Toothache is noted with caries, pulpitis, periodontal and periodontal diseases, purulent-inflammatory processes in the periosteum, bone and surrounding soft tissues. It can be observed with bruxism, TMJ dysfunction, tooth hypersensitivity, some neuralgia. It can be dull, sharp, constant, intermittent, twitching, bursting, aching. Often provoked by temperature, chemical and mechanical influences. It is diagnosed according to the data of a dental examination and additional studies. Treatment includes local measures, drug therapy. Operations are sometimes shown.
Caries is understood as a condition in which the hard tissues of the tooth are destroyed, a cavity of various depths is formed. Pain is aching, there is a reaction to hot, cold, sweet, sour. Clinical manifestations depend on the stage of the disease:
Secondary caries is formed in a previously treated tooth. Manifestations become noticeable no earlier than 3-6 months after the completion of treatment, they correspond to normal caries. Swelling and bleeding of the gums are possible. The cervical variant is distinguished by its localization, sometimes it covers the neck circularly, and is prone to rapid progression. Root caries may initially be asymptomatic, sometimes the stain is hardly noticeable, hidden under plaque or tartar. Subsequently, the clinic is the same as in other forms.
Acute pulpitis lasts from 2 days to 2 weeks. Toothache appears without connection with irritants, increases with temperature effects, persists after the disappearance of the trigger. Localized, paroxysmal, lasts 10-2 minutes. After 1-2 days, pain becomes pulsating, paroxysms become more frequent and lengthen. A decrease in the severity of the symptom is due to the destruction of the nerve. Chronic pulpitis can occur in the following ways:
Pulp necrosis develops with dental injuries, complicated by caries. Often asymptomatic, sometimes accompanied by toothache when in contact with hot food, which is due to the formation of gases in the affected area. Soreness slowly increases and also slowly decreases.
Apical periodontitis is an inflammation of the tissues surrounding the apex of the tooth root. Serous periodontitis is characterized by an acute course, pain when biting and chewing, aggravated by pressure, vertical tapping. The general condition is satisfactory. With the development of purulent periodontitis, painful sensations become strong, pulsating, interfere with food intake, radiate to the ear, temple, and eye. The tooth feels like it has grown. General hyperthermia, intoxication syndrome are observed. Chronic periodontitis occurs in the following variants:
Acute traumatic periodontitis develops against the background of trauma, is characterized by local pain, bleeding, pathological mobility. In a chronic course, signs are absent or mild. Acute marginal periodontitis is rare, characterized by lesions of the cervix. Toothache is aching, constant, aggravated by the action of irritants. After the transition to the chronic form, the symptoms disappear. Teeth loosen over time, the roots become exposed, become sensitive.
Toothache
This group includes gingivitis, periodontitis and periodontal disease. Gingivitis is an inflammation of the gums, including the following types of disease:
Pericoronitis - inflammation of the gums during eruption (more often - a wisdom tooth). Toothache is intense, often radiating to the ear or temple, sometimes preventing mouth opening, chewing and swallowing. The symptom is especially pronounced when the tooth is in the wrong position. Local hyperthermia is detected, less often - lymphadenitis, fever.
Periodontitis develops with the progression of gingivitis, affects the periodontal junction. Soreness with pressure, mobility of the teeth, and an unpleasant odor are observed. With a long course, the teeth loosen and fall out. Generalized periodontitis is considered the main cause of adentia in older patients. During periodontal disease, gum pockets form. Constant soreness and hypersensitivity of the gums are determined, which negatively affect the emotional state.
Purulent periostitis (flux) is a common complication of dental diseases. Occurs with periodontitis, pericoronitis, improper treatment, the development of infection in the hole after extraction. It is more often found in the molars. Accompanied by severe, sometimes throbbing toothache, which can radiate to the eye, ear, temporal zone. Painful sensations are aggravated by thermal influences, decrease by cold ones. Subfebrile condition, violation of the general condition, swelling of soft tissues with asymmetry of the face are noted.
When the infection spreads from the periosteum to the underlying bone, osteomyelitis of the jaw occurs. The pains intensify, become diffuse, spread to the entire half of the face. Body temperature rises to febrile figures. There is mobility of the teeth, swelling of the gums, outflow of pus from the gum pockets, putrid odor. There may be difficulty in swallowing and chewing. When the lower jaw is affected, sensitivity disorders are found in the chin area. The face is asymmetrical, regional lymph nodes are enlarged.
The maxillary abscess is provoked by dental diseases, soft tissue damage, and general infections. With the odontogenic nature of the disease, toothache develops, resembling that of periodontitis. The symptom is aggravated by biting. A painful seal is formed with asymmetry of the face or protrusion of the mucous membrane in the oral cavity. General intoxication manifestations are determined. With spontaneous opening, the condition normalizes, however, there is a high probability of a chronic process.
Unlike an abscess, the perimaxillary phlegmon does not have clear boundaries. More often odontogenic. Manifests weakness, weakness, rapid deterioration, fever. Toothache is combined with cephalalgia, pain in the muscles. The symptom is aggravated by talking and chewing, there may be a limitation of jaw mobility, difficulty breathing. The seal is diffuse, painful. The face is asymmetrical.
Toothache accompanies all dental injuries. Features of the clinical picture are determined by the type and severity of damage:
Sharp, but quickly disappearing toothache worries people with hyperesthesia of the teeth. Often accompanied by a feeling of discomfort, set on edge. It is provoked by the intake of cold, hot, salty, sweet and sour, hygiene procedures. Occurs due to enamel hypoplasia, erosion, mechanical damage.
Patients with bruxism suffer from involuntary contractions of the masticatory muscles and severe clenching of the jaws. Episodes occur in a dream, last for several seconds, and repeat many times. Overexertion of the muscles and excess pressure cause toothache, prosopalgia and cephalgia in the daytime. Dizziness, drowsiness are noted. Perhaps the formation of cracks in the enamel and wedge-shaped defects, the development of hyperesthesia, periodontitis and other dental complications.
With dysfunction of the TMJ, dental, facial and headaches, soreness and pressure in the eyes are disturbing. The widespread nature of the pain syndrome can cause the similarity of the clinical picture with osteochondrosis, trigeminal neuralgia and other pathologies. Joint damage is indicated by clicks during jaw movements, episodes of blocking (jamming) of the TMJ.
The main manifestation of ganglionitis of the pterygopalatine ganglion is spontaneous attacks of prosopalgia in combination with autonomic disorders. The pains are most pronounced in the hard palate, the base of the nose, the upper jaw, and the eye. Possible toothache. Irradiation to the temple, neck, ear, nape is noted. With neuralgia of the trigeminal nerve, prosopalgia is felt like an "electric shock". When the lower branches of the nerve trunk are affected, pain impulses pass through the lower jaw, which may be accompanied by a sensation of toothache.
Radiating toothaches are sometimes detected in the following diseases:
Dental checkup
Diagnostic measures are carried out by a dentist. Patients with nerve damage are referred to a neurologist. If there are indications, consultations of an otolaryngologist, cardiologist, and other specialists are prescribed. As part of the survey, the anamnesis of life and disease is ascertained. Particular attention is paid to the nature, intensity, time of occurrence, localization and duration of toothache, connection with external factors.
As part of the examination, the symmetry of the face, the condition of the skin, the line of a smile and the closing of the lips are evaluated, edema, hyperemia are detected. Palpate the TMJ, chewing muscles, lymph nodes. Then examine the oral cavity (vestibule, bottom, hard and soft palate). The teeth and periodontium are examined to detect mobility, chips, cracks, carious spots, cavities, bleeding, periodontal pockets, and other changes. Spend vertical and horizontal percussion, examine the cavities with a probe. The following additional methods are used:
During the examination, rheodentography, chewing test, rheoparodontography, and other functional techniques can also be used. According to the indications, luminescent diagnostics, axiography of the TMJ, and other procedures are performed. If necessary, conduct a neurological examination, prescribe laboratory tests.
Emergency measures are carried out without prior preparation. Before planned treatment, in most cases, removal of tartar and professional hygiene are recommended. Taking into account the nature of the pathology, the following procedures are indicated:
For toothache, the following operations can be performed: