Why do teeth need nerves? Why is toothache so painful?

Soldatova Lyudmila Nikolaevna

Candidate of Medical Sciences, Professor of the Department of Clinical Dentistry of the St. Petersburg Medical and Social Institute, Chief Physician of the Alfa-Dent Dental Clinic, St. Petersburg

Many of you are probably familiar with this unpleasant state: as soon as you bite off a piece of chocolate or take the first sip of aromatic coffee, your teeth begin to “ache.” And let's be honest, "breaking" is an understatement. The jaw literally cramps with pain, and the skin instantly breaks out in goosebumps.

We’ll talk today about why the jaw suddenly begins to “ache” and the teeth begin to ache, and most importantly, how to get rid of such manifestations in the present and prevent them in the future.

How can discomfort manifest itself?

In the language of dentists, this phenomenon is called hypersensitivity or hyperesthesia. And the main causes of discomfort are abrasion and cracks of the enamel.

Pain from so-called aching teeth can manifest itself in different ways. Some patients have pain in all rows at the same time, and in some patients only 2-3 teeth hurt. The following manifestations are characteristic of hyperesthesia:

• Sharp aching pain of uncertain localization. A person complains that “the whole jaw begins to ache at once.”
• Severe pain when eating sweet/hot/cold foods and drinks.
• Pain localized to a specific part, such as the front teeth or back molars.

Dentists classify enamel hypersensitivity in different ways - according to the degree of prevalence, stage of occurrence and origin.

According to the degree of prevalence, hyperesthesia is divided into two types:

• Localized.
  Occurs in the area of ​​one or more teeth. This type of aches is caused by carious cavities and wedge-shaped defects in the necks of teeth. Sensitivity can also be caused by grinding down the enamel to install crowns.
• Generalized.
  This sensitivity spreads throughout the entire jaw. Hyperesthesia is provoked by periodontal tissue diseases, blooming caries and enamel erosion.

According to the causes of occurrence, hyperesthesia can be classified as follows:

• Hypersensitivity due to dental damage - caries, grinding and erosion of enamel.
• Hypersensitivity due to exposure of necks, tooth roots, as well as systemic pathologies in the body.

They are divided according to the stage of occurrence:

• 1st degree. Teeth ache due to temperature changes; the electrical excitability of dentin does not exceed 8 microamps.
• 2nd degree. Dentin begins to react not only to temperature, but also to chemical stimuli. Maximum electrical excitability is 5 microamps.
• 3rd degree. The teeth begin to cramp under any irritant, electrical excitability increases to 3 microamps.

Frequently asked questions

Is it true that if a person has been in a state of nervous tension for a long time, he becomes more susceptible to various diseases? Can a nervous condition lead to illness?

Doctors' observations say that an initially mentally and physically healthy person is able to endure prolonged or severe stress without subsequent complications in the form of illnesses.

But if the body already has its own “weak points” in the form of a predisposition to diseases, disorders in the early (not yet identified) stages, or is weakened by a disease, then overstrain of the nervous system can trigger a whole cascade of ailments. Frequent examples of such developments are the formation of hypertension, weight loss or gain after stressful events.

Is it true that all “diseases are from nerves”?

Many diseases have causes and mechanisms of development in the form of disorders of the nervous system and psyche. But it is not correct to say that “all diseases are from nerves.” There are other causes for diseases: genetic defects, infections and poisonings, injuries, there are many disorders with an undetected etiology.

Can internal diseases cause mental disorders?

Yes. Body and psyche are connected. A significant part of diseases of internal organs can contribute to behavioral disorders and lead to mental illness.

For example, atherosclerosis and hypertension, if left untreated and progressing, will cause encephalopathy and psychoorganic syndrome (decreased memory, intelligence, emotional instability). Insufficiency of the thyroid gland leads to a decrease in intellectual capabilities.

Causes of toothache

As we have already said, the main reason for such painful sensations is the thinning of the enamel. Hyperesthesia can also develop due to:

• dentin reactions;
• allergies to dental medications;
• periodontal diseases;
• mechanical damage to enamel;
• hereditary predisposition.

Let's look at each cause of the problem in more detail.

How might the nerve react?

Often teeth due to deep caries and pulpitis. And such “ache” will very soon turn into more serious, excruciating pain, not only when cleaning and eating hot or cold food, but also in a calm state, both day and night.

With pulpitis, a cavity develops in the coronal part and root canals of the teeth, where the nerve fibers are located, which over time fills with pus and blood. And although the epicenter of inflammation in this case is the nerve, the patient may initially complain that the whole row of teeth is “aching.” The sensations are localized in one tooth a little later, the pain becomes unbearable and requires the intervention of a dentist.

Why do teeth hurt when the trigeminal nerve is inflamed?

How is inflammation of the trigeminal nerve related to teeth? The connection here is the most direct. Firstly, severe pain during attacks “radiates” to the upper or lower jaw (depending on which nerve extension is inflamed), and sometimes to both jaws. This causes severe and unbearable toothache.

Secondly, those nerves that are found in the upper and lower teeth and gums are directly connected to the trigeminal nerve. The second branch of the trigeminal nerve innervates the upper teeth and gums, and the third, respectively, the lower jaw and gums.

The trigeminal nerve can also be damaged during a number of dental manipulations. Unsuccessful tooth extraction or improper filling, surgical intervention in the jaw structure that ended unsuccessfully, and injuries can cause trigeminal neuralgia.

It is very important to distinguish inflammation of the trigeminal nerve from other diseases of the oral cavity, in particular pulpitis - inflammation of the internal dental tissues. A characteristic sign of inflammation of the trigeminal nerve is that, despite severe pain, the sensitivity of the teeth does not increase when they come into contact with cold and hot foods, and hypothermia or heating does not provoke the onset of a new pain attack. Acute tooth sensitivity is a symptom of pulpitis.

When the trigeminal nerve is damaged in the jaw area, acute toothache, pain in the chin, ears and sometimes in the lower lip occurs. The pain may become increasingly intense, and often the patient continues to feel a dull ache after the attack.

Thinning enamel

Tooth enamel can become thinner for a variety of reasons, such as:

• improper bleaching or poor-quality professional cleaning;
• using brushes that are too hard;
• using pastes with abrasives that expose the enamel to chemical and mechanical stress;
• vitamin deficiency (the pain in this case is characterized by an aching, twitching character and manifests itself during cleaning, rinsing the mouth, eating and drinking).

What to do when cracks appear in the corners of your mouth? perhaps these are jams?

Such cracks are painful, unpleasant, and unsightly. They are quite difficult to get rid of. Many people think that the occurrence of a jam is associated with a denture. In principle this is true. Quite often, dentures cause jamming. This may occur because the prosthesis is not installed correctly or is not properly maintained. If the prosthesis is large and the mouth gap is small, then when inserting the prosthesis, tears may appear that become infected. Jams may form in these places.

Dentin reaction

Dentin is the hard tissue of the tooth underneath the enamel. This is a layer that, after damage, can allow irritants to pass into the nerve zones. Dentin is destroyed during advanced stages of caries, and can also occur with inadequate dental treatment if an infection develops under a filling.

If teeth ache for this reason, the patient feels a drilling, sharp pain, similar to the sensations of purulent pulpitis.

In very rare cases, teeth ache due to the patient’s individual intolerance to certain dental medications, after visiting a doctor. In this case, the pain is accompanied by itching in the gums and palate.

Causes of pulsation

Common causes include exacerbation of oral diseases, dental injuries, consequences of poor-quality treatment, temporary condition after dental procedures, and dental hypersensitivity. You won’t be able to get rid of these reasons at home on your own, and they may even make the situation worse. The longer you put off going to the doctor, the more serious the consequences: the need for surgical intervention or loss of teeth. There are other reasons for pulsation.

Pulsation of the tooth under the filling. If the filling is temporary, pain is allowed for two days after its installation. Temporary fillings are often placed because of pulp pain, in order to relieve the patient of discomfort and to observe the body’s reaction to foreign material. In this case, sometimes a medicine is placed under the filling that kills the nerve. This may cause pain. If the filling is permanent, only a doctor can make a diagnosis after diagnosis.

Pulsation of the tooth under the crown. Here we are talking about two options: either an infection got under the crown during installation, or the nerve was poorly treated before installation. It is difficult to correct the problem in both cases - you will have to open the crown, which is not a pleasant process. But otherwise, you may lose the entire tooth.

Pulsation after tooth extraction. The pain can be temporary and even long-lasting if a wisdom tooth is removed, the soft tissues of the oral cavity are damaged (the gums are cut, for example), or surgery is performed to remove a dental unit. But there is a more dangerous option - suppuration of the empty hole. When a tooth is throbbing due to a purulent formation, home treatment is strictly prohibited! Contact your doctor, he will clean the hole and prescribe medication.

Pulsation without pain. This phenomenon is possible as a result of apical periodontitis (pus accumulates and gives a pulsating sensation) or periodontitis (inflammation of the tissues surrounding the tooth). If the area in the mouth is pulsating, there may be no pain in the tooth, but this does not mean that your health is safe. Advanced periodontitis is dangerous due to the development of sepsis (purulent infection), perimandibular abscess (a purulent tumor appears on the jaw) and the appearance of other diseases, including chronic ones.

Pulsation of teeth may not be associated with oral diseases. Other reasons include: diseases of the gastrointestinal tract, liver, development of sinusitis. In these cases, the pulse in the teeth is accompanied by a general deterioration in the condition of the body. What to do? First of all, contact your dentist. If he confirms that your teeth are healthy, contact your therapist, he will give you a referral to a specialized doctor.

How to relieve pain?

If aches and pain in your teeth caught you in the middle of the night, and you only made an appointment with the doctor the day after tomorrow, try to relieve the painful sensations for a while. Here are some popular and effective ways to temporarily soothe aching teeth.

• Acupressure
  will help relieve discomfort for a couple of hours. Try massaging the grooves between the phalanges of the index and thumb, the base of the ears, and the area between the cheekbone and lower jaw.
• Rinse
  . For an anesthetic rinse, a decoction of chamomile, St. John's wort, lemon balm, mint or oregano is suitable. Just pour 1-2 tablespoons of the dry plant with a glass of boiling water, and then keep the composition in a water bath for 20 minutes. If there are no medicinal herbs in your home medicine cabinet, rinse your mouth with a salt solution. Dissolve a teaspoon of the substance in a glass of water and begin therapy.
• Painkillers
  will help you rest before your visit to the doctor and relieve aching teeth. Dentists advise choosing new painkillers with each new attack of pain - Nurofen, Analgin, Ketanov, paracetamol, aspirin. However, do not under any circumstances overdo it with pills! Firstly, these drugs are addictive, and secondly, they have a bad effect on the liver, kidneys, gastrointestinal tract and other systems in the body.
• Clove, mint and sea buckthorn oils
  will help relieve pain and even relieve swelling of the gums. For pain relief, it is enough to soak cotton swabs and cover the sore teeth. Tampons should be changed every 2 hours.
• Propolis
  is an excellent natural anesthetic, similar in action to novocaine. To pacify dental aches and pain, you can wipe the gums with an alcohol solution of propolis or moisten cotton wool with it and cover the sore tooth. Some dentists advise using propolis in plates: you can simply cover the hole with a piece of the substance or put propolis on the gum near the tooth. The product is prohibited for patients who suffer from allergies to honey and other bee products.
• Garlic,
  according to patient reviews, helps to forget about the painful aches for a couple of hours. You can use a cut or ground clove, applying it to a sore tooth, or chew garlic with black bread and hold it in your mouth. This vegetable warms the skin, so it can be used as an irritant for acupuncture points. To soothe a toothache, a paste of two cloves of garlic should be applied to the inside of the wrist on your hand (the opposite side on which the tooth hurts). The medicine is fixed on the skin with a bandage and lasts for several hours.
• radishes
  have been used to treat toothache and gum inflammation. To prepare a natural analgesic, you need to wash the vegetable, peel it from the skin and grate it on a fine grater, and then pour 2 tablespoons of the pulp with 0.5 liters of boiling water. To relieve pain with the composition, you need to rinse your mouth every hour.
• Plantain root
  is an excellent summer analgesic. Simply rinse it and apply it to the sore tooth. After 20-30 minutes the pain will go away.

For toothache of infectious origin, Asepta Active mouth rinse is an effective analgesic, antibacterial and anti-inflammatory agent. This product combines a combination of benzydamine and chlorhexidine, which not only has a pronounced antibacterial effect, but also prevents inflammation and bleeding of the gums, freshens breath and prevents the formation of plaque.

What is absolutely forbidden to do?

In order not to double the painful sensations of aching in the jaw, it is important to adhere to several rules before visiting a doctor:

• Regularly clean the oral cavity of food debris; sometimes it is particles from lunches and dinners that often become the cause of especially severe pain in pulpitis and periodontitis.
• Never chew on the side of the affected tooth.
• Heating a sore spot is strictly prohibited. Any hot compresses increase blood flow and increase pain.
• Try not to be in a lying position; this position activates blood circulation in the periodontal tissues and increases pressure on them.

We have listed the main ways to relieve toothache. However, these methods, with all their diversity, will not help cure the cause of the unpleasant manifestation and are only a temporary measure. As soon as you feel your teeth hurting, make an appointment with the dentist. Believe me, the sooner you start treatment, the faster and cheaper you will get rid of painful sensations.

Clinical researches

Repeated clinical studies have proven that the two-component mouth rinse ASEPTA ACTIVE more effectively combats the causes of inflammation and bleeding compared to single-component rinses - it reduces inflammation by 41% and reduces bleeding gums by 43%.

Sources:

1. The effectiveness of the use of Asept “adhesive balm” and Asept “gel with propolis” in the treatment of chronic generalized periodontitis and gingivitis in the acute stage (Municipal Dental Clinic No. 4, Bryansk, Kaminskaya T. M. Head of the therapeutic department Kaminskaya Tatyana Mikhailovna MUZ City Dental Clinic No. 4, Bryansk
2. Study of the clinical effectiveness of treatment and prophylactic agents of the Asepta line in the treatment of inflammatory periodontal diseases (A.I. Grudyanov, I.Yu. Aleksandrovskaya, V.Yu. Korzunina) A.I. GRUDYANOV, Doctor of Medical Sciences, Prof., Head of Department I.Yu. ALEXANDROVSKAYA, Ph.D. V.Yu. KORZUNINA, asp. Department of Periodontology, Central Research Institute of Dentistry and Maxillofacial Surgery, Rosmedtekhnologii, Moscow
3. The role of anti-inflammatory rinse in the treatment of periodontal diseases (L.Yu. Orekhova, A.A. Leontyev, S.B. Ulitovsky) L.Yu. OREKHOVA, Doctor of Medical Sciences, Prof., Head of Department; A.A. LEONTIEV, dentist; S.B. ULITOVSKY, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I. P. Pavlova
4. Report on the determination/confirmation of the preventive properties of personal oral hygiene products “ASEPTA PLUS” Remineralization doctor-researcher A.A. Leontyev, head Department of Preventive Dentistry, Doctor of Medical Sciences, Professor S.B. Ulitovsky First St. Petersburg State Medical University named after. acad. I.P. Pavlova, Department of Preventive Dentistry