There’s a phenomenon known all too well by dentists in private practice: the predictably unpredictable dental emergency that requires immediate attention. All too frequently, the patient who calls my office with an urgent problem had an inkling for a while that something was amiss but delayed making the call in the hopes that the problem would disappear if given enough time.
So, the question is, why a toothache hurts so much that it becomes a dental emergency for so many people?
Yet, when necessity dictates immediate action (i.e., “I can’t take this pain any longer!”) and the call for help is made, yesterday is never soon enough. You’re in acute distress and ready to drop everything to get relief, regardless of time demands. My office staff “moves mountains” – or at least juggles the schedule – to make me available to my patients when this happens.
Why A Toothache Hurts So Much
A severe toothache can be a harrowing experience and is in many ways unique from your body’s other aches and pains. The intensity of tooth pain can be extraordinary, with severity rivaling true neuralgia – intense neurological pain of almost unparalleled proportions. So, why do toothaches hurt so much?
That painful tooth is literally in your head. That fact offers you little opportunity to find a comfortable position to neutralize the waves of discomfort. Compared to a painfully sprained foot which you can elevate and use ice packs to get some sort of reprieve, your teeth have an abundance of neural connections to pain centers in your brain. This seems to amplify the noxious “distress signals.”
And your face and head, including your teeth, are richly served by your nervous system and make for an exquisitely sensitive and responsive anatomic region. This is one of the “benefits” of being at the top of the evolutionary ladder. It’s also why a toothache hurts so much.
While teeth are especially sensitive to painful stimuli, they are also much like any other part of the body in that they can experience transient discomfort that can dissipate almost as quickly as it arises. Aches and pains are a part of an active lifestyle (at least for those of us over 40!), so why should teeth be different? I’m sure you’re familiar with the sudden wince you can feel when you bite into something unexpectedly hard or the piercing jolt when you chew ice or take too big a mouthful of ice cream. Equally familiar is the agony of a stubbed toe. In most cases, no real damage has been done, but the painful sensation is no less real.
A stubbed toe need not be broken to hurt, and similarly, a traumatized tooth that encountered a foreign object during the chewing cycle need not be cracked, broken, or split for you to experience pain?
Teeth Are Unique Organs
Your teeth are unique organs – inside the body of each tooth lies the dental pulp – what’s commonly referred to as the nerve. The dental pulp is very complex – it contains specialized cells that form the structure of the tooth, the blood vessels that nourish it plus connective tissue and nerve fibers. The blood supply coming into the dental pulp goes through a very tiny opening in the tip of the root and the rigid walls of the tooth itself.
Teeth do not respond to trauma the same way as other parts of your body. When you stub your toe, for example, a robust blood supply comes to its aid and produces an inflammatory and healing response.
On the other hand, because your tooth is a solid closed container, blood supply is restricted and confined. When you have a broken filling, chipped tooth, or early to moderate decay which is not too severe, your dental pulp can usually respond adequately to the challenge and maintain its vitality.
But, in the case of extreme tooth trauma, such as damage, deep decay, gum disease, etc., your tooth’s circulatory system is not flexible enough to cope with the noxious threat. Severe trauma can lead to cell death, pulp necrosis, and even abscess formation (infection). Yuck.
Dental Nerves Only Feel Pain
One of the unique characteristics of dental nerves is that they can’t feel heat, cold, sweets, touch. They only feel. That’s why a toothache hurts so much.
While your dentist may test the status of your tooth by using stimuli such as thermal testing and biting pressure to diagnose a dental problem, the only reaction to such stimuli is pain. Which stimulus the tooth responds to and how long the discomfort lingers is often the clue to the status of the pulp/nerve and helps determine the appropriate treatment such as a bite adjustment, desensitizing application, a filling, a crown, the root canal, etc.
What To Do When A Toothache Hurts So Much That You Can’t Cope
I have written numerous blogs about dental issues, including tooth-related problems. My blogs attract thousands of suffering people to my website looking for answers and relief. They ask many questions. My responses can only be of a generic nature because I do not have the luxury of examining them, But the urgency and often the desperation in the comments is often troubling. I can only offer what I believe to be helpful information, professional guidance, and encouragement to seek dental care.
(Unfortunately, what I am unable to offer is a dental miracle.)
When you experience a toothache, a visit to the dentist is warranted. While this may seem self-evident, many inquiries I receive express trepidation about actually going to a dentist. National statistics demonstrate a steady and dramatic rise in the number of dental emergencies being seen in hospital emergency rooms instead of dental offices or clinics. Not only is this a more costly approach to dental care, but it is also largely ineffective because hospitals will usually only dispense pain medication and antibiotics without treating the actual cause of the problem. (Especially during the pandemic.)
Emergency relief of tooth pain can be likened to first aid with definitive care (root canal, crown, extraction, etc.) being deferred until the immediate crisis is alleviated. It is best performed in a dental office.
Now that you know why a toothache hurts so much. If you are suffering, please seek care from a dentist as soon as you can. Even if the pain subsides, the problem that caused it will not go away on it is own. The longer you wait the more complicated and costly the solution may be.
Dr. Michael Sinkin is a general dentist in New York City. He loves being a dentist and is known throughout the city for taking outstanding care of his patients and for his wicked sense of humor. For more about Dr. Sinkin, click here.
DISCLAIMER: The advice I offer in response to your questions is intended to be informational only and generic in nature. Namely, I am in no way offering a definitive diagnosis or specific treatment recommendations for your particular situation. My intent is solely educational. My responses to your actual questions serve as a springboard to discuss a variety of dental topics that come up in day-to-day dental practice. Any advice offered is no substitute for proper evaluation and care by a qualified dentist.