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Top 9 Toothache Causes

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Dr Teresa Li
April 23, 2024

The dreaded toothache.  In the dark ages, people believed toothaches to be the result of a curse or witchcraft.  And if you've had one lately it's easy to understand why!

Luckily today we know better and understand the real causes and treatment options for a toothache.

Why is a toothache so painful?

No, you're not a “wuss”.  A toothache is excruciating, and there’s a good reason for that.  

Your face, head and teeth are richly supplied by the nervous system making it a sensitive area.  The inside of a tooth contains many neural connections to the pain centres in your brain.

A toothache is your body sending out an SOS distress signal.  It’s alerting the brain that something is wrong.  

So without further ado, I'm diving straight into the top causes of a toothache.

But first a disclaimer: this is not a way to diagnose what is causing your particular toothache.  The only way to confirm the cause of a toothache is for a dentist to see the tooth and take some x-rays.  

1. Tooth Decay or Cavities


Along with the common cold, it’s one of the most common human ailments and accounts for roughly 24% of all trips to the dentist.   

Nearly half of all Australian children under age six have some tooth decay in their baby teeth.  One in ten has at least one tooth with untreated tooth decay according to an Adelaide University study.

Australian adults (15 years and over) have nearly eight tooth fillings on average as a result of tooth decay.  

But here's the thing, tooth decay is a bit sneaky because in its early stages you won't feel any pain.  The first small lesion might just look like a stain, or you won't see it all if it's on your back teeth or upper teeth.  

As long as the decay is only on the outer part of your tooth - the enamel - there is no pain to alert you that something's wrong.  However, once the decay gets into your softer inner layers of the tooth - the dentin and pulp - then it becomes painful but also more challenging to treat.

You can learn more about the five stages of tooth decay and possible treatments in my previous post as this is a big topic that needed its own article!

If your toothache has persisted more than two days then it's best to see your dentist straight away.  

Catching tooth decay early means you may just need a tooth coloured filling or a sealant. This treatment is quick with minor to no discomfort. At TL Dental in Port Macquarie our dentists use the Injex needle-free system to numb your mouth, so you don't even need to worry about having a needle.

On the other hand, left untreated the decay can lead to an abscess (pocket of pus) forming on your tooth root which is not only painful but can lead to tooth loss.

2. Cracked or Chipped tooth

If you chip or break part of your tooth, you mightn’t feel any pain at first (especially with cracks), but it can lead to bacteria infecting your tooth and dental pain.  You’ll first get sensitivity to hot and cold and eventual pain when biting/chewing.  

Cracked and chipped teeth are so common that I’ve written an entire post on the causes, symptoms and dental fixes in my “Chipped tooth now what?” post. 

3. Gum Disease

Gum disease is common and a leading cause of tooth loss in adults.  Gum disease causes not only sensitive, red, swollen gums but also tooth pain.  

You may notice that your gums bleed and hurt during brushing and flossing.  Those with gum disease tend to describe it as a dull rather than a sharp toothache. 

Only your dentist can confirm if you have gum disease and advise you on the best gum disease treatment.  Caught early there’s a great chance of stopping gum disease.  If left untreated it will lead to bone loss around your tooth and possible tooth loss.

4. Sensitive teeth

Do feel a sharp tooth pain when you eat or drink hot/cold foods and drinks?  Chances are you have temperature sensitivity (provided you are cavity free and don’t have a cracked/chipped tooth).  

There many causes of sensitive teeth from worn down tooth enamel to teeth grinding.  The best way to get to the bottom of your tooth sensitivity is to visit your dentist and have them check for the cause and then prescribe the best treatment for you.  

5. Teeth grinding & jaw clenching

Grinding teeth (bruxism or bruxing) is a common and growing problem.  Prof. Christopher Peck, Dean of Dentistry at the University of Sydney recently said that “we’re all likely to have episodes of teeth grinding at some point in our lives”.  Further, about one in ten Australians have “ongoing” bruxism.

This is an involuntary clenching or grinding of the teeth than mostly occurs when we sleep but for some even when they are awake!

It’s thought to be caused predominantly by stress, anxiety and mental concentration but there are other causes too, and there is no clear-cut answer as to why some people do this habitually.

Grinding and clenching lead to sore teeth, neck and head.  Heavy grinders may even find that they are wearing down their enamel and this, in turn, causes tooth sensitivity and tooth pain.

Like most dental related problems there could be many reasons so your dentist will need to see your teeth, take some x-rays and look for the most probable cause and solution.  

One of the most common ways to prevent damage to teeth in bruxers is for your dentist to make a special splint that you wear at night.

6. Heavy-handed tooth brushing

Do you buy a toothbrush and find that the bristles quickly are worn, bent and haggard?  Aggressive brushing and flossing can lead to sensitive, irritated and painful gums.  It's even possible to damage the gum attachment near the tooth and cause the gums to recede causing further pain.

Always use a soft brush and gentle circular strokes when brushing your teeth and gums.  Your dentist will be able to visually check for any tell-tale signs of gum damage from vigorous brushing.

7. Impacted Wisdom Teeth

These teeth - our late-blooming third molars - are the last to erupt around the age of 17-24.  For many, there just isn't enough space in the jaw to allow the tooth to come through the gum and they become impacted.  

Impacted wisdom teeth are extremely painful.  Your dentist will take a special 3-D x-ray of your jaw to see the wisdom teeth and assess the best treatment for you.  In most cases, once they are infected and painful removing them is the best solution.

8. Orthodontic treatment

This one is fairly obvious.  Those who've had braces or clear aligners may have felt the discomfort from the gentle tooth movement.  This tooth pain usually happens when the braces are adjusted, or aligners changed and should clear within a couple of days.  Make sure you discuss this with the person providing treatment so they can check for other problems.

9. Damaged fillings

If a filling is damaged, it can expose the sensitive inside of the tooth too hot, cold and bacteria from the mouth.  This exposure can cause a toothache, and the best course of action is to have the damaged filling checked out and replaced.

Need a dentist in Port Macquarie? 

Have a toothache and need a dentist Port Macquarie NSW contact the TL Dental team today on 02 6583 4055 .  Emergency dental visits are typically seen and treated on the same day.  We are also able to provide  prescription only pain relief medication for severe pain.

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