Article by Dr Angela Ngauw, General Dental Surgeon, BDS (S’pore)
Toothaches have often been described as constant, sharp, throbbing pains in the teeth and jaws. If you are unfortunate enough to have suffered a severe toothache, you would know that it can be an extreme, debilitating pain that lasts for hours, keeps you up at night, and might not respond to over-the-counter pain medication. In a large number of patients, these severe pains are due to the nerves, blood vessels and connective tissues inside the teeth being inflamed. These tissues are known as the dental pulp, and an inflammation of the dental pulp is known as pulpitis.
Pulpitis can be caused by tooth decay, deep fillings, or trauma. These lead to the outer layers of enamel and dentine to be compromised and allow irritants such as bacteria to enter into the pulp, causing inflammation. When the pulp is inflamed, its primary symptom is that of pain, although less commonly, pulpitis may also occur without any pain. There are two main categories of pulpitis: reversible and irreversible pulpitis.
In reversible pulpitis, there is little or no damage to the pulp, and pulpal tissues are only mildly inflamed. Symptoms are typically sensitivity to cold or occasionally, sweet food, and lasts a few seconds only. In reversible pulpitis, there is a chance that the pulp may recover and the symptoms subside if the stimulus is removed and correct treatment is given. However, if no treatment is given, the pulpitis may sometimes escalate and lead to irreversible pulpitis.
In irreversible pulpitis, there is more damage to the pulp and more severe inflammation. The pulp tissue can no longer recover from the inflammation and as the inflamed tissues attempt to swell, the confined nature of the pulp space causes significant pressure buildup inside the tooth. This pressure buildup results in symptoms which are generally of a more severe nature, although it is important to bear in mind that some people may experience no symptoms at all. In majority of patients, however, typical symptoms of irreversible pulpitis are severe spontaneous, shooting pain that comes and goes, and may be more severe at night and disrupts sleep. The pain could also be triggered or aggravated by cold, hot, or sweet stimuli, and persists even after the stimulus is removed. In some cases, the pain may radiate to the ear, temple or head.
Tooth decay progression from reversible to irreversible pulpitis
Why is seeking treatment important?
It is important to seek treatment if you have any symptoms of pulpitis, more urgently if your symptoms are those of irreversible pulpitis. Your dentist would be able to diagnose the type of pulpitis and prescribe the appropriate treatment accordingly. In reversible pulpitis, where the pulp is still able to heal, the dentist may perform treatments such as removal of decay and fillings to cover up cavities. Once the irritants (e.g. bacteria in tooth decay) are removed, the symptoms of reversible pulpitis will also subside as the pulp recovers. It is pertinent to note that treatment of reversible pulpitis is almost always of a simpler and less invasive nature than that of irreversible pulpitis.
If, however, no treatment is sought during the stages of reversible pulpitis, the inflammation may progress to the irreversible stage. When the pulp is no longer able to heal itself, treatment would then be root canal therapy, or in certain cases, removal or extraction of the entire tooth.
If irreversible pulpitis is left untreated, the severely inflamed pulp will die, and bacteria will invade the pulpal space. The tissues in the area around the root will become inflamed in response to the presence of bacteria and other irritants in the pulp space. The bone around the base of the tooth is destroyed, and the surrounding tissue may swell with pus formation (abscess).
A dental abscess from infected pulp
Symptoms of a dental abscess vary in severity, but they include severe throbbing pain, pain on biting down or touching the tooth, bitter taste and foul smell in the mouth, swelling of the face, restricted mouth opening, and fever. In some instances, this infection can progress into a very serious or even fatal condition, whereby the infection spreads into areas around the neck, eyes, or even brain. Bacteria could also enter the bloodstream, leading to a widespread inflammatory response by the body, with symptoms such as fever, chills, rapid heartbeat, vomiting, and ultimately, septic shock, organ failure, and death. Patients who have weak immune systems, such as the elderly with underlying medical problems, cancer patients, or diabetics, are at greater risk of developing such life- threatening infections. Mild cases of dental abscesses can be treated with root canal therapy or extraction, and drainage of the pus. More severe dental infections would warrant hospitalisation, where intravenous antibiotic therapy and sometimes aggressive incision and drainage, in addition to the removal of the diseased tooth, would be carried out.
In short, early diagnosis and treatment of dental infection are crucial in preventing potentially severe complications. The early stages of any tooth infection are less complicated to treat, take less time to fix, and are usually associated with a better outcome, and less cost too! So, if you are suffering from any form of tooth discomfort, do make an appointment to see your dentist as soon as possible. Sometimes, a simple filling is all you need to get rid of that nagging pain in your tooth.