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

My two boys

Can you tel who's who?  One is the new born photo of Jack the other is Scott.

The most excited people get when talking about me is when they are talking about my two boys Jack and Scott.  So here are some photos of them.

This is what Jack thought of Scott when he first met him.

With the extra space around the photos I will fill with a bunch of stories of these two Leatham boys.

But after a few weeks he started to like his little brother.

An interesting thing about Jack and Scott is that I was the second child and had an older brother.  Already Jack and Scott seem to be similar.  Jack has to stay busy all the time like my older brother Mica.  Scott has been more reserved like his Dad.  Must be a second child thing.

Mom and Scott in the deliver room March 6, 2015

Jack wasn't so sure of Scott when he first met him at the hospital.  But after Scott came home Jack made up his mind, Scott was great... For about 2 minutes and then Jack moved on to more interesting things like his trucks.

 Luckily Grandpa Leatham was out to help and Jack had a new best friend to distract him from the needy little thing Mom and Dad brought home one day.

Jack fishing with Dad at the Clark county fair
in Logandale, NV Dr Leatham's home town.

After Grandpa left it didn't take Jack to long to warm up to his little brother.  Now he has been trying to fill Scott in on all he has learned in his 2 1/2 years in this world.

Both of the Leatham boys were ambitious from the start.   Jack was born 6 days early and Scott was born 10 days early.  Jack weigh 8 lbs 9.5 oz and Scott was exactly 1 lb less.  He was also 1.5 in shorter at 19 in. They were both born with a full head of hair. Jack went bald at 4 months then grew blonde hair, even though both Katey and I have dark hair we both have blonde brothers.

Dad and Scott in the delivery room.

Jack going down a carnival slide with Katey.

Another who's who photo of Jack and Scott both when they were newborns.

What makes you love your Dentist?

This morning I was at the grocery store buying gift cars for patients who have sent others to our office. The lady at the registrar asked why I was getting so many gift cards.  I let her know I was a Dentist and I used the gift cards to send to some of my patients.  Her smile dropped as she suddenly became solemn saying "I hate the Dentist."

I looked at her and brightly responded, "But we've just met."

She laughed and started to explain how she had once had a bad experience, so now she avoids seeing dentist but then when she needs to go it's for a root canal. I listened to her continue about how the sound of the drill and having her mouth open for a long time also made her dislike the dental visits.  I gave her my card and told her I would like to try to give her a better experience.

This is a fairly common occurrence for me.  I meet someone, they find out about my profession and they then let me know their felling for my profession. Sometimes it is very negative, and many times it is very positive.  The stories they tell me have helped me find what usually make one person love their dentist and the other person to dislike them.  The  following are some of the things I have learned that make people love or hate the dentist:

1. The Dentist's Personality
The Dentist was a very nice guy, or he was very impersonal.  Dentists are people and just like everyone else.  There are a lot of great Dentists and there are a few bad ones.  If you have had to deal with a bad one it is especially difficult because of the personal space they are working in.
The better personal relationship people have with their Dentist and his or her team the better their experiences tend to be.

2. That Numbing Feeling
Many people have expressed to me how much the dislike being numb for so long.  Well I have some good news we have a numb reversal agent called Oraverse. We can use this to greatly shorten the time you are numb after a procedure.  I've used this for patients who need to give presentations or are going to a social event so they can have normal function sooner.

3. Discomfort After Dental Procedures
Some people never notice any discomfort after dental work and others have had their teeth become sensitive or even hurt after dental procedures.

This can be difficult because dental surgery is just that, surgery.  If you just had surgery on your foot it would be unlikely that you would be walking on it the next day.  However this is what we do with our teeth.

Luckily there are some different agents that can be used to help relive this very common post operative sensitivity.  We use Microprime with all of our crowns and fillings.  Not only has this greatly reduced the percentage of our patients who experience after dental work but it also helps to decontaminate the tooth.

4. Cost
 I have heard people in all walks of life say that their dental care was worth every penny and others who say that it is just too expensive. On average people spend more on their cell phone or clothing. Beyond this the longer you wait to correct a dental problem the more expensive it will become.  A root canal which will then require a crown is 10 times the cost of a filling and a filling costs about the same as an extraction.

The difference with the cost of dentistry when compared to cell phone coverage, or clothing is that it tends to come all at once.  To help with this we offer several financial options to help make the dental care you need more affordable.

In Summary
The dental office can seem like a scary place for many reasons.  We understand this and work hard to create comforting memories for those we serve.  We encourage you to take care of your smile and would love to take your oral health to the next level.