How Can I Soothe a Toothache?

Note: Never start taking any medication for the first time (even OTC products) without consulting a medical or dental professional first. Never exceed the prescribed dosing for a medication or use it in a method for which it was not designed. 

Toothaches always seem to spring up at the least convenient times. Often enough, they show up 6pm on a Friday before a long weekend. When you can't get to a dentist right away, what should you do about your pain? In this article, we hope to give you some direction (and comfort) in helping your dental woes.

The first thing to do with any type of dental pain is give your general dentist a call. Even after hours, every office should have a means of getting into contact with either your own dentist or one of their associates. An exception to this would be excruciating pain, possibly combined with swelling, fever and warmth around a tooth. In these instances, your first choice should be to head to an emergency room, as this can be the sign of a serious infection. 

Beyond getting into contact with a dental professional, there are a few steps you can take to reduce your symptoms. If the pain feels like it is coming from a tooth directly, we suggest taking an NSAID medication like ibuprofen (Advil). Most dental pain comes from pressure inside the tooth or bones, and is best treated by drugs (such as ibuprofen) with anti-inflammatory properties. We do not suggest taking any left over narcotics you may have on hand, as they are potentially harmful and will not stop the pain as effectively as an NSAID. 

If your pain feels like it is coming from your gums, try flossing gently to see if you can dislodge any stuck food (popcorn kernels are the worst offenders). Beyond this, we recommend rinsing with warm salt water to soothe inflamed tissue. Never try to apply Asprin, Advil or other medications directly to the gums. This will only irritate the tissue and create more pain. We also suggest staying away from topical toothache creams/gels, due to their lack of effectiveness and potentially dangerous side effects.

If your pain has a specific trigger, make note of it and try to avoid using your teeth in that manner. Knowing what causes the tooth to flare up can be an important factor in diagnosing the exact problem. If you would like to know more about toothaches, dental pain or gum pain, please give our office a call! 

Dental Questions: Why does my tooth hurt after a filling/crown?

If you've ever had dental pain after a filling or crown, you know how frustrating this situation can be. Did something go wrong? Is it normal? Rest assured, "post operative sensitivity" is one of the most common complaints after dental work. Depending on the type, timing and severity of pain, it can indicate a few potential problems. Read on to catch a glimpse into how we interpret and treat patients with after-treatment pain!

Any time a dentist uses an instrument to modify the structure of a tooth, there is a chance that this procedure will irritate the dental nerve. Typically, this pain is reversible and is a response of the tooth cells being transiently injured during treatment. It is usually described as weak or dull and resolves on it's own in about two weeks. If we are working near the pulp of the tooth (such as with deep cavities and certain fractures) there is a higher likelihood of causing irreversible irritation of the dental nerve. In this scenario, the tooth becomes hyper-sensitive as the inner tissue becomes necrotic. Patients usually describe this pain as a sharp, prolonged sensitivity to hot/cold foods. Over time, it transitions to a spontaneous pain and sensitivity to taping and chewing. In these instances, the best solution is to perform a root canal to clean out the dead tissue and relieve any infection that may be present. 

Beyond these types of nerve irritation, some fillings become sensitive due to the nature of the materials we use in dentistry. Many types of fillings and crown cements are physically bonded to the tooth. This process involves painting on a resin "glue" and using a light to cure it to the tooth. The chemical change causes a small amount of shrinkage that can put pressure on the microscopic tubes in the tooth's dentin layer. Patients usually feel this pain as sharp and sensitive to biting and chewing. To solve this, we may change the material used to fill your tooth or remove the old filling and place a temporary "sedative" filling and see if the nerve calms down. Interestingly, we usually see this type of pain on smaller fillings, as they tend to have more walls made of natural teeth, and thus more surface area to place tension on. 

A final (and probably most common) source of post-operative pain is the filling/crown simply being too high. We check every single restoration we place with marking paper to make sure it doesn't change the way your teeth together. However, the ligaments in your teeth can feel changes on a microscopic level and can be difficult to account for. This problem is easily detected and fixed- we simply need to remove the area of the filling/crown that is interfering with your opposing teeth. 

Any patient complaint of pain after a procedure is taken very seriously and typically handled the same way. We will have you come in for an emergency appointment where we will take an X-ray (to see where the nerve is) and check the bite (to rule out a "high" restoration). We use this information to perform other tests to narrow down the possibilities to a correct diagnosis. Our ultimate goal at this visit is to get you out of pain and make a plan to protect the tooth long-term. If you would like to know more about the fillings we place and the risks/benefits of these procedures, please give our office a call. 

Root Canals

Root Canal- Likely the most feared of all procedures. The name alone brings up visions of pain, discomfort and dental woes. But what is a root canal? Why would you need one? What does it do? In this article, we will shed some light on the world of endodontics, dental subspecialty that encompasses root canals. Contrary to popular belief, you will find that this procedure is both comfortable and provides near instant pain relief!

A Diagram of the different parts of the tooth. 

Before explaining how a root canal works, it is important to understand the different parts of the tooth and what they do. There are three basic layers to all teeth- the enamel, the dentin and the nerve/pulp. The enamel is mostly inorganic (nonliving) material and gives the tooth its strength and rigidity (it’s the hardest material in the human body!). Dentin provides support to the enamel and contains a mix of living and nonliving materials. The innermost layer is the pulp chamber and nerve canal. This space contains innervation that provides information on biting pressure, temperature and pain to the central nervous system. It is mostly organic material and has has it’s own blood supply.

Different teeth will have different numbers of canals. The number varies between tooth types, arch location and even person to person. In general, teeth typically have between one and four canals, with posterior teeth having more than anteriors. On top of this, a tooth can have any number of accessory canals.These can range in size from easily visible to microscopic.

With this information in mind, let’s discuss root canals. In the most basic terms, a root canal is performed by removing the root/nerve from the tooth, cleaning out the now-empty space and filling it with a stable material. Why would we remove the nerve from a tooth? This is typically done because:

A) Long term decay, stress or fracture has aggravated the nerve and it is causing constant pain. This is what happening when patients come in with a “hot tooth.”

B) The aggravated nerve has now “died,” leaving a perfect alcove of organic material for bacteria to feed on. Here, patients might have very little feeling in the tooth and may notice a change in color to a grayish hue.

C) Bacteria have found the dead tissue and there is an active infection. The bacterial abscess can be seen on an X-Ray and the patient will feel soreness, swelling or even draining from the gum tissue.

Condition A will eventually progress to condition B and usually to condition C. Since active infections are both difficult to treat and potentially life threatening, we will usually treat dying nerves early-on and aggressively. Waiting can often lead to more pain and higher long term costs to our patients.

The actual root canal procedure is based on a simple ideology: If you remove the dying/dead nerve, you remove the source of pain and bacterial “food.” We start by getting you numb using standard dental anesthesia.  You should not be able to feel any part of this procedure, from start to finish. The tooth is then isolated using a dental dam to keep your saliva and the inner tooth completely separated. We access the tooth canal and begin clean out the canal. We use a system of specialized files to shape and clean the canal, along with a number of sterilizing irrigants to eliminate any bacteria. Once the canal is the right size and shape (confirmed via X-Ray), we fill it with a material called gutta percha. Modern gutta percha is engineered in a lab, and is extremely resistant to deterioration, infection or absorption.

Tooth Second from left- Before and after root canal. The gutta percha shows up bright white in the X-Ray, highlighting the shape of the canal.

Once the canal is filled, it is topped of with a filling to give the tooth structure. This final step may be done the same day as the canal filling or may be delayed to allow the tooth time to adjust to the procedure. Most of the time, the tooth will require a crown to give it long term structural stability and strength. Removing the nerve from teeth can make them more brittle, and the capping effect of a crown can help counteract this.

After the nerve is removed from the tooth, it physically cannot feel any more pain. The surrounding tissues can still feel tender, but the specific tooth will no longer have a way to relate sensory information to the brain. This is what makes root canals great at ending tooth pain permanently and instantly.

Overall, root canals are about 80% successful long term. They are an excellent way of buying time with a tooth that would otherwise need to be extracted and replaced with an implant or dentures. At our office, we evaluate root canals on a patient-to-patient basis. If we feel your specific case could benefit from the perspective of a specialist, we will refer you to an endodontist. These tooth canal experts bring a number of technologies to handle complex or difficult cases, including microscopes, CT Scanners and cutting edge materials.

If you have further questions on root canals or why we place them, please contact our office. We understand that this procedure seems intimidating, and will try our best to make it more manageable. As with any procedure provided at our office, we want you to be happy, pain-free, and satisfied with the end result!