Clinical Signs and Symptoms of a Toothache

A toothache is oftentimes an excruciating experience that may affect your quality of life and daily function. It may be difficult for you to chew properly, get through the day or even sleep at night when there is untriggered, throbbing pain. When this occurs, it is important to see your dentist for immediate attention.

Possible Causes of Tooth Pain and What You Can Do

Below is a list of common pain symptoms, possible causes and some steps you can take to temporarily alleviate any discomfort prior to your dental visit. 

1. Momentary sensitivity to hot or cold foods
   Possible cause: When the underlying dentine of the tooth is exposed due to enamel wear or initial decay, you may be experiencing dentine hypersensitivity. It is sharp and brief in nature and is triggered by temperature changes in foods or brushing and flossing. It does not linger once the stimulus is removed and does not occur spontaneously.What to do: You can try to apply a desensitizing toothpaste with a soft-bristled toothbrush in the sensitive areas. You may also wish to seek a consultation with your dentist to check for any possible tooth decay or loose fillings.

2. Sensitivity to hot or cold after a dental filling
   Possible cause: After a recent dental filling, there may be heightened sensitivity of the pulp. This is what dentists diagnose as reversible pulpal inflammation. The symptoms are characterized by a short and sharp sensitivity when triggered by temperature changes in foods and do not linger.What to do: Monitor the sensitivity for two to four weeks. If the sensitivity worsens in intensity or has evolved into a dull and lingering ache, see your dentist or an endodontist for a consult.

3. Sharp pain or dull ache when biting
   Possible cause: Sharp pain on biting on foods may be due to decay, loose filling or crack. A dull pain on biting may also signal periapical infection due to pulp necrosis of the tooth.What to do: Seek evaluation by a dentist, who may refer you to an endodontist to determine if there is any pulp disease which will necessitate root canal treatment. If it is just a decay or loose filling, it can be treated with a dental filling. If it is a deep decay or a crack, the tooth may need a root canal treatment.

4. Lingering, throbbing pain (more than 20 seconds) after eating hot or cold foods and spontaneous pain at night
   Possible cause: Lingering ache after a thermal stimulus or unprovoked pain at night (when lying down) may signal irreversible damage of the pulp caused by deep decay, crack or even severe gum disease.What to do: See your dentist or an endodontist as soon as possible to identify the problem tooth. They can remove the inflamed pulpal tissues and retain the tooth with root canal treatment. You may take over-the-counter painkillers in the meantime to break the pain cycle for temporary relief.

5. Swelling or pus around gums
   Possible cause: There may be a dental abscess caused by the surrounding periodontal tissues of the tooth. This may be due to a root canal infection or periodontal (gum) disease. It is not common, but the swelling can progress to the cheeks and the jaw.What to do: Seek a clinical evaluation with your dentist to diagnose the source of the infection. If the abscess is caused by a root canal infection, your endodontist may perform root canal treatment. If the swelling is due to periodontal disease, your dentist will carry out a deep cleaning around the gum region.

Above are the common situations when toothache occurs. There are instances where the patient perceives the pain as toothache, but it is actually caused by structures other than the teeth or the gums. To name a few: Sinusitis, Temporomandibular Disorder (jaw-joint issue) and Myalgia (pain involving the muscles).

Proper Examination and Correct Diagnosis

To treat the toothache, the dentist or the endodontist have to first arrive at the correct diagnosis. 

The diagnosis of a toothache will require a proper understanding of the patient’s pain and careful examination of the tooth. During the examination, the dentist or endodontist will have to conduct a few tests to find out the triggering factors and attempt to reproduce the pain. In addition, they will take radiograph/s to assess the extent of disease and the health of the surrounding structures.

To understand Root Canal Treatment Procedures, you can refer to our other Blog articles.

ROOT CANAL TREATMENT PROCEDURE: WHAT SHOULD YOU EXPECT?

Why would I need Root Canal Treatment?

Root canal treatment is a procedure that helps to relieve patients’ toothaches and to clear the infection present inside a tooth. The common reasons for toothaches or infection is tooth decay and cracks. 

How does a toothache come about? A tooth has a chamber and root canal spaces within the center of the tooth, which is where the soft tissues of the pulp are located. Pulps have nerve tissues and when the tooth is damaged by decay or a crack, bacteria can infiltrate into these tissues. It can then become inflamed or infected, giving rise to severe pain commonly known as a toothache. When no treatment is rendered, the infected pulp will affect other tissues such as the jaw bone and the gums. This can potentially cause severe pain of the jaw bone and sometimes swelling of the gums, cheeks or the lips. Root canal treatment is necessary to eliminate the infection and spare the tooth from an extraction. 

It is unfortunate that many people think that root canal treatment is a painful procedure. In fact, the experience of severe pain during and after root canal treatment is unlikely. The fear for root canal treatment usually stems from the lack of knowledge of the procedure itself. With reassurance and explanation from the dentist or the Endodontist, the patient can understand why they need root canal treatment and what can be done to resolve their dental issues and pain.  

Root Canal Treatment Procedure 

Before the Procedure: The dentist or the Endodontist has to make a thorough examination of the teeth so that the painful tooth is correctly identified. There are several examination procedures and some are done to reproduce the symptoms of the painful tooth. A radiograph is also taken to check the tooth and the surrounding tissues. 

Demonstration of Rubber Dam Isolation with a Dummy Training Head.

Preparing The Treatment Area: Anaesthetic injections are necessary for patients before the actual procedure. Patients with long-standing toothaches or severe infection require special attention so that the teeth are properly anaethesized. Endodontists are experienced in this aspect and will be able to employ the appropriate technique according to the severity of the patients’ pain or infection. Once the anaesthetic injection is successfully delivered, the patient should not feel any severe pain during the procedure. 

During root canal treatment, it is important to prevent further contamination of the root canal space. A rubber dam, which is a rubber sheet, is used to isolate the tooth from the rest of mouth, creating a clean environment. The rubber dam and the affected tooth will also be disinfected prior to starting the treatment. 

Picture of a cleaning file fitted on a motor

Creating A Small Hole and Cleaning the Root Canals: After the rubber dam and the affected tooth has been disinfected, the dentist or Endodontist will then drill a small hole on the surface of the affected tooth to access the root canal spaces. If there was decay in the tooth, the decay should be removed before preparing the hole. Once entry to the canal is achieved, the dentist or the Endodontist will use small files and disinfecting solution to clean the canals and remove the infected or inflamed pulp tissues. The cleaning can typically take an hour. Medicament paste is commonly placed in the canal for at least a week and the hole is sealed up with a temporary filling. 

Picture of gutta percha material

Applying Root Canal Fillings: Following the thorough cleaning of the root canal, the dentist or the Endodontist will fill the canal space with a rubber-like material known as gutta percha. Pressure and/or heat is applied to the gutta percha so that the material adapts to the walls of the root canal. A sealer, which is a cement, is placed together with the gutta percha so that it creates a better seal to prevent reinfection of the canals. 

Root Canal Treatment Aftercare: The numbness following anaesthesia can last for a few hours but patients can still consume their meals, with extra care to avoid hot food and eating on the affected side. Patients should also avoid any hard food which may cause fracture of the affected tooth. Daily brushing and flossing should be continued as per normal. 

Root canal treatment is less invasive than an extraction and an implant procedure and patients should not expect any severe pain or swelling. However, patients with severe infection and pain before the procedure should expect the symptoms to subside only after a few days. Painkillers may be prescribed if pain is expected to persist, while antibiotics are only warranted for some cases. 

After the root canal treatment has been completed, the tooth will need a permanent filling or a crown. This restores the tooth to full function. 

Reach Out To Our Root Canal Treatment Specialist Today

If you are currently worried about undergoing a root canal treatment, there is no need to fret. Our Endodontists, the root canal treatment specialists at The Endodontic Office can walk you through the procedure as well as the aftercare. If you have any further questions, please reach out to us through our Contact Page. 

By Dr Helena Koh
Dr Helena Koh is an Endodontist in The Endodontic Office and is accredited as a specialist by the Singapore Dental Council. She has 10 years’ of clinical experience in Root Canal Treatments. 

Root Canal Vs. Extraction: Which Is Better For You?

The dental pulp in teeth can become inflamed or infected as a result of deep caries, cracks, fractures or severe gum disease. Patients may present with pain or a swelling, although at times there may be no symptoms as well. When this occurs, dentists will recommend one of two options – a root canal treatment versus an extraction. The risks and benefits of either treatment option depend greatly on the specific conditions of the individual tooth and patient. Here we share some insight behind how a root canal treatment can save your tooth.

What is root canal treatment?

Root canal treatment involves the disinfection of the root canals in a diseased tooth followed by a filling with a biocompatible material. 

• A thorough examination inclusive of a dental X-ray is performed to determine that a root canal treatment is required.
• Local anaesthetic is administered to numb the affected tooth. 
• A small opening is made through the crown of the tooth.
• Instruments are used to clean the root canals and a medicament may be placed inside the tooth.
• Depending on the complexity of the case, root canal treatment might be completed in a single or multiple visits.
• Finally, biocompatible materials are used to fill the root canals and a permanent filling (core) is placed to close off the opening
• If a crown is required to protect the tooth, we will refer you back to your general dentist for further management
• The tooth is retained in the mouth and functional

When might the tooth be unsuitable for a root canal treatment?

In the following situations, we may recommend an extraction:

• Assessment of the tooth confirms a deep crack
• Decay or a fracture that is too extensive
• Severe bone loss around the tooth
• Signs and symptoms persist despite adequate root canal treatment

In patients with certain medical conditions, we might advise against an extraction even for teeth which are otherwise unsalvageable. These conditions include a history of radiotherapy to the head and neck region, bisphosphonate or anti-resorptive/anti-angiogenic drug use for the treatment of osteoporosis or certain cancers. Please inform your dentist if you have any of these conditions so that the safest treatment option can be planned for you. 

What should I do if I need an extraction?

After a thorough assessment of the diseased tooth, if an extraction is recommended, we will liaise with your referring dentist to complete the extraction for you in a timely manner. Generally, extraction involves the removal of the diseased tooth with forceps but sometimes a minor operation may be required to fully remove the tooth. Extractions are usually performed under local anaesthesia. If several teeth are indicated for extraction, it may be performed under sedation or general anaesthesia. Your dentist will also be able to provide a suitable replacement for your extracted tooth, for example, an implant. 

Our team of root canal specialists at The Endodontic Office are well trained in the diagnosis and treatment of painful teeth. If you are suffering from a toothache, make an appointment to see one of our dentists via appointment@endooffices.com today.