What are they?

Dental pain comes into 4 main categories.
• Pain on stimulation i.e. hot, cold, sweet or pressure.
• Intermittent or fluctuating aching.
• Continuous, persistent, severe pain.
• Soft tissue pain (ulcers etc)

What causes it?

1. Sensitivity to hot, cold and sweet things is usually caused by exposed dentine either in a cavity or where the enamel or gum is no longer covering the dentine at the neck of the tooth.
2. Tenderness to touch or on eating with sensitivity to cold but relieved by warmth indicates a cracked cusp (only the cusp in question is sensitive), mild inflammation or infection in the nerve or under the tooth (common temporarily after a filling particularly if the filling is a little proud), or gum problems developing.
3. Extreme tenderness with throbbing pain on heat and on lying down but relieved by cold and with pain in the gum as well indicates an abscess developing. Untreated the pain will increase until the abscess causes swelling or relief of pressure by draining. At this stage the infection is still present and will start to affect general health even though there may no longer be dental symptoms. Almost inevitably it will recur without warning becoming severe within a very short period of time (usually 1-4 hours). Root canal treatment will be necessary but may have to be deferred a few days until the worst of the infection can be controlled.
4. Sinusitis and hay fever can cause pressure pain in the upper back teeth, which disappears when the sinuses improve.
5. Saliva glands can become blocked with stones and cause pressure pains at meal times.
6. Wisdom teeth can cause pressure pain, stiff neck, earache joint ache and even a stiff arm if impacted.
7. Joint and bite problems can cause migraines, headaches earache and non-specific toothache.
8. Tumours may cause unusual and non-specific pain symptoms.
9. Ulcers are caused by viruses, abrasion or trauma and don’t respond to antibiotics.

What to do about it?

• Exposed dentine or cavities can be treated with sealants or fillings.
• Pulp damage and abscesses can cause painful toothache but the pain will usually end very quickly when the root canal is cleaned out; temporary relief can be achieved with antibiotics but can make the long-term situation worse if the cause is not treated in a timely fashion.
• Without a root filling a tooth with a dead pulp would have to be taken out;
• Painful impacted wisdom teeth need removing.
• Joint and bite problems need careful assessment and treatment planning over a period of time.
• Gum problems need advice and treatment from a hygienist.
• Ulcers usually require treatment for the symptoms and resolve in 4-5 days.
• Tumours need specialist care from the hospital.

Dental pain is a warning that something is wrong. Ignoring it will lead to additional treatment and larger dental bill.