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Toothache - Why Won't My Tooth Pain Go Away?

There are many causes of toothache and pain in the area of the mouth. When experiencing tooth pain and/or swelling, it is important to see your dentist to have the area evaluated. The pain and/or swelling is most often related to a disease process that originates within a particular tooth.

The pulpal tissue within the tooth can be irritated by bacteria, external traumatic events, repetitive or extensive dental procedures, or even periodontal disease which can lead to a toothache. When this irritation occurs, the pulpal tissue reacts by becoming inflamed. Since the pulpal tissues and the tissues supporting the tooth have a rich supply of nerve fibers, the inflammatory process can cause pain as these nerve pathways are stimulated. Additionally, the pulp tissue is encased inside tooth structure and it cannot swell and expand in reaction to injury like tissues in other areas of the body. When the injured pulp tissue attempts to swell within the confined root canal space, the pressure buildup can cause a significant toothache.

Pain originating from the dental pulp can be either "spontaneous" or "elicited." Spontaneous pain occurs without an identifiable stimulus, whereas elicited pain occurs only in specific situations. Elicited pain requires a specific stimulus such as drinking cold or hot fluids or biting on the tooth.

As is typical anywhere in the body, the initial stages of a disease process do not always cause symptoms. Millions of teeth have irreversible pulpal disease yet the patients have no clinical symptoms. Most of these situations will become evident when the dentist obtains a thorough history, does a clinical examination, performs specific tooth tests, and takes a series of well-angulated radiographs. It is important to note that pulpal disease can refer pain to other areas within the head and neck.

If the results of the endodontic examination indicate that root canal disease is not the source of the patient's symptoms, then the dentist must consider other possibilities. When attempting to identify the source or cause of facial pain and/or swelling, the dentist must consider that the symptoms could actually originate in a tooth (endodontic disease), the gum tissues (periodontal disease), the muscles (myofacial pain), the joints (TMJ), the sinuses (sinusitis), or even the surrounding vascular (blood vessels) or nerve tissues. Tooth pain requires an accurate diagnosis so that the proper treatment can be recommended. At times, various medical and dental specialists may need to be consulted before an accurate diagnosis can be determined.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Root Canal Frequently Asked Questions

Q. Why would I need a root canal?

A. When the nerve of a tooth becomes irreversibly damaged -- due to decay, trauma, or a crack in the tooth -- you'll need root canal treatment.

Q. How can the dentist tell if I need a root canal?

A. Often nerve damage causes tooth pain, swelling and sensitivity to hot or cold. You may also notice that the tooth is becoming darker in color. Sometimes, it can only be diagnosed with an X-ray or other tests.

Q. What happens during a root canal?

A. During root canal treatment, the dentist cleans out the infected pulp tissue within the roots. After all the nerve has been removed, the canals are filled with a sealer.

Q. How long will it take?

A. Usually, root canal therapy takes one or two appointments for a front tooth (anterior), and two or three appointments for a back tooth (posterior). A tooth can have from one to four roots and all the roots must be treated.

Q. After the root canal is finished, will the tooth need more work?

A. The tooth is more brittle after a root canal and requires a permanent restoration. This could range from a simple tooth filling to a large build-up with posts and pins. If the tooth filling is large, the tooth may also need a dental crown to protect the tooth from breaking.

Q. Why not just take out the tooth?

A. It's usually healthier and less expensive to save the tooth with root canal treatment. Replacing an extracted tooth involves either expensive bridgework or a partial denture. If the tooth is extracted and not replaced, adjoining teeth can move into the empty space, creating even more problems.

Q. Will root canal treatment be painful?

A. Your tooth will be numb during the treatment. If your tooth was aching or sensitive prior to treatment, it may take a few days for the tooth to get back to feeling normal. You can take a mild painkiller during that time. If it's necessary, something stronger will be prescribed. If the tooth had been badly infected, you may need to take an antibiotic.

Q. How much will it a Root Canal cost?

A. The cost of root canal treatment usually depends on the number of canals which are infected and need treatment. There will be a separate charge for the restoration, which will vary from the cost of a simple filling to a crown. All expected treatment charges will be discussed with you before treatment.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.