Types of Toothache - How to find out the cause

A variable pain

Although toothache is an extremely variable and subjective symptom, it is possible to evaluate the different types of pain based on the cause of origin.

Toothache is a common symptom of many ailments, ranging from dental infections to stress, and from hearing disorders (otitis) to heart problems.

Depending on the nature of toothache, the pain felt can take on a different connotation. For example, sometimes the toothache manifests itself progressively, while on other occasions it begins suddenly. Again, if sometimes you can control with pain medications, often the toothache is so alive and pounding that not even the common analgesics are able to stop the torment. In milder cases, toothache is perceived only in certain specific conditions: for example when taking food that is too hot or iced, or salty or high in sugar. In the latter case, more than a toothache properly so called, the discomfort perceived in response to thermal or chemical stimuli translates more correctly into dentinal hypersensitivity.

Interpreting toothache

Given that every form of toothache presupposes the need to undergo an adequate dental examination, for a preliminary self-diagnosis of the disorder it is important to know how to interpret the signals that the organism sends us.

To assess toothache, it is necessary to consider some important parameters:

Pain intensity (tolerable, acute, excruciating, unbearable)
Location of toothache (affects a canine, a molar, a wisdom tooth, involves more teeth, etc.)
Frequency: pain is continuous or intermittent
Possible accentuation of pain with hot, cold, bitter, salty, acidic, sweetened foods ...
Onset speed (sudden, progressive pain)
Co-presence of satellite symptoms such as gum bleeding, fever, bad breath, etc.

Knowing how to recognize the type and intensity of toothache, as well as being able to place pain in a certain area of the dental arch is important to get an idea, however general, about the disorder that could be hidden behind a toothache . But that is not all. Knowing how to describe pain in its own words can be extremely useful for the doctor, who can thus put a diagnostic hypothesis in a more convenient way already starting from the anamnesis, or from the analysis of the symptoms reported by the patient.

Hypotheses on the causes

The table shows the main characteristics of toothache, distinct on the basis of the triggering disorder.

Description of toothache	Possible hypothesis on the causes
Toothache is acute, spontaneous and assumes a typically neuralgic character. With mastication alone, the toothache is accentuated and becomes excruciating. The affected tooth is extremely sensitive also to physical (hot / cold) and chemical (sweet, salty) stimuli and does not immediately regress when the stimulus is interrupted. Toothache, even if not very bearable in the most intense moments, presents an intermittent / remittent course, that is to say the painful and acute peaks are mixed with episodes of slight soreness, which tends to fade away to reappear soon afterwards with the same violence. Toothache is also difficult to control with classic analgesics (eg ibuprofen).	The description of toothache suggests a PULPITIS, a common complication of caries in the advanced stage not adequately cured by filling.
Toothache is quite bearable, even if annoying. The gums are particularly swollen and inflamed. After brushing or flossing or brushing, gums tend to bleed. Gingival pain can sometimes be experienced by the patient as a mild toothache, which is regularly accentuated by using a hard bristle toothbrush or an electric toothbrush.	From the analysis of the symptoms we can hypothesize a GINGIVITIS. Inflammation of the gums could be a soon solvable phenomenon or conceal an infection still in the asymptomatic stage.
Toothache is heavy, spontaneous and continuous, and is accentuated in response to mechanical stimuli (chewing or slight pressure on the tooth with the tongue). The intensity of toothache can sometimes hinder chewing, making it a real torture. The gums are fragile and obviously inflamed, even near the root apex. Toothache can be accompanied by secondary symptoms such as fever, halitosis and general malaise. The administration of antibiotics supported by properly dosed painkillers can relieve pain. This type of toothache can still be repaired through specific dental procedures. If not properly treated, toothache is exacerbated by the formation of an evident and turgid fistula, which is localized on the gingival mucosa.	Symptoms suggest a dental implant in progress.
Toothache appears without a precise motivation, on apparently healthy teeth. The gums are swollen, the breath bad and the lip slightly swollen. On radiographic examination, the doctor diagnoses a swelling of a bone / mandibular section. On the gingiva, immediately below the root of the tooth, a small pathological sac can be found peppered with gaseous, serous or mucous material.	In this case, toothache (which appears in an advanced stage of the disorder) is explained by a dental CISTI, a consequence of pulpits, included teeth, poorly performed tooth extraction or inadequate devitalization. The symptoms described above may also suggest a GRANULOMA. In this case, the differential diagnosis is very important to proceed with the most appropriate intervention.
The affected tooth is initially sensitive to too hot or iced food: at first, there is no mention of toothache because the discomfort is very bearable and regresses by removing the stimulus. Subsequently, the dolenzia takes on an increasingly intense connotation, until it turns into real toothache. Visibly, the crown of the tooth is damaged and there is a dot or a dark spot. Even the tooth enamel is altered in its natural brilliance: the tooth appears yellowed or opaque.	The symptomatology just described makes one think of a CARIE: initially, caries does not cause any symptoms. As the bacteria go deep, creating an important lesion, the symptoms progressively increase.
Toothache starts 3-4 days after a tooth is extracted The perceived pain is particularly intense, rather resistant to the classic NSAID treatment Toothache is accompanied by symptoms such as high fever, gingivitis, halitosis and bad odor in the area affected by toothache	Typical case of ALVEOLITE toothache. Even today this type of toothache is quite common after a dental avulsion operation. Fortunately, the pain resolves within 7-15 days from the day of the operation.
Toothache is localized precisely in a tooth that is traumatized or severely chipped by an accidental fall. Visually, the crown of the tooth appears fractured and sometimes the dental pulp is even evident.	The cause essentially depends on the TRAUMA suffered. The origin of toothache is not infectious.
Toothache manifests itself in a small child. The gums are swollen and inflamed, and the small one accuses an annoying perception of gum soreness, is clearly agitated and tends to continually bring the hands to the mouth	The most obvious response to these symptoms is the imminent growth of the TOOTH.
Toothache begins within 24-48 hours from a tooth whitening performed with laser lamps. The teeth are extremely sensitive to thermal or chemical stimuli. Even brushing your teeth with whitening toothpastes can be painful or annoying.	If the toothache resolves completely after a couple of days from the WHITENING procedure, the cause lies in the temporary hyperemia suffered by the dental pulp
Toothache is transient, easily reversible with a dose of analgesic drug. The patient experiencing the symptoms is subject to a cooling syndrome.	In all likelihood, toothache finds explanation in a SINUSITE. In this case, toothache does not present an infectious origin.
Toothache occurs punctually in the morning, after a night's rest. The pain is not limited to one or two teeth, but tends to involve the entire dental semi-arch The patient is facing a particularly stressed period	The symptoms described above presume a toothache that recognizes BRUXISMO (uncontrolled dental grinding) as the main causative agent