Why Have I Got Toothache?

What causes teeth to be painful and how is it treated?

Toothache can range from a tooth being sensitive to cold, to pain on biting or even be a constant pain that mean people can't sleep properly! There are many causes of toothache and we will discuss some of these and different options available for how they can be treated. 

Dentine Hypersensitivity

This tends to occur in patients who's gums have shrunk back due to gum recession, leaving the roots of their teeth exposed. The roots of a tooth can become incredibly sensitive to cold, touch or even toothbrushing because they aren't protected by enamel which is the hard outer layer we have on the tops of the teeth. In these early stages we can take a non invasive approach, where a fluoride gel is placed on the exposed root surfaces and starting to use a sensitive toothpaste that you place on the exposed root surfaces before going to sleep and leaving on overnight to soak into the tooth.

Over time these root surfaces can become worn incredibly quickly as they are softer than enamel. As the wear progresses deeper the nerves in the tooth can become very inflammed and painful, to the point where toothache becomes more constant and worsened by heat in which case teeth may require root canal treatments or even extracting! So one option available would be to cover exposed root surfaces with a composite filling, which helps to protect the nerves in the tooth and treat the sensitivity to cold.

Reversible Pulpitis

This most typically occurs as a result of decay deep in a tooth, in close proximity to the nerves. This causes the nerves in the tooth to become painful in short bursts usually when something cold comes into contact with the tooth. At this stage treatment is based around removing the cause which is the decay deep in the tooth and placing a filling. However in the future the nerves in the tooth may die off as a result of the previous damage they have recieved in which case root canal treatment or extraction may be considered.


If left untreated reversible pulpitis will progress to irreversible pulpitis or to the point where the tooth becomes infected.

Irreversible Pulpitis

This again is most commonly caused by decay deep in the tooth but at this stage the nerves in the tooth have become so badly damaged that they are going through the process of dying. The nerves in the tooth can be constantly painful throughout the day even without any trigger which can worsen when heat is applied. At this stage treating the cause of the problem means removing the nerves in the tooth either by way of a root canal treatment or removing the tooth itself.

If left untreated the tooth will eventually become infected leading to further pain and possibly a facial swelling in the future.

Infected Tooth

At this point the tooth will usually be constantly painful through day and night, causing sleepless nights, which can be worsened when pressure is applied to the tooth when biting and chewing. Tooth infections can be present without experiencing any pain however if left patients risk bacteria entering their blood stream or facial swellings that interfere with breathing. The treatment options here involve removing the cause of the infection which is bacteria within the root canal system of the tooth through root canal treatment or removing the tooth.

Now it would be great if we can avoid these problems before they occur which is why we advise people to regular dental check ups and consider having fillings on decayed teeth before they get to this point.

Posted By Matt Dash BDS

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