Why does my tooth hurt?

There can be many reasons a tooth can hurt and sometimes there is actually nothing wrong with the actual tooth.  People often wonder why a tooth hurts when it has had a root canal, or why it only hurts to with pressure but not colds or the other way around.  Others come in confused  by symptoms that are inconsistent.  There are plenty of patients I see that fell a tooth ache but are not sure which tooth or even if it is a top of bottom tooth or even multiple teeth.  There are many thing that can cause a tooth to hurt and only a few sources of tooth pain.

Have you ever been frustrated with trying to figure out why your tooth is hurting?  I will explain the different neural sources of tooth pain and the causes that lead those sources to hurt.

First a very brief anatomy lesson 

http://en.wikipedia.org/wiki/Pulp_(tooth)

The tooth has a hard enamel shell on the top part the sticks out of the gums.  The part of the tooth in the bone, the root of the tooth, is made up of a less hard material called cementum.  Going from the outside in just past the enamel is dentin.  The dentin is softer like the cementum and is more porous. In the center of the tooth is the pulp which consists of the blood vessels and nerve.

Supporting the tooth on the outside is the gingiva or gums.  Inside the gums is the bone and between the bone on the tooth is a ligament.  Tiny nerves inter and exit the tooth from all around the root, but the main nerve exits out of the tip of the root.  This nerve then connects to larger and large parts of the nerve that are connecting to other teeth and even other parts of the mouth.  Eventually the nerves travel all the way back to the brain.


Sources of tooth pain

A tooth will hurt if the nerve is aggravated.  This can happen in many ways but I will narrow it down to four categories:

1. The nerve inside of the tooth is aggravated
2. The nerve in the ligaments and bone surrounding the tooth is aggravated
3. The nerve in the gingiva or gums is aggravated.
4. The nerve is aggravated at a different spot heading back to the brain and is referring back to the tooth.  

Causes of pain: A long list that is a brief view of possible problems.

There are a signs and symptoms that help me as a Dentist to find out what might be causing one of the sources of pain hurt. It is very helpful to know how the tooth is hurting, what causes it to hurt and even when it hurts.  There are also things I can look for and test for that help to find the cause of the pain.  Using both your description of the pain and what we find on x-ray, photos and tests we are able to find the cause of the pain.

What can cause these different sources of pain to actually hurt?  Well the list is long but I will do my best to list some of main causes per category

1.  The nerves inside the teeth can hurt because of: 

• A cavity reaching the never, 
• a crack reaching the nerve, 
• the dentin being exposed from worn enamel, the dentin pores the communicate cold and hot more with the nerve,
• a cavity extending into the dentin causing dentin pore communication of cold, hot and sweets
• swelling in the tooth putting pressure on the nerve from physical trauma
• swelling in the tooth from dental work, Yes we need to do this in order to correct worse current or future problems with tooth, the soon a problem is addressed the lower the chances are 
• a broken tooth exposing the pulp/nerve of the tooth 
• chemical exposure opening pores in the tooth that communicate with the nerve (this is usually from tooth bleaching)

2. The nerves for the ligament and bone can hurt because of:

• an infection from the inside of the inside of the tooth coming outside in the ligament space
• a crack extending down the root of the tooth that is under bone, this can irritate the ligament and the bone
• swelling of the ligament from physical trauma
• swelling of the ligament from a traumatic chewing habits
• swelling of the ligament from an unstable bite when chewing
• loss of bone support cause the tooth to become loose and irritate the remaining bone
• physical trauma that breaks the bone an not the tooth
• abnormal growth in the bone affecting the nerve

3. The nerves in the ginigva (gums) is aggravated:

• Physical trauma to the gums (from multiple sources)
• Chemical trauma to the gums (from multiple sources)
• Burns on the gums
• plaque leading to bacteria infecting the gums 
• Tartar (hard plaque) leading to bacteria infecting the gums but also placing physical presser on the gums
• viral infections, such as cold sores
• fungal infections
• abnormal growth in the gums affecting the nerve

4. The nerves can be aggravated in a different location referring pain to the teeth because:

• Swollen salivary ducts from an infection
• Swollen salivary ducts that are just clogged (for lack of a better laymen term)
• Swollen clenching muscles that refer pain back to the tooth
• Swollen jaw balancing muscles that refer pain back to the tooth
• Tense muscles that refer pain back to the tooth
• Sinus troubles that refer pain back to the tooth
• Any of the first three sources problems getting mixed up in the nerve highway back to the brain that refers pain to another tooth instead of the actual problem tooth

With the many possibilities of tooth pain it's a good thing we take time with our patients so we can get a clear picture of what is going on and why.  This is how we take our patients oral health to a level they did not know could be achieved.

I would love to hear your comments on any confusing dental problems you may have had as well as what happened to help correct it.  For more information about our office please visit www.leathamdental.com