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Alternative names
Pain - tooth or teeth

Considerations
A toothache is generally the result of tooth decay or sometimes an infection. Tooth decay is often caused by poor dental hygiene, although the tendency to get tooth decay is partly inherited.

Sometimes, pain in other locations is perceived as occurring in the teeth (this is called referred pain or radiating pain).

Common causes

• tooth decay
• abscessed tooth
• earache
• injury to the jaw or mouth
• acute MI (can present with jaw pain, neck pain, or toothache)
• sinusitis

Home care
Over-the-counter pain medications may be used while waiting to see the dentist or primary health care provider.

For toothaches caused by a tooth abscess the dentist may recommend antibiotic therapy and other treatments, like root canal.

To prevent tooth decay, use good oral hygiene. A low sugar diet is recommended along with regular flossing, brushing with fluoride toothpaste, and regular professional cleaning. Sealants and fluoride applications by the dentist are important for preventing tooth decay.

Call your health care provider if

• there is a persistent (longer than a day or 2) or severe toothache.
• there is a fever, earache, or pain upon opening the mouth wide.

Note: The dentist is an appropriate person to see for most causes of toothaches. However, if the problem is referred pain from another location, you may need to see your primary health care provider.

What to expect at your health care provider's office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting toothache in detail may include:

• time pattern:
  • When did the pain start?
• quality:
  • How severe is the pain?
• location:
  • Where is the pain located?
  • Does it involve the jaw or ears?
  • Does it radiate to other parts of the body, such as the neck, shoulder, or arm?
• aggravating factors:
  • What makes it worse?
  • Is it worse after cold foods or liquids?
  • Is it worse after sweet foods or liquids?
  • Is it worse after chewing?
  • Is it worse after drinking?
  • Is it worse when you touch the area?
  • Is it worse after physical exertion?
• relieving factors:
  • What helps?
  • Is it better after you use medications? (Which ones?)
  • Is it better after you use a heating pad?
  • Is it better after you rest?
• other
  • What other symptoms and factors are also present?
    • Fever?
    • Previous dental problems?
    • Nausea?
    • Sweating?
    • Indigestion?
    • Chest pain?
    • Bleeding?
• additional important information
  • What medications are being taken?
  • Have there been any injuries?
  • When was the last checkup with the dentist?

The physical examination may include an examination of the mouth, teeth, gums, tongue, throat, ears, nose, throat, neck. Dental X-rays may need to be performed. Other tests may be recommended depending on the suspected cause.

Intervention:
The dentist will fill cavities or extract the tooth if necessary. Root canals might be performed if the problem is severe in both the primary and permanent teeth. If there is a fever or swelling of the jaw, an antibiotic will usually be prescribed.

After seeing your health care provider:
You may want to add a diagnosis related to toothaches to your personal medical record.

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