There are two classifications of dental inflammation (which is the source of the pain): reversible and irreversible.
“It is often difficult to determine whether a tooth needs root canal treatment [the treatment for irreversible tooth inflammation] or not,’ says Dorfman. “We can do many tests, but one of the simple ones is to see how teeth react to hot or cold. If a tooth doesn’t respond to temperature, it’s usually dead, but not always.”
When a toothache is reversible, it means that when heat, cold, or pressure is applied to the tooth, the pain will lessen and disappear as the tooth heals. Also, if the tooth only reacts while the stimulus is on the tooth, it is probably inflamed, but can still heal.
However, in the case of an irreversible toothache, the pain does not stop after the stimulus is applied. If this is the case, you probably need a root canal, says Dorfman. “When a tooth needs a root canal, it’s because the tooth’s nerve has died or is dying,” he says.
Once the nerve is dead it becomes necrotic and if left in it the tooth can cause a massive infection. “When you do a root canal, you remove the nerve and fill the tooth with an inert material, so hopefully you can keep the tooth for many years,” he says.
Common toothache symptoms include the following, says Sharon Huang, DDS, founder of Les Belles NYC Dentistry in New York:
- Pain. “Toothache can be a sharp, dull, or throbbing pain in a tooth,” says Huang. “The pain can be constant or sporadic, whether it comes from the tooth or not. Intense toothache often keeps people awake at night.
- Swelling in the gums
- Swelling in the face
- Redness in the gums
- Bad taste in the mouth
- Headache or migraine
- Muscle pain in neck and upper shoulder
- Bad smell from the mouth or from the abscess of an infected tooth