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Toothache / Pain / Sensitivity

Why do all my teeth hurt?

tooth grinding
Learn more about tooth grinding.

The condition where all your teeth hurt is called generalized tooth pain. There are many reasons why all your teeth hurt. Long-term tooth grinding in response to stress is one of them. People who have receding gums with multiple exposed tooth roots may complain of thermal sensitivity (hot, cold, sweets). Excessive tooth decay and tooth enamel demineralization can produce toothaches. People with eating disorders or chronic acid reflux conditions may dissolve away their tooth enamel from continuous exposure to acids that erode tooth structure. This can make teeth sensitive.

Excessive teeth whitening can produce severe pain. Severe gingivitis and periodontal disease produce inflammation, which causes pain. Orthodontics can cause the teeth to ache, especially if the treatment just recently began. Patients who have recently undergone significant restorative dentistry may complain of pain or sensitivity in multiple teeth, which may or may not improve without further intervention, depending on whether the tooth pulp becomes irreversibly inflamed.

My tooth is sore and tender – just generally aching. What causes toothaches?

reversible pulpitis
Learn more about reversible pulpitis.

Toothache is typically a continuous dull, achy pain that may be aggravated by extremes of temperature, exposure to sweets, and biting (or tapping) on the tooth. Depending on the cause, the tooth may ultimately be diagnosed with any of the following: reversible pulpitis, irreversible pulpitis, acute apical periodontitis, or various types of abscesses such as a acute apical abscesses, lateral periodontal abscesses, or phoenix abscesses. There may also be underlying causes for those conditions, like tooth decay, or a cracked tooth.

It is also possible for non-dental conditions to produce pain that feels like a toothache. Examples include sinus infections; heart pain (angina)—which can radiate to the jaws; and rarely, lymphomas, jaw cysts, or jaw tumors.

My tooth is throbbing. I have a pulsating pain, and a pounding in my tooth when I am running. What causes this?

tooth decay
Learn more about tooth decay.

Throbbing is a sign of excess blood flow into a tooth, which occurs when the tooth becomes inflamed. There are many reasons why teeth become inflamed, including tooth decay, infection (abscess), failing dental restorations (like fillings and crowns), food compaction injuries, gingivitis, and periodontal disease. You may also have a cracked tooth or a chipped tooth

Some people have a habit of tooth grinding while exercising. If the teeth are aligned such that only a few teeth touch when the jaws are fully closed (malocclusion), the excess pressure on those teeth may cause them to throb.

A throbbing tooth is frequently diagnosed with irreversible pulpitis. Sometimes the condition is aggravated by vigorous activities like running, or by postural changes such as bending down to tie your shoe.

I have a sharp pain in my tooth, almost like an electric shock – especially in cold temperatures or when I drink something cold. What are some common causes?

receding gums
Learn more about receding gums.

Sharp tooth pain, such as that produced by exposure to cold substances, is generally caused when the outer enamel layer of the tooth is missing and the underlying dentin layer of the tooth is exposed. This can be caused by receding gums or tooth decay. Pain can also occur if you have a cracked tooth or a chipped tooth.

Pain can also be caused by inflamed tooth pulp (pulpitis) following dental procedures (known as post-operative sensitivities).

Other issues with the tooth may also cause pulpitis. Normally, if the tooth has a sharp response to cold food or drinks that rapidly diminishes when the cold source is removed, the pulpitis is considered “reversible pulpitis.” However, in some cases, the sharp sensitivity becomes more lingering and may be accompanied by a continuous aching. If you have those symptoms, you may have irreversible pulpitis.

Cracked teeth may produce a sharp, painful response when biting, even if cold and sweets do not bother the tooth. Teeth whitening and long-term tooth grinding are also common causes of a condition called dentin hypersensitivity.

My tooth/teeth are sensitive to heat. It hurts when I drink hot liquids. Why?

cracked teeth
Learn more about cracked teeth.

If your tooth is sensitive to heat, it may be an indication that the tooth has bacteria inside of it. Bacteria can get inside a cracked tooth, large tooth decay, or a leaking dental restoration like a filling or crown (see failing dental restorations.) An explanation for the heat sensitivity is that bacteria produce gas as part of their life processes.

Heating the tooth heats the gas, which is confined to the volume of the tooth’s hollow interior. Gases generally expand when heated, and since the gas inside a tooth cannot freely expand, the pressure inside the tooth increases and is applied to the very sensitive nerve tissue. This causes you to feel pain. In these cases, irreversible pulpitis is often diagnosed, as well as some sort of infection (abscess) such as a acute apical abscesses, lateral periodontal abscesses, or phoenix abscesses.

I’m in a lot of pain. Could I have a tooth infection? What is a “hot tooth?”

irreversible pulpitis
Learn more about irreversible pulpitis.

The term “hot tooth” is a common name given to an infected tooth which exhibits severe pain. Sometimes hot teeth have living nerve tissue inside of them, but the extent of inflammation prevents the tooth from being able to recover. Such teeth are generally diagnosed with irreversible pulpitis. Many times hot teeth will no longer have living tissue inside of them. This is called a (also known as necrotic tooth, non-vital tooth)dead tooth. Dead teeth have hollow root canals open to the inside of the body.

If bacteria gain access to the root canals of a dead tooth, they can create a significant colony before the body’s immune system even knows they are present. Large bacterial colonies are capable of producing a significant amount of tissue destroying enzymes and acids, and when the immune system begins to fight the infection, the bone and soft tissues around the tooth can be extremely tender even to light finger pressure.

Hot teeth and the area around them can be difficult to anesthetize, due to the acidic environment and the amount of infectious fluid present. Many times treating the tooth comfortably requires localized antibiotic administration to treat the the infection prior to performing root canal (endodontic treatments) procedures on the tooth.

My tooth pain is giving me a headache. What causes this?

reversible pulpitis
Learn more about reversible pulpitis.

Tooth pain which results in a headache often results in multiple diagnoses—one or more for the teeth, for the jaw muscles, jaw joints, etc. Tooth pain is a very non-specific symptom. Refining the symptoms can help. For example, sharp pain to cold and sweets, which subsides when the stimulus is removed may result in a diagnosis of reversible pulpitis.

If the pain is sharp, but lingers for some time when the stimulus (for example, hot, cold, or sweets) is removed, you may have irreversible pulpitis. If the pain is continuous and dull, there may be an infection (abscess) present such as a acute apical abscesses, lateral periodontal abscesses, or phoenix abscesses.

Heart pain (angina) may radiate into the jaws producing pain that resembles a toothache. Sinus infections can produce pain in the upper teeth, which can seem like a headache and cause multiple upper back teeth to ache. Sometimes a long-term tooth grinding habit can cause teeth and or jaw joints to ache.

The jaw muscles may also be tender (myalgia), and a long-term tooth grinding habit may result in TMJ disorders. Excessive teeth whitening can make teeth very sensitive. There are also rare cases of sinus lymphomas presenting with symptoms of toothache.

I just got a filling / crown / inlay / onlay / veneer. Now my tooth hurts. What should I do?

Known as post-operative sensitivities, pain in the teeth following dental procedures is usually caused by the body’s inflammatory response to working on the teeth. This response produces an increase in blood flow to the affected teeth, which if significant, makes them sensitive. Materials and techniques to minimize post-operative sensitivity are commonly used, but the problem cannot be predictably eliminated in all cases.

A cracked tooth, or a tooth with deep tooth decay or a history of previous trauma may be especially uncomfortable following dental procedures, and may not improve on their own.

Teeth which receive bonded restorations (like fillings, inlays, onlays, crowns, or veneers) without being isolated from mouth moisture for the procedure may have significantly weaker bond strengths, a higher incidence of microscopic leakage and a higher incidence of discomfort following dental procedures. If symptoms do not resolve, the tooth may ultimately require endodontic treatments (such as a root canal treatment). Teeth with large fillings may then need an onlay or crown to provide them with long term service.

I have pain in the area where I just had a tooth removed. Should I be concerned?

A fairly common occurrence following the removal of a tooth is premature loss of the blood clot, followed by extreme pain. This condition is known as a dry socket.

My teeth are sensitive to sweets. They hurt when I drink soda pop or eat candy. What causes this?

sensitive teeth
Learn more about sensitive teeth.

Candy, soda, fruit juices and other beverages contain sugars, which, when placed in contact with exposed tooth dentin, causes fluid to move out of the tooth. The same painful response may also accompany exposure of the teeth to concentrated liquids in general, including fruits (especially those high in citric acid or natural sugars), sauces (like tomato sauce) and pastes (including some toothpastes).

Fluid movement in response to differences in concentration inside and outside the teeth produces a pressure change on nerves inside the tooth which you feel as pain. Teeth which are sensitive to sweets may have exposed dentin, which allows the pressure change to occur. The trick is finding it, and determining its cause. The problem is identified as sensitive teeth (dentin hypersensitivity) if there is exposed dentin. Causes of the exposed dentin include receding gums, chipped teeth, abfractions, cracked teeth, attrition (tooth wear), failing dental restorations, and tooth decay.

My teeth are just sensitive in general, especially to cold temperatures. What are common causes of teeth sensitivity?

Sensitive teeth are generally caused by exposed dentin, a porous layer that allows fluid to move freely within the tooth structure. Dentin is normally completely covered, either by the protective enamel layer, or the gum tissues. When this happens, the pressure inside the tooth (where the nerves are located) changes. This causes you to feel pain.

Exposed dentin may be caused by chipped teeth, cracked teeth, receding gums, and attrition (tooth wear). All of these can be produced by long-term tooth grinding.

Even if dentin is not exposed, teeth may become chronically inflamed from long-term tooth grinding, resulting in a lower tolerance to painful stimuli like ice water. Sensitive teeth may also be caused by tooth decay, tooth movement produced by orthodontics, trauma to a tooth, and teeth whitening.

I have a lingering tooth pain. Should I see my dentist?

If you experience a sharp pain in a tooth that lingers following removal of the stimulus (for example, hot, cold, or sweets), you may have irreversible pulpitis.

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Author: Thomas J. Greany, D.D.S. / Editor: Ken Lambrecht

This page was last updated on January 9, 2018.

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