Pain has a purpose: it tells us when something's wrong with our bodies. Sometimes it's obvious, like a cut or bruise. Sometimes, though, it takes a bit of sleuthing to find out what's wrong.

That can be the case with a toothache. One possible cause is perhaps the most obvious: something's wrong with the tooth. More specifically, decay has invaded the tooth's inner pulp, which is filled with an intricate network of nerves that react to infection by emitting pain. The pain can feel dull or sharp, constant or intermittent.

But decay isn't the only cause for tooth pain: periodontal (gum) disease can trigger similar reactions. Bacteria living in dental plaque, a thin film of food particles on tooth surfaces, infect the gums. This weakens the tissues and can cause them to shrink back (recede) from the teeth and expose the roots. As a result, the teeth can become painfully sensitive to hot or cold foods or when biting down.

Finding the true pain source determines how we treat it. If decay has invaded the pulp you'll need a root canal treatment to clean out the infection and fill the resulting void with a special filling; this not only saves the tooth, it ends the pain. If the gums are infected, we'll need to aggressively remove all plaque and calculus (hardened plaque deposits) to restore the gums to health.

To further complicate matters, an infection from tooth decay could eventually affect the gums and supporting bone, just as a gum infection could enter the tooth by way of the roots. Once the infection crosses from tooth to gums (or gums to tooth), the tooth's long-term outlook grows dim.

So, if you're noticing any kind of tooth pain, or you have swollen, reddened or bleeding gums, you should call us for an appointment as soon as possible. The sooner we can diagnose the problem and begin appropriate treatment the better your chances of a good outcome — and an end to the pain.

If you would like more information on diagnosing and treating tooth pain, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Confusing Tooth Pain: Combined Root Canal and Gum Problems.”

You experience a painful toothache that lasts for a few days, but eventually the pain subsides. Since there's no longer any pain, there's no longer anything wrong with the tooth, right?

Maybe not — the toothache may be the result of a decay-induced infection that has developed deep in the pulp of the tooth. The infection inflames both the pulp tissue and the nerves bundled in it (a condition known as pulpitis). Because it occurs in an enclosed space, the pain is even more severe.

Now it's possible for the inflammation to subside and the nerves to heal, which would explain the pain subsiding. But there is another, more likely scenario: the infected pulp tissue can no longer fight the infection and dies. The affected nerves die also, which is why you no longer feel any pain — the dead nerves are no longer transmitting a signal to the brain. The infection, however, is very much alive and continues to advance deeper into the surrounding tissues where it may eventually develop into a painful abscess.

So, how can we determine which of these two scenarios you are actually experiencing? A visit to our office for testing is the surest way to find out. The most common test involves temperature sensation, usually with the application of ice to the affected tooth. If there's no sensation, then that's evidence the nerves in the tooth have died.

If that's the case, it's important then to take steps to stop the infection's advance before it does even more damage. The most likely treatment is a root canal, a procedure that accesses the pulp from the top of the tooth, removes the dead tissue, and then cleans and prepares the root canals for filling. This procedure can usually be performed in our office, but more involved cases may require an endodontist, a specialist in root canals.

In any case, if you experience a severe toothache, please have it examined. And remember — the absence of pain after a toothache doesn't necessarily mean the problem is gone.

If you would like more information on the diagnosis and treatment of an acute toothache, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Severe Toothache.”