My Tooth Hurts, Why?

Most dentist hear this almost daily.  The ‘why’ can sometimes be harder than the ‘fix’.  Fortunately or unfortunately, we have antibiotics for the ‘fix’.  Yes, I said ‘unfortunately’!  Many in the health care fields rely on antibiotics to fix the unknown ‘why’ in those rare mystery cases.  Either from lack of clear symptoms or lack of knowledge, many doctors will rely on antibiotics to make the patient feel better.  In the mouth this sometimes works, rarely the issue goes and never comes back, usually, the issue comes back, sometimes worse.

Pain in the body can be very difficult to diagnosis.  The body is a complex group of systems.  Sometimes it amazes me we live as long as we do with the 1000s processes the body must maintain to stay upright.  The mouth can be very difficult when it comes to diagnosis.  In Dental school, we all took rotations through the Emergency Medicine Department.  This is where patients would come in and we would learn to decipher all the clues.  One day, a doctor who ran the Restorative Department of the school came in with a toothache.  He swore it was an upper tooth that was the source.  After a thorough evaluation, it was determined to be a lower molar.  How this happens, is that the nerves of all the teeth on the same side, top and bottom, all converge into one main nerve bundle before it reaches the brain for deciphering.  So the brain can misread the incoming information, especially if it being overloaded, as in a toothache.

The mouth has many types and intensities of pain.  The biggest part of a toothache appointment is usually the interview process.  It sometimes takes all of the clues to determine the cause.  In some cases, it is extremely obvious when the patient opens their mouth or you first glance at the x-ray, so clear, an untrained person would look at either and point and say ‘ouch, that’s gotta hurt!’  The interview becomes more important when the x-ray looks normal and there is nothing obvious on clinical exam.

The standard questions are; where is the pain, when did it start, what caused it to start, is it constant, intermittent or only brought on by certain actions, does anything make it better or worse and the duration of the pain.  The biggest question is usually ‘what type of pain are you experiencing?’

For general problem solving, I break pain into major categories: sharp, dull, throbbing, constant or intermittent.  All of these are very judgmental.  One person’s intermittent pain may be considered constant by another.  Intensity of pain can be extremely judgmental.  Everybody handles pain differently.  Even some of the biggest, toughest guys I’ve seen, who fight for a living, can have a minor tooth problem that will make them cry.

Sharp pain can be described as a stabbing pain, like being stuck with a needle.  Dull pain is more subtle, usually lower in intensity, generally described as an ‘ache’.  The throbbing symptom can actually be seen both with sharp and dull pain.  You can have a variation and/or a combination of all of the pains, confusing the diagnosis even more.  A lot of the pain you feel, is the body is trying to fix the problem.  When it involves the nerve inside of the tooth, it can throb, caused by the body directing more blood to the issue.  In the tight confines of the nerve chamber, the extra blood can feel like a pulsating time bomb every time your heart beats.

The following example is a good illustration of how one area can have all of the symptoms.  If a patient has advanced gum disease, they can have a deep pocket around a specific tooth that has a constant ‘dull’ ache.  If something like a popcorn kernel gets stuck down in the pocket, the body can react, and that extra attention from the body can change that pain from dullish to more of a ‘sharp’ pain.  Within days of the popcorn kernel being stuck, the sharp or dull pain can be accompanied by a ‘throbbing’ pain.  The dull pain may have been ‘intermittent’, but now, as it has changed to sharp, it is more ‘constant’.

So the next time you have a toothache, think about the questions you will probably be asked, and keep them in mind, or even better, write them down as they change, with dates and times.  Even if a patient is seen within hours, they may have already forgotten some important symptoms.  Therefore, from the time you feel you need to call the doctor, through the time it takes to make the call, and get into the doctors’ chair, keep notes, preferably on paper!  It can save you and the doctor a lot of time.

About the author Dr. Carl Herrera

Dr. Herrera practices at Family & Cosmetic Dentistry, located at 3311 Watt Avenue in Sacramento. He can be reached at (916) 483-3213, and you can find him online at http://www.drcarlherrera.com.
More posts by Dr. Carl Herrera