Toothache / Dental (odontogenic) pain is a common problem. It can be extremely debilitating and is one of the primary reasons people seek dental care.
Causes of Toothache
Toothache occurs when the tooth’s sensitive pulp is exposed to hot, cold, sweet or physical stimuli (dental pulpitis).
It commonly arises due to:
- Tooth decay (dental caries)
- Fractured or cracked tooth
- Loose or missing filling
Other causes of acute dental pain include: - Receding gums and exposure of the dental root
- Dental abscess (infection)
- Inflammation due to erupting teeth (pericoronitis). Pain can also arise from inflammation subsequent to dental treatment, mouth ulcers and abrasions caused by dentures or braces. It can sometimes stem from problems in other parts of the body, e.g. intermittent, sharp, shooting pains may arise from trigeminal neuralgia, whereas sinusitis may cause a unilateral, dull throbbing pain.
Dental decay
Dental decay is a common cause of pain. Irreversible pulpitis (when pain is severe and the dental pulp cannot be saved) is one of the most common reasons for emergency dental appointments.
Since toothache is often the result of dental decay, many cases could be prevented by avoiding a cariogenic diet (i.e. avoiding frequent consumption of sugary foods and drinks) and maintaining good oral hygiene.
Management of Toothache
Delaying or avoiding treatment increases the risk of pulp damage, more pain, and having root canal treatment or extraction as the only treatment options.
Self-care advice
- Use a dental pain-relieving gel
- Take painkillers, like ibuprofen or paracetamol
- Try rinsing your mouth with salt water (children shouldn’t
try this) - Eat soft foods (e.g. yoghurt, scrambled eggs), avoid foods
that are sweet, very hot or cold, and try to avoid chewing
with the sore tooth
Painkillers
A simple oral analgesic can be advised to temporarily relieve toothache in adults and children (from 2/3 months of age).
Most dental pain is relieved effectively by non-steroidal anti-inflammatory drugs, such as ibuprofen. Paracetamol can also be used to help relieve mild to moderate pain. However, whereas paracetamol can take up to an hour to work, ibuprofen can relieve pain within 20-30 minutes, and when taken in regular doses, may also ease inflammation.
Opioid analgesics are not advisable for management of toothache. They are relatively ineffective for dental pain and can cause unpleasant side effects.
Dental pain-relieving gels
Dental pain-relieving gels may be preferred to oral analgesics as they can be applied directly to the painful area to rapidly target the source of pain. Pain-relieving gels on general sale contain either a local anaesthetic or analgesic:
- Lidocaine hydrochloride, for example, is a useful surface anaesthetic in concentrations up to 10%10 – it is found in gels indicated for oral lesions in adults
- Choline salicylate is a derivative of salicylic acid with some analgesic action – Choline salicylate gel 8.7% is indicated for mild oral lesions (from 16 years of age)
- Benzocaine is a powerful local anaesthetic used in dental pain-relieving gels to provide fast, effective relief from toothache pain, and also in mouth gels to relieve pain associated with mouth ulcers and denture sores.
Benzocaine gels
Benzocaine is a powerful local anesthetic used in dental pain-relieving gels to provide rapid relief of toothache pain associated with open carious lesions and exposure of dental pulp, and also in mouth gels to relieve pain associated with mouth ulcers and denture sores.
Benzocaine is absorbed into the mucosal membranes where it blocks the path of pain signals and rapidly relieves pain by numbing the area. Several small studies demonstrate the efficacy of benzocaine dental gels (see next slide) in relieving pain associated with open tooth cavities.
Agents containing 20% benzocaine typically start to produce an effect within 30 seconds, and achieve their full effect within 2-3 minutes.
Warning to avoid hot drinks
Benzocaine has poor water solubility and residues remain on the applied surface for relatively prolonged periods. There is no need to avoid eating or drinking – though avoiding hot drinks is advised to reduce the risk of scalding the numbed area.
Using benzocaine gels
Benzocaine dental gels are easy to use. However, they are unsuitable for children under 12 years and usage instructions
should be followed carefully.
They are intended for short-term use until a dentist can be consulted. A pea-sized amount of gel should be applied into the tooth cavity up to four times daily.
Side-effects are possible and excessive absorption may produce a potentially fatal condition called methaemoglobinaemia (where the amount of oxygen carried through the blood is greatly reduced).
Other treatments options
- Desensitising toothpaste for dental sensitivity
- Chlorhexidine mouthwash for oral hygiene, plaque inhibition,
denture stomatitis and gingivitis - Hydrogen peroxide mouthwash for acute ulcerative gingivitis
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