By Dr. Nizar Kharma
“The man with a toothache thinks everyone happy whose teeth are sound”. Billions around the world would strongly agree with George Bernard Shaw’s genius description of the astounding distress and misery caused by toothache. But what is toothache? What causes it? And why is it so overwhelmingly perceived as the most distressing torment endured by a human?
Types of Toothache
Toothache refers to pain in and around the teeth and jaws. Toothache is notoriously painful due to the fact that the inflammation causing the pain is usually trapped in the very small and hard tooth tissue, therefore magnifying the pain’s intensity. Toothache can be classified according to its nature as:
- Intermittent or constant
- Spontaneous or initiated by eating or drinking
- Mild, moderate or severe
- Sharp or dull
Causes of Toothache:
1. Inflammation of the pulp (nerve) of your tooth. This can be caused by:
- Dental decay or caries, mainly caused by excessive and frequent sugar consumption.
- Trauma: such as accidental fracturing of a tooth.
2. Gum disease, which can cause painful inflammation of the gums and surrounding tissue. Severe gum disease leads to bone loss around teeth, thus making them less supported, more sensitive and tender to bite on.
3. Tooth-wear: This is mainly due to acid erosion, excessive tooth-brushing or severe bruxism (teeth grinding). This leads to cavities due to wear of the enamel and sometimes dentine layers. This type of wear usually causes mild to moderate sensitivity or pain, as the exposure does not usually reach the nerve. However, pain can become severe in more advanced cases, inflaming the pulp and leading to severe toothache.
4. Inflamed sinuses (sinusitis): Maxillary sinuses are in very close proximity to the roots of most upper teeth, therefore giving the same sensation as genuine toothache.
5. Jaw Pain: This happens in the joint connecting the upper and lower jaws. When inflamed, it gives the same sensation as toothache.
6. Wisdom Teeth )Pericoronitis(: Also known as impacted wisdom teeth, this will cause severe throbbing dental pain. Young adults are the most commonly affected.
7. Non-dental causes: Medical conditions such as angina can give a similar feeling to severe toothache. If dentists encounter this problem in a patient, they will refer him or her to hospital.
The Role of the Dentist
Depending on the cause of the problem, dentists will manage the situation as follows:
- Root canal treatment, which is complete removal of the nerve, is the best treatment for pulpal inflammation, severe tooth wear or pulp-involving gum disease.
- Extraction: Complete removal of the affected tooth is needed if root canal treatment fails, or in cases of severe gum disease, tooth-wear and chronic wisdom teeth.
- Fillings : can produce excellent results when tooth-wear is mild to moderate and only causing sensitivity or mild to moderate pain.
- Referral to Hospital: This may be inevitable in cases of unmanageable jaw pain, inflamed sinuses and in medical conditions.
In addition to dental treatment, pain killers (analgesics) can help patients manage their pain if there is a long delay before a dentist is available. Pain killers also help reduce pain following dental procedures. The most popular are:
- Paracetamol: The most common pain relief tablet for mild to moderate dental pain. One or two 500mg tablets of paracetamol up to four times a day is a safe dose for adults. Side effects are rare and this dose can be taken regularly.
- Ibuprofen: Having stronger pain relieving properties than paracetamol, so-called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, seem to work better when there is clear evidence of an inflammatory cause. However, if taken for long periods, there’s an increased risk of stomach upset, including bleeding, and kidney and heart problems.
- Codeine: An even stronger painkiller used for severe toothache, it doesn’t work very well on its own. It gives better results when combined with paracetamol in a single pill.
- Morphine and morphine-like drugs (for example, oxycodone, fentanyl and buprenorphine) are the strongest painkillers available. They will only be prescribed after consultation with your GP or a pain specialist. The dose response will be closely monitored.
The many side effects of pharmaceutical medications make them a less desirable option once natural alternatives are considered. Let’s take a look at the affordable and highly effective natural alternatives for managing toothache.
Smelling delicious and offering many health benefits, cinnamon oil is derived from the Laurel plant family, which can be found in Sri Lanka, China and Indonesia among other countries. It can be used as a disinfectant because of its ability to kill germs, and is non-toxic, which is beneficial for toothache caused by harmful bacteria. It can also assist in preventing cavities. In addition, cinnamon oil has antimicrobial, antiseptic and antioxidant characteristics.
A study by Amity University found cinnamon oil to be nearly twice as effective as clove oil when tested for their antibacterial properties on teeth.
To apply cinnamon oil, it is important that it be highly diluted, as too much can cause skin irritation. For every 50 ml of water add 6 drops of cinnamon oil. This natural mouthwash can then be gargled.
This oil’s main ingredient, eugenol, is the power behind its analgesic (pain relieving) and antiseptic properties. For centuries, clove oil has been used as a home remedy for toothache. More recent studies have confirmed its anti-fungal, anti-microbial and anti-bacterial effects, reaffirming clove oil’s potential to treat tooth infections and gum disease.
If you have a toothache, dab a small amount of clove oil onto a cotton bud and apply it to the problem tooth. After a few minutes, the area will be numbed.
Garlic has been enjoyed in dishes worldwide for centuries. Its health benefits are numerous; it contains manganese, as well as vitamins B6 and C, offers anti-cancer, antibiotic and anti-inflammatory properties and boosts the immune system.
When crushed or finely chopped, garlic releases two chemicals that create allicin, which is beneficial for relieving toothache due to its antibiotic nature.
To apply garlic, peel a clove, wash it, put it in your mouth and bite it between your teeth. Keep chewing until the pain goes away. When you have finished, take the chewed up clove out of your mouth (and maybe brush your teeth).
Ginger has been highly regarded in Chinese culture for thousands of years for its healing properties, and is considered a sacred herb. The Chinese philosopher Confucius extolled the virtues of ginger as a digestive aid. Ginger contains vitamin C, magnesium and potassium. It also has potent pain relieving and anti-inflammatory properties, making it a valuable treatment for toothache.
To use ginger root, first wash it under water and scrub the surface. Cut a piece and bite down on it, allowing the juice to flow to the area where you’re experiencing pain.
And Finally, Prevention Is Better than Cure
Excellent oral hygiene: This helps to eliminate bacteria-containing plaque deposits on the teeth and gums. Plaque removal will dramatically reduce the chance of developing dental decay, gum disease and painful wisdom teeth problems. Brushing your teeth twice a day and flossing once a day is highly recommended.
Healthy diet: This includes focusing on high quality nutrients such as proteins, complex carbohydrates, fresh fruit and vegetables, and dairy, in addition to limiting the amount of sugary foods in the diet.
Regular fluoride use: Despite the controversy surrounding fluoride, the useful benefits of its controlled use have been consistently scientifically proven. The most commonly used fluoride products are toothpaste and mouthwash. Dental professionals will advise patients on the appropriate dose and frequency of fluoride use according to each individual case.
Despite the wealth of information we have about managing dental pain, there is nothing better than preventing toothache in the first place. Regular six monthly visits to the dentist will help diagnose any early problems which might potentially cause toothache.References