A toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection. A toothache may feel like a sharp pain or a dull ache. The tooth may be sensitive to pressure, heat, cold, or sweets. In cases of severe pain, identifying the problem tooth is often difficult. Any patient with a toothache should see a dentist at once for diagnosis and treatment. Most toothaches get worse if not treated.

  Causes and symptoms

Toothaches may result from any of a number of causes:

• tooth decay (dental caries)
• inflammation of the tooth pulp (pulpitis)
• abscesses
• gum disease, including periodontitis
• loose or broken filling
• cracked or impacted tooth
• exposed tooth root
• food wedged between teeth or trapped below the gum line
• tooth nerve irritated by clenching or grinding of teeth (bruxism)
• pressure from congested sinuses
• traumatic injury

  Diagnosis

Diagnosis includes identifying the location of the toothache, as well as the cause. The dentist begins by asking the patient specific questions about the toothache, including the types of foods that make the pain worse, whether the tooth is sensitive to temperature or biting, and whether the pain is worse at night. The dentist then examines the patient's mouth for signs of swelling, redness, and obvious tooth damage. The presence of pus indicates an abscess or gum disease. The dentist may flush the sore area with warm water to dislodge any food particles and to test for sensitivity to heat. The dentist may then dry the area with gauze to determine sensitivity to touch and pressure. The dentist may probe tooth crevices and the edges of fillings with a sharp instrument, looking for areas of tooth decay. Finally, the dentist may take x rays, looking for evidence of decay between teeth, a cracked or impacted tooth, or a disorder of the underlying bone.

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