I have tooth pain

Question:

Hi, I have been experiencing some weird tooth pain.  It comes as quickly as it goes and does not seem to last long( a few seconds) and has happened three times in the last 2 days.  It is not a throb pain, more a constant pain if that makes sense.  It feels like someone is touching ice cream to my tooth in the whole tooth but 10x worse, and is one of the worst pains I have ever experienced.  I am going to the dentist, I am just curious on your opinions.  Had a cavity filled in the tooth a couple months ago so not too sure why it would hurt all a sudden.  Thanks in advance.

Answer:

Thanks for submitting your question with us.  Now, the main piece of information that will determine the diagnosis of your tooth is:

Is the Pain provoked?

• Does the pain have a trigger point?  For instance, is it painful when you eat hot or cold food or drinks.
• Does the pain occur sporadically and unprovoked?  Does the pain come and goes as it pleases with no trigger point?  For example, the tooth becomes painful randomly throughout the day.
• Does the pain come when you bite down into food?  Or does the pain come when you open your mouth after biting down on food?

You’re probably wondering, why all the questions?  But believe it or not, answers to these simple questions can guide us down the right path to a correct diagnosis.  Let’s examine each answer:

Yes, the pain is provoked by eating cold/hot food or drink.

Then you have reversible pulpitis.  This means that you have slight inflammation of your pulp inside of your tooth.  This is caused by

• Bacteria/decay
• A recent deep filling without a protective base (Deep restorations need a protective layer underneath it to protect the tooth nerve/pulp)
• Recent deep cleaning

Reversible Pulpitis Treatment

Luckily, this can be easily treated by making a slight adjustment to the filling

No, the pain is not provoked by anything and occurs on its own

You may have irreversible pulpitis.  This means the pulp is damaged beyond repair.  This means that bacteria have leaked into your tooth nerve/pulp and are now irritating the tooth and needs to be removed to avoid serious infection.  Some signs of irreversible pulpitis include:

• Spontaneous, unprovoked pain
• On and off pain
• Continuous pain
• Pain lasts even after food/drink/or stimulus is removed
• Lying down or bending over produces pain

Irreversible Pulpitis Treatment

The treatment for irreversible pulpitis is a root canal treatment.

I feel pain when I bite down

Again, this indicates reversible pulpitis and can be treated by adjusting your filling.

I have pain when I open up after biting down

This indicates a fracture of the tooth.

Fractured Tooth Treatment

Treatment for this depends upon the extent of the fracture and can include anything from a new filling, or a root canal, or even an extraction.

For more information on tooth pain, check out our article here.

Also, see below for a descriptive chart of how to diagnose tooth pain.

We hope this helps and good luck,

Save My Smile Team

My root canal failed!

Question:

I had a root canal done and it abscessed. I haven’t got it finished all the way yet. Can I safely pull the tooth, and be done with it.

Answer:

Now before you think about pulling the tooth, let’s think about some other factors that will come into play down the road.  Once that tooth is gone, the tooth behind it and the tooth across from it (in the opposite jaw) will begin to slowly drift into the open space.  This will cause the other teeth to drift also, resulting in open spaces amongst your teeth.  You will eventually have to replace the space with either a bridge, implant, or partial denture which are all pretty costly.

Root canal procedures don’t have a 100% success rate, sometimes they do fail.  However, retreatment is always an option and definitely cheaper as compared to some of your other options.  Being that your procedure wasn’t finished, the pathway for bacteria wasn’t completely blocked meaning it had an opportunity to repopulate or wasn’t completely removed.

If would be best, in the long run, if you were to return to have the procedure completed or retreated.  Yea, it may be cheaper and easier to pull the tooth now, but believe us, you may regret this decision down the road.

Good luck with your decision,

SaveMySmile Team

I can’t afford porcelain crowns

Question:

Almost three years ago a water bottle accident caused me to chip the back of my front teeth; which I never really noticed until my dentist said it was cavity. My dentist proceeded to drill a hole in my front teeth and decide to tell me that it was actually a root canal and that since I was on medicaid because of my parents low income, that all they could do is put temporary white fillings in the holes they drilled, as well as filing one of my teeth shorter than the other(?!). Over the past year the filling has discolored and made me very self-conscious of my smile. Before this event I had a beautiful smile and it is a sad thing to have a ruined smile at 18 years old because of a dental misjudgment. I don’t have the money being a college student having to pay rent to pay thousands of dollars for porcelain caps. Is there any other option for me? Please let me know, thank you so much.

Answer:

We are very sorry to hear about your situation yet excited to announce that, depending on your location, a majority of dental schools provide free work for individuals on Medicaid!!  The American Dental Association website can direct you to the nearest dental school in your area.  Use this link to connect to their website and search for a dental school near you.  Also, be sure to check with your medical clinic on campus.  As a college student, most of your medical care should be covered in your tuition, meaning no out-of-pocket costs for you.

Several dental clinics also provide low-cost dental work to individuals in need, sometimes it just takes A LOT of research, persistence, and patience.  Use the Internet to research local dental clinics in your area and don’t be afraid to call around.  You may be surprised with your results.  There are plenty of dentists willing to help those in need, they are just sometimes difficult to locate.

Also, if the dentist indicated that you may need a root canal on your front teeth, be sure to use extra precaution when caring for your teeth.  Be sure to brush after each meal and floss at least once a day.  Based on your description, you may not need porcelain crowns.  Crowns are rarely placed on front teeth unless the damage is extensive.  Sounds like all you need is a root canal and a new filling.  So, until your trip to the dentist, continue to practice good oral hygiene.

We wish you the best of luck!!

My tooth hurts when I eat hot or cold food or drinks

Question:

My tooth hurts whenever I eat hot or cold food or drinks.  If feels like a sharp pain, then it goes away.  What does this mean?

Answer:

This is a sure sign of reversible pulpitis.  The feeling that you are experiencing is caused by exposed dentin.  Remember that dentin is normally covered by enamel (see article on tooth anatomy), if for some reason a portion of dentin is left uncovered, you will usually feel sensations of short, sharp pain when exposed to hot or cold substances.  Exposed dentin can be caused by a cavity, a defective filling/restoration, or recent dental work.  The good news is that this problem can be fixed easily, the dentin just needs to be covered.  Your dentist will be able to give you a filling, simply fix your existing filling, or a pulp cap if necessary.  However, don’t wait too long.  Reversible pulpitis, if left untreated, can turn into irreversible pulpitis.  Unfortunately, irreversible pulpitis can only be treated with root canal therapy, which costs a lot more in the end.  So be sure to act now by visiting your dentist.

Good luck!

The tooth under my crown is hurting

Question:

Help!!  The tooth under my crown is hurting.  What does this mean and what should I do?  I’ve only had this crown for one year!!

Answer:

Sorry to hear that your tooth is in pain.  This can mean a number of things.  For starters, it could mean that there is a carious lesion/cavity under your crown.  Sometimes, bacteria are able to find its way under the margins of crowns if not cleaned properly (see article on brushing).  There is also a possibility that some of the bacteria was not removed after the dentist prepped your tooth for the crown.  Or, the pain can be coming from your crown not being correctly adjusted in your mouth.  It could be “too high”, which means your bite could be off, and may need to be reduced by the dentist.

Your best bet is to go to the dentist to evaluate your options.  First, make sure the dentist runs a couple of tests to ensure that the pain is indeed coming from that tooth.  Sometimes, pain in one area is projected to a nearby area, this phenomena is called referred pain and occurs quite frequently.  If the dentist identifies this tooth as the source of the pain, then you’ll have a couple of options.  The crown may just have to be readjusted, which will only take a few moments, or it may have to be removed and the situation assessed from there.  Depending on the extent of bacterial invasion, you may just need the crown re-prepped, a root canal, or even an extraction.  Also, depending on your dentist’s office polices, he/she may offer to re-do your crown for free.

Good luck!

Tooth Anatomy

The tooth is composed of 4 layers, the enamel, dentin, cementum, and dental pulp.

What is enamel?

Enamel is the hardest substance in the entire body.  It’s the outside layer of the tooth, completely covers the dentin, and is actually transparent in color.  That means the color of our teeth is due to dentin and not enamel.  However, enamel is comprised of enamel rods which can hold stain quite easily, including red wine, coffee, tea, and cigarettes.

What is enamel comprised of?

Enamel is comprised of 96% calcium hydroxyapatite and 4% organic material and water.  Bone is composed of 50% hydroxyapatite and 50% organic material including collagen, thus making enamel the hardest substance in the body.

If I chip or break enamel, will it repair on its own?

Unfortunatley, enamel does not contain any living cells.  Therefore, if chipped, it will not repair itself.  However, dentin can repair itself if damaged.

What is hydroxyapatite?

Hydroxyapatite is a storage form of calcium in the body.  99% of calcium in bone is stored as hydroxyapatite.  The chemical formula for hydroxyapatite is Ca₅(PO₄)₃OH.

What is dentin?

Dentin makes up the bulk of the tooth.  It completely surrounds the pulp, and is covered by enamel on the crown portion of the tooth, and by cementum on the root of the tooth.  Dentin is usually yellow in color and ultimately determines the color of the tooth, being that enamel is transparent.  Dentin is composed of dentinal tubules that communicate directly with the pulp.  This means that is bacteria reaches the dentin, usually some type of pain will be felt.  Dentin is composed of 65-70% calcium hydroxyapatite, 20-25% organic material, and 10% water.

What is cementum?

Cementum covers dentin on the root surface of the tooth.  Cementum connects the tooth to the periodontal ligaments and is therefore somewhat responsible for securing the tooth in the bone.  It is composed of 50% calcium hydroxyapatite and 50% organic material and water, the same consistency as bone.

What is pulp?

Pulp is the livelihood of the tooth.  Pulp supplies nutrients, blood, and nerves to the tooth.  This means that the pulp is responsible for keeping the dentin, cementum, and dentin strong.

Well what if my pulp is removed with a root canal?

Once bacteria reaches the pulp, depending on how extensive, it’s usually recommended to have the pulp removed.  This is because the pulp communicates directly with the rest of the body, and if harmful bacteria is present in your pulp, and it easily move to other areas of the body, including the brain!!  Please see the article on root canal for further information on this subject.

Toothache Got Cha Down?

Tooth pain is definitely a sign of bad things to come if not treated properly.  Please do not ignore these signs!!  It’s best to find out a cause early on then wait until it’s too late to be saved.  The first question to ask yourself is, what type of pain is it?  The type of pain can tell you a tremendous amount of information as to the next step in treatment.

Type of pain

• Brief, short pain
• Pain when eating or drinking cold food/liquids or exposed to air
• Long lasting pulsating pain
• No sensation/tooth discoloration

Brief short pain:

If the pain only occurs occasionally, such as when drinking cold liquids, this is a sure sign of reversible pulpitis.  Depending on the extent of bacterial invasion and condition of tooth structure, this condition can usually be treated with pulp cap.  The good news is that the pulp of the tooth can likely be saved.

Long lasting pulsating pain:

Long lasting lingering pain is usually indicative of irreversible pulpitis.  This means the bacteria has invaded the tooth’s pulp and, depending on the extent of invasion, the entire pulp or portion of the pulp may have to be removed.  If the amount of bacterial invasion is extensive, or if a substantial amount of tooth structure has been destroyed, the tooth may have to be extracted.  The treatment options for irreversible pulpitis include:

• Extraction
• Pulpotomy/Pulpectomy
• Root Canal Therapy

No sensation/tooth discoloration:

If you noticed a major discoloration of the tooth in question, necrotic pulp is probably the culprit.  This means the pulp of the tooth is dead.  If the pulp is dead, the tooth is dead and it needs to be removed.  If substantial tooth structure remains, the dentist may be able to retain the tooth by performing root canal therapy.  The only treatment for necrotic pulp is extraction or root canal therapy.

Keep in mind that a series of tests must be performed by the dentist before a diagnosis can be reached.  Tooth pain can also indicate a fractured root, impacted tooth, gum disease, or even problems with the temporomandibular joint.  So, if you experience any type of pain with a tooth or any structure in your mouth, be sure to contact your dentist as soon as possible for the best possible treatment options.