Dental cavity is the most common cause of toothache. Dental cavities are holes in the two outer layers of a tooth called the enamel and the dentin. These layers serve to protect the inner lining of the tooth tissue called the pulp, where blood vessels and nerves reside. Bacterial infections in the mouth convert simple sugars into acid which softens and dissolves the enamel and dentin, thus, creating cavities. Small shallow cavities usually do not cause pain and may be unnoticed by the patient. It is the larger deeper cavity that becomes irritated by bacterial toxins when food debris collect causing toothache. Foods that are cold, hot, sour, or sweet can also cause pain.

Dental filling is usually the treatment for small and shallow cavities, while larger cavity involves an on-lay or crown. For cavities that have penetrated and injured the pulp, treatment requires either a root canal procedure or extraction of the affected tooth. Pulp injury can lead to the death of pulp tissue, resulting in tooth infection or dental abscess. The root canal procedure involves removing the dying pulp tissue and replacing it with an inert material to save the dying tooth from extraction.

Gum disease or gingivitis is considered to be the second most common cause of toothache characterized by the inflammation of the soft tissue and abnormal loss of bone that surrounds the teeth and holds them in place. This condition is caused by toxins secreted by bacteria in “plaque” that accumulate over time along the gum line. Gum bleeding without pain is an early symptom of this disease while pain is of more advanced gum disease symptom as the loss of bone around the teeth leads to the formation of gum pockets. Advanced gum disease can cause loss of otherwise healthy teeth.

Early gum disease is treatment involves oral hygiene and removal of bacterial plaque. Thorough cleaning of the teeth and teeth roots called “root planing” and “subgingival curettage.” Root planing is the removal of plaque and tartar from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment may include various types of gum surgeries. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.