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

What about stains that don't respond to tooth whitening?

A common desire for a healthy looking smile is to have bright teeth.  For most people the different whitening products can do a great job of brightening their smiles'.  Some people have stains that do not respond to the most common methods of whitening.  (see blog post :Ways to whiten your teeth)

Here are some reasons why teeth may night respond to whitening.

Tartar stains

You may notice the yellow on the sides of the teeth mainly
on the bottom teeth in front, these are stains from tartar.

Tartar naturally can build up on your teeth and will appear yellow and chalky.  Tartar builds up mostly between teeth and near the gums.  More brushing will not removed the tartar, it's bound to the tooth.  The Dental hygienist has the tools and skill need to remove the tartar and give you a brighter smile.

Cavities
The by products produced by the bacteria in cavities results in a brown to black appearance.  The tooth will be soft and eventually start to break apart.  Cavities will not whiten with tooth whitening, the cavities need to be removed to get ride of the stain, not to mention all the other problems they can cause.

Demineralized tooth structure
Prior to the tooth getting a cavity it first start to demineralize from the acid it is exposed to. The demineralized tooth with often appear a chalky and different shade of white or even yellow.  These stains are commonly seen once braces are removed because of plaque or other acid exposure build up around the brackets but doesn't extend under.

Staining before microabrasion

After one treatment of microabrasion

These stains will not respond to traditional tooth whitening.  The key here is to remineralize the tooth. There are several ways this can be accomplished including microabrasion and adding a no drill filling that is absorbed into the demineralized area of the tooth.

Fluoride stains
With all the benefits teeth get from fluoride one of the draw backs is that at high levels during tooth development the fluoride can stain the teeth.  The difficulty with fluoride stains is that they are deep in the tooth because the develop into the teeth as they develop from the inside out.  They look similar to the staining of demineralized teeth but with a shiny surface instead of a dull surface.  The no drill filling is not an option but microabrasion can be successful.

Tetracycline stains
The dark grey staining that results from the use of the tetracycline antibiotics during tooth development is one of the most difficult to address.  Again since this occurs during tooth development the staining is deep inside the tooth.  About the only treatment that can get rid of these stains to to crown the teeth with a porcelain crown that has a metal interior that will block out the stain.

Ways to whiten your teeth

A common desire of patients is to have their teeth a brighter shade.  Typically this can be achieved in several ways.

1. First is by a professional in office whitening.  This is a great way to get a quick couple of shades by getting the surface of the tooth whitened.  In our office we spend about 1 hour with this procedure and get about 2-3 shades brighter for most patients.  Since the whitening agent is so strong it needs to be done in office to avoid burning the rest of the mouth.
2. Second is by making custom trays to wear at home.  Some of the benefits to this method is that the longer slower whitening can get deeper into the tooth and give some additional results you can not get from in office whitening.  You can also use the trays for other things such as fluoride gel.
3. Third stock trays are a popular trend now.   This includes whitening strips.  Other companies make similar whitening products we use opalescence which are the same makers of our in office and take home tray whitening products.
4. Fourth is by touch up products.  I will group most other products in this section since there is a plethora of options including: tooth pastes, on the go pins, gum, mouth rinses and the list can continue on.  These may not get a lot done for you unless you have already whitened your teeth and you want to help maintain your smiles new brightness.

There are also some ways which you should not whiten your teeth:

Chemical burn of the gums from hydrogen peroxide

1. Bleaching your teeth with bleach.  A common term for tooth whitening is bleaching your teeth. When you whiten your teeth there is not any bleach involved.  In fact using bleach is very toxic, will burn your gums (if not worse) and will not result in a brighter smile.
2. Using hydrogen peroxide to whiten your teeth.  The concentrations on hydrogen peroxide sold at the store will also burn your gums and create very sensitive teeth.  Whitening agents use a peroxide to whiten your teeth so hydrogen peroxide will get your teeth whiter but the cons of damaging your gums and creating very sensitive teeth can be avoided by other whitening agents.
3. Baking soda is a common one I hear of patients using to clean their teeth to make them brighter.  Baking soda is very abrasive and will not only remove stain from your tooth but it will move some of the actual tooth.

A few random facts about whitening your teeth:

1. Most modern whitening products contain a tooth desensitizer.  This is because whitening products naturally create tooth sensitivity. So something needs to counter that sensitivity.
2. Tooth brightening is probably a better term.  If your teeth looked more white they would also look odd and dull.  This is because the tooth is partly clear and some colors, such as reds and blues, appear in small amounts naturally to help the teeth to look brighter.  Think of a toilet bowl, a very solid white, and it would look horrible as the shade of your teeth.
3. There are some stains that will not whiten by these traditional methods.  They include fluoride stains, tetracycline staining and demineralized teeth. There are other ways to deal with these stains but that is a topic for another day.