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Toothache and Dental Abscess


Toothache is one of the most common reasons why people see an emergency dentist. Toothache can present as a constant or intermittent sharp, stabbing, dull or throbbing pain.

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What are the common causes of dental pain?

1.Tooth Decay (caries)

Teeth decay when bacteria in the mouth, in the presence of acid from dietary sugars, soften and break down the outside hard surface of the tooth (enamel) forming small holes. This is preventable and even reversible if detected early by your dentist. If these holes in the tooth are left to progress, and reach the softer inner layer of the tooth (Dentine) an irreversible cavity forms, allowing
communication between the nerve of the tooth and the outside world causing pain. This will require treatment by your dentist, which will involve cleaning the rotten part of the tooth and restoring it to its function and form again. This is performed under local anaesthesia, so you should not feel any
pain during treatment.

2.Periapical Abscess

An abscess is a collection of pus caused by bacterial infection. When the pus collects at the tip of the roots of the tooth inside the jaw it is called a periapical abscess. Unlike some other types of infection in the body, a dental abscess will not get better on its own or by simply taking antibiotics alone, it
must be treated by a dentist. This will involve cleaning the tooth and its roots and filling the tooth and the roots, this is what is known as a Root Canal Treatment.

In these cases, the tooth is usually weakened by the deep decay and the infection and will require a crown to protect the tooth and prolong its life. Alternatively, the involved tooth will need to be extracted to rid the body of this dental infection.

3.Dentine Sensitivity

This arises when the gum shrinks (gingival recession) exposing the sensitive part of the tooth (Dentine). Gingival recession can be due to age, wrong and damaging tooth brushing technique or gum disease(periodontal disease).

The symptoms of Dentine sensitivity can vary from mild and occasional sensitivity to cold to a severe and constant pain. Treatment will depend on the severity of the symptoms, from simple varnishes that are applied temporarily to the exposed surface, to covering the exposed surface with a
permanent filling.

4.Periodontal Disease (periodontal abscess)

This is when bacteria infect the gum causing inflammation and pus collection between the gum and the teeth. Periodontal disease is preventable and even reversible in its early stages (gingivitis), if left unchecked and untreated, it will progress into the irreversible and destructive (periodontist), which
causes pain, bone loss and tooth loss. Your general dentist and/or the periodontist (specialist gum dentist) will advise you on how to prevent and treat periodontal disease.

5.Temporo Mandibular Joint Pain (jaw pain)

Injury or stress to the joint that connects the lower jaw to the skull can cause severe pain, tooth ache and headache. This can be caused by stress or bruxism (teeth grinding). Simple over the counter painkillers and anti-inflammatory can help the odd episodes. Those who suffer more
frequently may need their dentist to construct a removable appliance (mouth splint) to allow the jaw and its surrounding muscles to relax and recover and to protect the teeth from excessive wear. Other causes of toothache include sinusitis, a creaked tooth and wisdom tooth eruption.

Dental Abscess

A dental abscess is a collection of pus that can form inside the teeth, in the gums, or in the bone that holds the teeth in place. It’s caused by a bacterial infection. Dental abscess is one of the most common reasons why people see an Emergency Dentist.

Types of Dental Abscesses

There are two types of abscesses

Periapical Abscess: An abscess at the end of a tooth is called a periapical abscess.

Periodontal Abscess: An abscess in the gum is called a periodontal abscess.

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Symptoms of a Dental Abscess

Symptoms of an abscess in your tooth or gum may include:

  • An intense, throbbing pain in the affected tooth or gum that may come on suddenly and gets gradually worse
  • Pain that spreads to your ear, jaw and neck on the same side as the affected tooth
    or gum
  • Pain that’s worse when lying down, which may disturb your sleep
  • Redness and swelling in your face
  • A tender, discoloured and/or loose tooth
  • Shiny, red and swollen gums
  • Sensitivity to hot or cold food and drink
  • Bad breath and/or an unpleasant taste in your mouth

If the infection spreads, you may also develop a high temperature (fever) and feel generally unwell. In severe cases, you may find it hard to fully open breathing. your mouth and have difficulty swallowing or breathing.

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What Causes Dental Abscesses?

Your mouth is full of bacteria, which form a sticky film on your teeth called plaque. If you don’t keep your teeth clean, acids produced by the bacteria in plaque can damage your teeth and gums, leading to tooth decay or gum disease.

The following can increase your chances of developing a dental abscess:

  • Poor oral hygiene – plaque can build-up on your teeth if you don’t floss and brush your teeth regularly
  • Consuming lots of sugary or starchy food and drink – these can encourage the growth of bacteria in plaque and may lead to decay that can result in an abscess
  • Having a weakened immune system – this includes people with certain underlying health conditions, such as diabetes, and those having treatment, including steroid medication or chemotherapy

What to do if you have a Dental Abscess?

if you think you have a dental abscess, the most important action that can be taken is an immediate visit to an emergency dentist, which will hopefully spell the end of the problem as soon as possible. It’s important to get help as soon as possible, because abscesses don’t go away on their own. If the issue is ignored for a long period of time, the infected tooth may need tooth extraction, as the problem may spread to other areas of the mouth. Therefore, it is absolutely vital for individuals to ensure they visit a dental professional at the next possible opportunity.

Relieving your Symptoms

While you’re waiting to see a dentist, painkillers can help control your pain. Ibuprofen is the preferred painkiller for dental abscesses, but if you’re unable to take it for medical reasons, you can take paracetamol instead. Aspirin shouldn’t be given to children under 16. If one painkiller doesn’t relieve the pain, taking both paracetamol and ibuprofen at the doses shown in the medicine leaflet may help. This is safe for adults, but not for children under 16.

What is the best painkiller for Toothache?

Wisdom tooth infections are normally inflammatory based infections. Generally speaking, over the counter non-steroidal anti-inflammatory medication are all that you will need. Everyone reacts differently to painkillers for dental pain. There are a few over the counter painkillers which are readily available.

Ibuprofen- this can really help with toothache as it is an anti-inflammatory as well as an analgesic. It is not advised for asthmatics or people with certain stomach problems.

Paracetamol- This is readily available over the counter and comes in tablet and soluble. Many patients find this effective for dental pain.