation itself is also noticeable in the form of dull pain that is difficult to localize. Periodontitis destroy the jawbone in the medium term.
Tooth eruption: When the baby teeth erupt in babies or the wisdom teeth in adults, this can also be painful.
Tooth fracture: Teeth can also break, for example as a result of an accident or when you bite on something hard. This can - as with a broken arm or leg - a lot
be painful.
Filled out fillings, crowns and temporaries: Tooth restorations can fall out, for example when eating. Then the ground tooth is exposed underneath and reacts painfully to external stimuli such as food particles, liquid, pressure (when brushing your teeth) and air.
Barotrauma: Cavities, for example as a result of tooth decay or under leaky fillings and crowns, often react painfully to pressure differences. Divers are often affected, and the phenomenon occurs less often at high altitudes or when flying.
Dental treatment: grinding the teeth to prepare fillings or crowns irritates the tooth nerve and can cause temporary pain after the treatment.

Common causes of toothache

Toothache is usually caused by inflammation of the pulp or the tooth bed. As caries progresses, the pulp inflammation spreads to the tooth bed or the tooth root.

Another possible cause of toothache are pain-sensitive teeth: a cold draft of air, an ice cream for dessert or the dressing in a salad often triggers a short, violent toothache in people with pain-sensitive teeth (so-called lightning pain). Behind it are mostly exposed tooth necks with unprotected dentinal tubules (e.g. as a result of periodontitis). Sour, sweet, cold and hot can then penetrate the dentinal tubules into the tooth nerve and irritate it.

But there are other reasons for hypersensitive teeth:

worn chewing surfaces, for example due to permanent incorrect stress caused by grinding teeth at night or as a result of the natural aging process
frequent exposure to acids (through repeated vomiting, for example in the case of bulimia, reflux disease or through frequent consumption of fruits, vegetables, salads)
too much pressure when brushing your teeth (scrubbing)
Dental treatments such as whitening, grinding the teeth to prepare fillings or crowns
congenital tooth formation disorders

Other causes of toothache

Diseases in other parts of the body can also be the cause of toothache:

Heart attack and angina pectoris: Typical for both are severe pain behind the breastbone, which can radiate into the left shoulder, left arm and lower jaw. In the so-called Buddenbrook syndrome, a diseased tooth in the left lower jaw can lead to the actual cause of the toothache - a heart attack or an angina pectoris attack - being overlooked.
Sinusitis (sinusitis): The upper molars and the sinuses are close together. If the latter is inflamed, the inflammation can therefore spread to the root of the tooth and cause pain.
Shingles (herpes zoster): The rash associated with this viral disease can also appear on the face and mouth, where it can cause severe pain on the skin, mucous membranes and teeth.
Headaches and migraines: Sometimes a headache is accompanied by a toothache. Migraines, which usually occur on one side only, can also lead to it, since, which usually only affects one side of the head, can cause teeth to hurt on this side. In addition, migraine sufferers often suffer from phantom tooth pain. This is pain that occurs even though a sick tooth has already been extracted.
Trigeminal neuralgia: The trigeminal nerve is a facial nerve that also supplies the teeth. If it is inflamed, this also leads to severe toothache.
Earache: Ear diseases such as otitis media often radiate into the jaw and teeth.
Cysts: Cysts in the area of the jaw can also cause toothache.
Medication and radiation: Inflammation from certain medications (bisphosphonates) and radiation to the jawbone are other possible causes of toothache.

How does a toothache actually develop?

Teeth are by no means lifeless. On the contrary, every single tooth contains not only blood vessels but also nerve fibers. These penetrate through openings in the jawbone from below into the tooth root and lie in the middle of the tooth pulp (pulp). The nerve fibers react very sensitively to even the smallest stimuli.A protective coat made of dentin (dentin) and tooth enamel surrounds the pulp and protects against irritation from heat or food residues. In the case of dental diseases such as tooth decay or periodontitis, however, this natural barrier is destroyed, so that irritants can get into the interior of the tooth unhindered - toothache develops.

Toothache: what helps?

How one can effectively relieve toothache depends largely on the cause of the discomfort.

Dental treatment for dental problems

In the case of tooth decay, for example, the dentist drills away the affected areas and closes the hole with a tight filling.
If the cause of the toothache lies in the tooth root or in the jawbone, a tooth root treatment can help. Most of the time, just opening the tooth relieves the pain, as this reduces the pressure in the tissue. The same applies to purulent abscesses in the tissue.
In the case of inflammation of the gums, the gum pockets are cleaned. Sometimes it is also necessary to take a sample to determine the type of bacteria and treat it with appropriate antibiotics.

If you have an acute toothache, you can take a pain reliever as a first aid measure. But do not use the active ingredient acetylsalicylic acid, as this inhibits blood clotting. The subsequent dental treatment can then lead to increased bleeding. Painkillers with the active ingredient paracetamol are more suitable.

Why dental treatment is important

Untreated dental problems keep causing pain and can even affect other areas of the body. This is because the bacteria that have entered enter the bloodstream via the teeth and can lead to the rare heart valve inflammation. In the case of chronic sources of inflammation, the risk of vascular diseases also increases in the long term. In pregnant women, the risk of miscarriage is increased by certain bacteria that cause inflammation of the gums.

Therefore, always have a toothache clarified by the dentist. A visit to the dentist is particularly urgent for:

persistent toothache, despite good and thorough oral care
Toothache that occurs suddenly at night or that gets worse and worse
Tooth discomfort with swollen gums, swelling of the mouth or face, possibly accompanied by a fever
frequently bleeding, reddened gums
Toothache when chewing

Treatment of other causes of pain

If the cause of the toothache is not in the mouth, it is advisable to consult other specialists (ENT doctor, internist, etc.). The dentist will give a patient appropriate advice depending on where he suspects the cause of the toothache.

Concomitant symptoms can also indicate which specialist is responsible for clarifying the symptoms (e.g. an ENT doctor for accompanying earache). This doctor can then find out the exact cause of the pain and initiate appropriate treatment (e.g. pain relievers and possibly antibiotics for otitis media).

In the event of unusually severe toothache that affects the entire lower jaw rather than a single tooth and is accompanied by unusual tightness in the chest, shortness of breath or pain up to the shoulder, please notify the emergency doctor immediately! Then a heart attack can be the cause of the toothache.

Home remedies for toothache

Do you suffer from toothache on weekends or on public holidays - that is, when your dentist is not on duty? Then tried and tested home remedies can help as a first aid measure:

The clove has been used as a home remedy for toothache for centuries. It should be bitten into pieces near the sore tooth. The active ingredient eugenol it contains has an anesthetic effect and is also used in dentistry in some preparations. Clove oil from the pharmacy can also help. But be careful: the eugenol can kill the tooth nerve.
Placing a damp cloth or an ice pack wrapped in a towel on your cheek soothes a toothache by restricting blood flow to the inflamed area.
A tea made from two parts peppermint, four parts each of St. John's wort and lemon balm, as well as a little quendel and valerian relieves toothache.
Mouth rinses with sage tea have an anti-inflammatory effect.
A highly concentrated, lukewarm salt water rinse can also help. Keep the solution in your mouth for two minutes until the pain subsides.

Prevent toothache

You have the most effective protection against toothache in your own hands: thorough oral care. Because regular tooth brushing with the right technique prevents tooth decay, periodontitis and the like and thus helps to prevent toothache.

Dentists recommend cleaning your teeth at least twice a day. This is the only way to remove plaque and food residues from the tooth surface, which provide bacteria with an ideal breeding ground. It does not matter whether you use an electric or a manual toothbrush. It is more important that you brush with a system so that all areas are cleaned. A tried and tested toothbrushing technique is, for example, the Bass method:

Start at the top left on the outer surface of the molars. To do this, place the bristle surface of your toothbrush diagonally against the tooth and gums from below.
Now guide the toothbrush, shaking it and applying little pressure in light stroking movements along the outer surface of each molar tooth. The bristles also penetrate the spaces between the teeth. In this way you not only remove the plaque, but also massage the gums. This stimulates the blood circulation and protects against periodontitis.
Then work your way forward to the opposite side and back again on the inside.
Then brush over the chewing surfaces of the upper row of teeth.
Then repeat the whole procedure for the teeth in the lower jaw.

In addition to brushing, you should use dental floss or an interdental brush once a day to thoroughly clean plaque from the spaces between your teeth. After all, the most common type of caries occurs in this area that is difficult to access for the toothbrush.

More tips for healthy teeth:

To keep your teeth healthy, you should avoid sugar as much as possible. The caries-forming bacteria feed on the glucose it contains.
Snack on sweets as rarely as possible between meals so as not to constantly supply the oral bacteria with new food.

Have a dental check-up twice a year. In this way, your dentist can identify and stop the onset of tooth decay before toothache occurs.

Use fluoride toothpaste and dental care chewing gum with xylitol. Both active ingredients inhibit the growth of caries bacteria and strengthen the tooth enamel.

Tips for hypersensitive teeth

If the sensitive tooth necks and with them the so-called dentinal tubules are exposed, every bite on the teeth can hurt. Cold, hot, sweet and sour foods and drinks in particular often trigger brief but extremely severe pain. You can use these tips to protect your hypersensitive teeth:

When brushing your teeth, be careful not to scrub or press the toothbrush too hard. In this way you can prevent your gums from receding even further.
Seal the dentinal tubules. Toothpastes and mouth rinses with strontium chloride or potassium salts seal the tubules. This makes the teeth less sensitive to external stimuli. The dentist can also seal the exposed surfaces: the neck of the tooth is protected with fluoride varnish or a fine layer of thinly flowing plastic.
In particularly severe cases or congenital disorders in which tooth enamel is missing, crowning the teeth can be the last measure against toothache.

Additional information

Guidelines:

Guideline "Caries prophylaxis in permanent teeth - basic recommendations" of the German Society for Tooth Preservation and the German Society for Dentistry, Oral and Maxillofacial Medicine

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