[Click! Health] Toothache Has Stages Too... "Proper Treatment Must Accompany"

Toothache, which is pain felt in the teeth, is divided into stages depending on its progression. Experts advise that appropriate treatment should be administered according to each stage of toothache.

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According to Kyung Hee University Dental Hospital on the 15th, when a patient experiences tooth pain, they often cannot accurately point to the tooth causing the problem. This is due to the "cross-talk" phenomenon where sensory nerves from different peripheral areas converge in the central nervous system. This is why radiographic examinations are conducted not only on the tooth the patient complains about but also on the adjacent teeth and the opposing upper or lower teeth.

The stages of toothache develop in the order of pain felt from cold water, pain from hot water, and pain when at rest. If the extent of the cavity is small and degeneration of the dental pulp, the nerve inside the tooth, has not occurred, symptoms such as "sensitivity to cold water," "pain when chewing," and "food getting stuck frequently" are reported. If treatment is delayed and the cavity progresses further, inflammation occurs in the pulp.

The structure of a tooth consists of enamel, dentin, and pulp from the outer layer inward. The pulp is a soft tissue located inside the tooth, surrounded by hard tissues, and contains cells, blood vessels, and nerve tissues. Professor Osoram of the Department of Conservative Dentistry at Kyung Hee University Dental Hospital explained, "Even if the cavity has not invaded the pulp, small bacteria or bacterial byproducts can move to the pulp through microscopic channels in the dentin and cause inflammation." He added, "When severe inflammation and degeneration occur in the pulp, a characteristic symptom is pain from hot water." Professor Oh further explained, "If acute inflammation occurs in the pulp, the tooth throbs painfully even without any stimulus, and pain is actually reduced when cold water is held in the mouth."

When a patient complains of tooth pain but cannot accurately point to the causative tooth, it can be an obstacle to diagnosis. There are two reasons why patients cannot precisely identify the painful tooth. First, the nerves inside the tooth (pulp) do not have nerve fibers responsible for proprioceptive sensation, so the exact location cannot be identified. Second, the cross-talk phenomenon occurs because sensory nerves from different peripheral areas converge in the central nervous system, making it difficult for the patient to identify the origin of the pain.

Professor Oh said, "Patients complaining of tooth pain should first check for tooth fractures or cavities." He added, "Radiographic examinations of the teeth and jawbone are very useful and essential tools for confirming cavities." Whether the nerves and blood vessels inside the pulp are healthy is determined by interpreting multiple tests comprehensively, including electric pulp testing, which sends an electric current to the outer surface of the tooth, and tests that check for pain induced by cold or heat stimuli.

If the cavity is at a relatively early stage, removing the cause will relieve the pain. After removing the cavity, the tooth is restored to its original shape using dental materials. If the cavity is extensive or has existed for a long time causing degeneration of the dental pulp, root canal treatment is performed before restoring the tooth to its original form.

However, the degree of pain does not always correlate with the severity of the cavity. If new sharp pain or sensitivity, or discomfort such as food getting stuck between teeth occurs, it is advisable to visit a dentist. Sometimes, when the pulp dies due to a cavity and inflammation spreads around the tooth root, there may be no pain at all. Therefore, regular dental check-ups are essential, according to Professor Oh.

Professor Oh explained, "Even if pain decreases after taking painkillers, if sharp pain or sudden sensitivity to cold water occurs, you should visit the dentist promptly." He added, "Especially when cavities develop between teeth, it is difficult to detect them by simply opening the mouth and looking in a mirror; accurate diagnosis is only possible through radiographic examination at the dental clinic." He also advised, "If food suddenly gets stuck frequently between teeth, you should definitely get a check-up."

Professor Oh So-ram, Department of Conservative Dentistry, Kyung Hee University Dental Hospital.
[Photo by Kyung Hee University Dental Hospital]

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