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TYPES OF PAIN AND THEIR CAUSES
Atypical Toothache
I feel pain on some of my teeth. I had checked it out with my dentist and found no cause for it. I am still having the mild pain and am irritated by it. I want to extract those teeth. Why is my dentist refusing to do it?
A less common condition is the atypical toothache. The pain is chronic and usually, there is no identifiable cause for it. Extracting the teeth usually does not solve the problem as the pain tends to stay.
Features:
- Distressing continual pain from a tooth or teeth
- Pain stays longer than 4 months
- Tooth / teeth and surrounding gum and bone look normal
Management:
- Medication is the treatment of choice
Facial Nerve Pain (Neuralgias)
I suffer from spontaneous sharp, electric-like pain on my face. This occurs various times a day, with the pain lasting for a short duration. So far, the condition has not improved, and has even triggered whilst washing my face or mouth. Is this common?
This could be an uncommon condition of the nerves which tends to affect older people. Trigeminal neuralgia is the most common of such conditions.
Features:
- Sudden pain of varying intensity on the face or jaw; triggered by jaw movements or touch
- Pain is of short duration and can recur several times a day
- Pain can be excruciating but often comes and goes
Causes:
- No known cause, commonly attributed to nerve instability
Management:
- Medication is the treatment of choice
- Imaging of the head to rule out brain lesions is often advised
Gum Infections
I have had very severe pain, ulcers and bleeding gums for the past 3 days. My whole mouth is sore and I cannot eat properly. My spouse tells me that I have bad breath. What could I be suffering from?
The condition you described is termed Acute Necrotising Gingivitis. You will need to see a dentist for gum treatment or, if necessary, be referred to a gum specialist.
Acute Necrotising Gingivitis
Acute Necrotising Gingivitis
Features:
- Ulcers on tips of gum between teeth and along gum line
- Bleeding gums
- Sudden onset of pain
- Foul odour
- Increased salivation
- Metallic taste
- Repeated infections lead to bone loss or periodontitis which causes: enlarged gum margins, triangular gaps between teeth and gum recession (i.e. teeth appear longer)
Causes:
- Bacterial infection
Factors which increase your risk:
- Poor oral hygiene
- Smoking
- Systemic diseases (e.g. diabetes)
- Stress
Management:
- Proper brushing of teeth
- Using a mouth rinse
- Professional cleaning of gum areas
- Antibiotics
- Oxidizing antiseptics
- Gum surgery
Flossing - a necessary ritual
I have had pain and swollen gums near my tooth for the past few months. It lasts for a few days and then disappears. Why is this so?
What you have is gum abscess, commonly referred to as "gum boil". Most gum diseases are without symptoms. Apart from Acute Necrotising Gingivitis (as mentioned above), Acute Periodontal Abscess also features pain prominently.
Acute Periodontal Abscess
Features:
- Localised gum swelling; red and tender to touch
- Sudden onset of pain
- Increased mobility of tooth
- Tooth can be tender on biting
- Soreness at site leading to throbbing pain
- Pus discharged from the gums
- Loss of supporting bone (detectable by X-ray)
Causes:
- Bacterial infection
Factors which increase your risk:
- Poor oral hygiene
- Smoking
- Systemic diseases (e.g. diabetes)
- Stress
Management:
- Proper brushing of teeth
- Using a mouth rinse
- Professional cleaning of gum areas
- Antibiotics
- Oxidizing antiseptics
- Gum surgery
Impacted Wisdom Tooth (Infections)
The last tooth in my lower jaw is causing some discomfort. I can only see part of the tooth and food gets trapped in the overlying gum. Occasionally, the overlying gum swells a little and the side of my neck appears swollen too. Do I need to remove this tooth?
Wisdom teeth appear during early adulthood. In some cases, the jaw size does not allow proper eruption of wisdom teeth, leading to impaction against the tooth in front. Surgical removal of wisdom teeth is a common procedure.
Features:
- Pain on lower jaw usually around last molar teeth
- Pain can be acute, with an apparent decreased mouth opening
- Swelling
- Swollen lymph nodes
- Region around the molar may be sensitive and painful to touch
Causes:
- Impaction of wisdom tooth causing food to be trapped
- Infection of overlying gum
- Triangular gaps between teeth
- Decay of wisdom tooth and adjacent tooth
Management:
- Cleansing of the gum area with gargle or mouthwash
- Antibiotics may be required for serious infection
- Extraction or trimming of the opposing tooth to reduce biting on swollen gum
- Surgical removal of the upper wisdom tooth
Swollen gums near wisdom tooth
X-ray of an impacted wisdom tooth
Jaw or Temporomandibular Joint (TMJ) Disorders
My jaw used to click and appear lopsided when I opened my mouth. Recently, I have noticed my jaw being rather stiff in the morning. Also, my muscles tend to ache when I chew food. I fear my jaw may lock on me. Sometimes, I also suffer from headaches. Is this a serious condition?
Not all clicking sounds need to be treated. However, a worsening click, difficulty in opening the mouth and muscle pain may warrant a visit to the dentist.
Features:
- Jaw pain (muscles and joint) on movement or after waking up
- Clicking jaw joints
- Difficulty in opening mouth
- Jaw "stuck" or locked and dislocated
- Headaches
Causes:
- Subconscious night grinding or clenching of teeth
- Emotional stress and anxiety
- Bad jaw habits (e.g. chewing on hard foods, chewing on only one side)
- Poor teeth alignment leading to a bad bite
- Systemic diseases (e.g. arthritic disorders)
Headache can result from night grinding
Identification:
- Palpable pain in jaw muscles, joint and head
- Reduction of mouth opening
- Excessively worn, cracked teeth, fillings or prostheses
- X-ray may show bone changes; Magnetic Resonance Imaging (MRI) scan may show position of displaced disc
- Questionnaires on medical and chronic pain history
Decreased mouth opening
Management:
- Patient education and reduction of jaw use
- Splints fitted over teeth to reduce further damage
- Medication
- Counselling sessions
- Heat and ultrasound physiotherapy
- Arthrocentesis (jaw joint manipulation)
- Arthroscopy (jaw joint surgery aided by miniature camera)
- Occlusal rehabilitation to stabilise jaw function
Apthous Ulcers
I suffer from recurrent mouth ulcers. This affects my eating and even brushing of teeth. The discomfort usually lasts about a week. Is there any way to hasten the healing? Does gargling with salt solution help?
Ulcers in the mouth can take some time to heal due to constant abrasion with the ulcer site. Application of a gel or paste prescribed by your dentist may help to protect the site from further abrasion. Garling with mouth rinse or salt solutions will help reduce contamination of the ulcer site.
Features:
- Single or recurring painful ulcers in the mouth
- Ulcers can range from 2mm - 10mm
- Eating is interfered for a few days
- Persists for 7 - 14 days
Causes:
- Localised injuries from self-inflicted bites, brushing of teeth etc.
- Stress
Management:
- Usually heals without treatment
- Steroid ointment or topical medication prescribed by dentist
 
Minor apthous ulcer Major apthous ulcer
Tooth Sensitivity
When I eat food, drink water or suck air through my teeth, I feel a sharp pain on my teeth. The pain can range from a few minutes to quite a while. What could be happening?
A likely cause could be tooth sensitivity.
Features:
- Brief, sharp and painful sensations in teeth during brushing; flossing; or consuming hot, cold, sweet, sour and acidic foods
Causes:
- Exposed dentine layer in the crown or root portion of the tooth
- Dental decay
- Fractured or chipped teeth
- Vigorous brushing of teeth causing abrasion to tooth material near the gumline
- Teeth grinding during sleep leading to fractures of tooth portions gumline (abfraction cavities)
- New fillings or crown and bridgework
Factors which increase your risk:
- Receding gum due to gum disease
- Excessive chewing of hard foods
- Teeth grinding during sleep (nocturnal bruxism)
Causes:
- Bulimia
- Dry mouth (frequently results from radiotherapy to head and neck)
Professional treatment options:
- Application of chemical agents to affected areas
- Restoring worn areas with fillings
- Crowning severely worn teeth
 
Abfraction fractures due to the flaking of enamel from night grinding
Toothaches
I had a sudden toothache on one tooth. The gums are slightly swollen. I feel the tenderness when I touch it. After a few days, it subsided and I ignored it. A few days later, the problem recurred. What can I do about this?
Sudden excruciating pain or toothache may indicate the deep spread of decay in the tooth. Often, root canal treatment is necessary. If you note mild symptoms on the teeth, a check-up with your dentist will help prevent a bigger problem from occurring.
Features:
- May start with sensitivity to hot or cold drinks and food
- Sudden pain from tooth or jaw of moderate to severe intensity
- Pain may last a few days or longer
- Pain can be isolated to one tooth or can be spread over a wide area
- Possible swelling
Causes:
- Tooth decay
- History of trauma to teeth
- Cracked teeth from excessive wear; chewing on hard foods
Management:
- Remove decayed area and protect tooth with filling
- Root canal treatment if decay is extensive and has affected nerve of the tooth
- Drainage of swelling
- Antibiotics
- Tooth extraction
- Painkillers may provide temporary relief
Front view - the decay is often missed
Palatal view - decay is easily seen |
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