Toothache

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Toothache

On the Registry of Pain, toothache is right up there with listening to a 5,000 kazoo concert or clobbering your thumb with a hammer. It's the kind of pain that makes you want to yowl.

Most toothaches are due to bacteria and decay that have penetrated the tissue at the tooth's center, according to Kenneth H. Burrell, D.D.S., director of the American Dental Association's Council on Dental Therapeutics in Chicago. The subsequent inflammation causes pressure, which causes pain. These bacteria can also create localized areas of infection, called abscesses, at the root tip. Both situations can produce a deep, sharp throbbing sensation and extreme sensitivity. (If it's just a sharp "burst" of pain that quickly vanishes, you probably have sensitive teeth rather than a toothache.) In addition, gum disease, failed restorative work, tooth fractures--even sinus infections and heart ailments--can produce intermittent bursts or a constant stabbing pain that'll drive you up the wall.

This long day's journey into excruciation can easily be avoided by practicing a daily routine of brushing and flossing and seeing your dentist twice a year. But that probably doesn't mean too much if your molar is already beating like a bass drum. When the pain is on the march, you'll soon be marching to the dentist. But in the meantime, here are a few things you can do to grin and bear it.

Rinse with warm salt water. Hot or cold water will only aggravate an already sensitive tooth, but swishing some warm salt water will relieve a lot of the pain, says William P. Maher, D.D.S., assistant professor of endodontics at the University of Detroit Mercy School of Dentistry.

Just mix two to three teaspoons of salt in a glass of water. The salt draws out some of the fluids causing the swelling and has a general soothing effect. The saltwater rinse also cleans the areas around the infected tooth. Even unsalted lukewarm water (about body temperature) can flush out an irritating piece of rotting food and provide some relief.

When to See the Doctor Make an appointment with your dentist as soon as you feel a toothache--and keep that appointment, no matter what. "If you have a toothache and the pain goes away, you should not assume you are cured," says William P. Maher, D.D.S., assistant professor of endodontics at the University of Detroit Mercy School of Dentistry. Have your teeth checked by a dentist. "The condition could actually worsen with no outward symptoms at all." The problem is that the pulp can go dead even while the bacteria are still very active. The bacteria may be working under the crown, but after the pain dissipates, "you wouldn't even know it, because your early warning system has been removed," says Dr. Maher. But unless you have the underlying problem taken care of, you may risk losing the tooth.

Take an analgesic. "Anything you would take for a headache you can take for a toothache," says Dr. Burrell. That old standby, aspirin, works wonders to tame toothache pain and inflammation. If you have adverse reactions to aspirin, try ibuprofen (Advil or Nuprin). lbuprofen has even more anti-inflammatory power, and it's gentler to the stomach than aspirin.

If you do use aspirin, never put it directly on a tooth or gum, warns Dr. Burrell. It will only produce a painful acid burn. Also, don't give aspirin to children because of the risk of Reye's syndrome.

Find relief in the freezer. "Ice will shut down some of the superficial nerves," says Thomas Lundeen, D.M.D., co-director of the Clinical Pain Program at the University of North Carolina in Chapel Hill. It is particularly helpful with bruises or other traumatic injuries to the tooth or mouth, since ice can greatly reduce swelling. But don't apply ice directly to a tooth: Use an ice pack wrapped in a towel outside the mouth.

Try some oil of cloves. Eugenol (oil of cloves) is available over the counter and provides exceptional temporary relief, especially for toothaches that are temperature-sensitive. Such pain is usually due to problems of the pulp, the tooth center, says Martin Trope, D.M.D., chairman of the Department of Endodontology at Temple University School of Dentistry in Philadelphia. Most drugstores sell eugenol toothache kits. You can even mix liquid eugenol with zinc oxide to create your own temporary fillings for painful cavities. A few drops on the tooth surface or in a cavity or crack should do the job until you can get to the dentist.

Numb it with benzocaine. "Benzocaine is a local, over-the-counter anesthetic that works well if there is a large cavity or damage to the tooth surface," says Dr. Maher. "It numbs things. The closer you can get it to the pulp, the better it works."

Several easy-to-apply, brand-name oral gels and ointments contain this numbing agent. Dab the gel on the entire tooth surface and surrounding gum with your finger or a cotton swab. If you have a visible cavity, try to get the gel inside the cavity area.

Don't get all heated up. Keep heat away from your teeth, warns Dr. Trope. In fact, avoid both temperature extremes. Very cold or hot drinks may increase the pain when they hit your nerve endings. Extremely salty or sugary foods and drinks can have the same effect, he adds.

Use some more ice on your hand. Here's a neat trick developed by pain researcher Ronald Melzack, Ph.D., of McGill University in Montreal, Quebec. Rub a piece of ice on the V-shaped area between your thumb and forefinger for five to seven minutes, until that area goes numb. This treatment significantly eases tooth pain by sending impulses along the same pathways that toothache pain travels. The impulses close the gate on incoming pain messages--in effect, shutting off the ache.

You may want to exercise ... or not. "Most people with a throbbing toothache just want to sit still--and that is probably best," says Dr. Lundeen. "On the other hand, physical activity, especially of the aerobic type, may produce enough endorphins (the body's natural pain relievers) that the pain will be greatly reduced." If you can, try a brisk walk or jog. But don't force yourself to keep going if the pain gets worse.

Breathe deeply--and listen up. "Soothing music and deep breathing bring about a relaxed state, which can help alleviate some toothache pain," says Dr. Lundeen. Researchers at the University of Washington in Seattle have discovered that slow rhythmic music effectively reduces your awareness of much acute pain, including dental pain, by distracting your attention and generating pleasant moods and images. So sit back, turn on the stereo, and let the dulcet tones of your favorite crooner chase away your toothache blues.

Put out that cigarette. "Tobacco is associated with a great number of dental and oral problems and can really irritate sensitive gums," says Dr. Lundeen. "Snuff and chewing tobacco are especially damaging." Tobacco stimulates adrenaline, which sensitizes us to pain. And the nicotine in tobacco blocks endorphins.