mouth pain

When caring for your teeth and gums, it is essential to look out for new dental problems. One of the typical signs of any dental disease is a pain. Oral pain comes in all shapes and forms.

From tooth sensitivity to sore gums and jaw pain, there are numerous sources of oral pain in the mouth.

Usually, oral or facial pain is a common effect of injury or trauma. However, dental problems like tooth infection, gum disease, dry socket, and temporomandibular joint disorder can contribute to the development of painful conditions. Treatment for pain management depends on the source of pain and the type of dental condition present.

Usually, pain management involves a comprehensive diagnosis of the dental condition, followed by a strategic treatment plan. Minor oral pain can be treated with immediate symptomatic relief. However, chronic infections may require specific dental procedures in addition to medication therapy. Today’s article will highlight the different types of oral pain and appropriate treatment modalities to manage the dental condition.

What causes oral pain?

Oral pain is primarily defined as any feeling of distress or discomfort that involves the tissues of the mouth. Usually, oral pain includes toothache, gums, jaw bone and muscles, tongue, and cheeks. Around 9-10 types of dental diseases can lead to oral pain. Each type of oral pain is initiated from a different source. However, in some clinical conditions, the exact cause may not be apparent. Common causes of oral pain can be categorized as follows –

  • Mouth and jaw pain – cold sores, ulcerations, sinusitis, temporomandibular joint disorders, dry socket
  • Gum pain – gum inflammation and infection, a periodontal abscess
  • Tooth pain – tooth decay, infected pulp tissue, tooth sensitivity (1)

The types of oral pain mentioned above are typically the warning signs of chronic dental condition. Early symptoms of dental problems usually include –

  • Bleeding gums
  • Tooth discoloration
  • Food impaction
  • Loose teeth
  • Recurring bad breath
  • Presence of irregular patch or discoloration of oral tissue

The best way to manage such symptoms is to seek immediate dental care.

Early diagnosis and prompt treatment of specific dental issues help to maintain the oral condition efficiently.

How is oral pain clinically diagnosed?

Oral pain is one of the common complaints encountered in a dental office. A proper diagnosis of the cause is essential to determine the treatment plan. Diagnosis of oral pain usually includes the following elements –

Patient history

A thorough history of the patient’s symptoms is taken to evaluate the present condition. Often, the dentist may ask the patient about the presence of pain in the tooth, gums, and soft or hard tissues in the mouth. Additionally, a history for extra-oral pain like that of the face and jaw is taken. Sometimes tooth sensitivity or fractured tooth can cause radiating pain. For this, the dentist may consider the history of any traumatic injury within the past six months.

Physical examination

Followed by the patient, history, the dentist performs a full mouth examination. This process allows evaluating the oral health status of the patient visually. The dentist looks for any signs of disruption or discoloration of the teeth, gum bleeding, abscess or swelling, broken or cracked tooth, traumatic injury, ulcerations or lacerations, and periodontal status. (2)

Vitality tests

Usually, these tests are performed to check the vitality of the concerned tooth. Pulp vitality tests are done before implementing any restorative or endodontic procedures. Some of the pulp vitality tests are listed below –

  • Cold test – in this, an ice stick is placed on the cervical area of the tooth to check for tooth sensitivity. This test typically lasts for 1-3 seconds, indicating vital pulp. However, failure to respond to this test directs towards irreversible tooth infection or dead tooth.
  • Heat test – similar to the cold test, a hot instrument or heated pice of gutta-percha is placed over the cervical area of the tooth.
  • Electrical pulp testing – this test consists of two electrodes, one is placed on the patient’s finger, and the other is placed on the tooth. A mild electric current is applied to check the patient’s response. Each tooth is typically tested for 2-3 seconds, and the results are then compared. Absence of any sensation indicates dead tooth.
  • Tooth sloth – often when a dentist suspects a vertical tooth fracture or extensive pulp infection, he may ask the patient to bite on a hard object like a tooth sloth. Tooth sloth is a device with a small indentation which delivers the force of bite to one cusp at a time. It helps to locate tooth fractures and cracks.

Assessment of the condition through dental x-rays

Dental X Ray Importance

Dental x-rays are usually required for dental problems related to the teeth, gums, and jaw. During the first visit, a panoramic radiograph may provide a complete view of the patient’s oral health status.

Panoramic radiograph typically consists of a single large film that covers all the oral tissues of the mouth, including the teeth, jaw bone, and temporomandibular joint. Dental problems like tooth decay, pulp infection, or abscess may require an additional set of x-rays like periapical and bitewing. (3) Dental x-rays primarily help to find the source of oral pain and confirm the dental condition. They are beneficial for making an effective treatment plan.

Tooth Pain and management

The tooth consists of a central pulp tissue which is made by a network of nerves and blood vessels. Pulp tissue also maintains the vitality of the tooth. Tooth pain commonly occurs when the decay approaches the pulp tissue and causes inflammation. Some of the common causes of tooth pain include –

  • Dental caries
  • Large and extensive cavities
  • Traumatic injury to the tooth
  • Infected pulp
  • Fracture of a tooth which involves the pulp tissues
  • Referred pain
  • Wisdom tooth pain

The nature of tooth pain depends upon the type of dental condition. Generally, it can be sharpshooting, dull, or throbbing. Unlike tooth sensitivity, dental pain persists for a more extended time even after the removal of the stimulus. Moreover, as the disease progress, it increases the inflammation and pain in the tooth.

Treatment of toothache mainly depends on the cause and source of the pain. Professional dental procedures for tooth pain management may include –

  • Simple tooth fillings can treat a vital tooth with a cavity or decay that has not reached the pulp tissue.
  • A dead tooth or irreversible pulp infection requires root canal treatment. During this procedure, the root canals and the pulp chamber is thoroughly cleaned and sealed, followed by crown placement.
  • For extensive tooth decay or loss of tooth structure, the dentist may advise tooth extraction and replacement therapy.

What causes gum pain?

Gum disease can often be distressing and irritating. Painful gums interfere in activities like eating, drinking, and tooth brushing. Several factors lead to soreness of the gums. Some of them may include –

  • Gum disease or periodontal infection – gum disease is the most common dental problem that causes sensitive or painful gums. It is mainly caused by inadequate oral hygiene. Excessive accumulation of plaque and bacteria can progress the disease to cause periodontal pockets, bone, and tooth loss. (4)
  • Canker sores – canker sores are painful ulcers that usually form on the surface of the gums. The leading cause for the formation of a canker sore is stress. Contributing factors of canker sore include tissue injury, underlying health condition such as nutritional deficiency, gastrointestinal disease, and impaired immunity.
  • Cuts or abrasions – gum pain comes hand in hand with cuts, lacerations, or abrasions of the gingival tissue. Often, this condition arises during orthodontic treatment. Additionally, other dental appliances like sharp edges of a denture or retainer can also irritate the gum tissue and initiate pain in the gums.
  • Sinus infection – sinus infection may not be the exact cause of gum pain. However, the inflammation of the sinus tissue causes referred pain to the gums and teeth. Such type of referred pain is called sinus gum pain.
  • Hormonal changes are another source of gum inflammation; for example, pregnancy causes sensitive or sore gums.

Management of gum pain

Gum pain can be localized to a particular area or involve a large area around several teeth. The treatment for gum pain is always standard, which mainly focuses on the betterment of oral hygiene. Most of the times a proper oral healthcare routine as mentioned below can suffice for soothing sore gums –

  • Brush your teeth at least two times a day with an anti-gingivitis toothpaste which is specially formulated to neutralize plaque and bacteria in the mouth. Use a soft or extra-soft-bristled toothbrush to reduce the chances of gum injury.
  • Electric toothpaste is more effective in stimulating the gums while brushing.
  • Floss your teeth once a day.
  • Rinse your mouth with warm saltwater.
  • In some cases, over-the-counter mouthwash or gel specifically made for gum pain relief can be used.
  • Avoid spicy, salty, or acidic food till the pain subsides.

Professional treatments play an essential role in identifying the exact cause of gum pain. If you notice frequent gum bleeding or continuous episodes of gum pain, consult your dentist. Usually, red and swollen gums are a sign of gum disease called gingivitis. Professional tooth cleaning can help to treat such gum diseases with ease.

What causes jaw and facial pain?

clicking jaw and TMD

The most frustrating pain out of all the types is usually that of the face of the jaw. A dull, lingering soreness or a stabbing sensation can typically be debilitating. Some several factors and conditions may lead to jaw and facial pain. Let’s take a closer look at some of the causes behind the disturbing jaw and facial pain –

Temporomandibular joint disorder

TMJ disorders are one of the most common causes of the jaw and facial pain. This condition involves the lower jaw, face, neck, and head. Additionally, TMJ disorder causes stiffness of the jaw muscles, clicking of the joint, and difficulty in opening or closing the mouth. (5)

Several factors may cause TMJ disorder like teeth grinding, dislocation of the TMJ joint, and soft tissue problems. Treatment of temporomandibular joint typically includes –

  • Pain medications
  • Stress reduction exercises
  • Use of a mouthguard
  • Surgical procedure for aligning the jaw

Trigeminal neuralgia

Trigeminal neuralgia as the name suggests is a chronic pain disorder which involves the trigeminal nerve of the face. Typically, this nerve provides sensations to the scalp, forehead, cheeks, lips, and lower jaw.

Some of the causes of trigeminal neuralgia include nerve damage due to injury or stroke, multiple sclerosis, and compression or pressure on the trigeminal nerve. A person suffering from this pain disorder may complain of a severe stabbing pain that may involve one side of the face. Usually, the triggering factors may include tooth brushing, face wash, chewing movement, or even a wind blow on the face. (6)

Treatment of trigeminal neuralgia includes –

  • Avoidance of trigger factors
  • Prescription medications like anticonvulsants, anti-depressants and botox injections
  • Trigeminal nerve surgery

Sinusitis

Sinuses are small cavities that are typically present behind the nose, cheekbones, and forehead. Sinusitis is a condition caused by inflammation of the sinuses. The common factors that may cause sinus inflammation include the common cold and nasal allergies like hay fever. (7) Symptoms of sinusitis include –

  • Stuffy nose
  • Tenderness around the face, nose, cheeks, and forehead
  • Secretion of greenish-yellow mucus from the nose
  • Pain around the eyes

Sinusitis usually subsides on its own. However, professional treatment may be required if the symptoms persist for more than 12 weeks. During this time, over-the-counter pain medications, nasal sprays, and saltwater irrigators may help to reduce the symptoms.

Chronic sinusitis may be treated by a surgical approach to open the passage and facilitate drainage.

Dry socket

Dry socket is a painful oral condition that usually occurs after recent tooth extraction. It is mainly caused due to dislodgment of the blood clot at the site of tooth extraction. As a result, it exposes the underlying bone and nerves, causing intense pain that may radiate to the side of the face.

Clinically, a dry socket looks red, inflamed, and tender to touch. Additionally, the patient may have an unpleasant taste in the mouth. (8) Treatment of dry socket usually involves a course of pain medications followed by the placement of medicinal dressing at the extraction site. The patient may have to take care of and avoid spicy or hot food, smoking, and acidic drinks consumption.

Sialadenitis

This rare condition involves the infection and inflammation of the parotid salivary gland. Typically, sialadenitis causes pain in the front of the ear and can spread till the chin covering one side of the face or mouth. Symptoms of sialadenitis usually include –

  • High fever accompanied by chills
  • Pus drainage in the mouth
  • Flushed skin near the infected gland
  • Swelling of the mouth and face on the affected side

Often, such conditions are treated by a full course of antibiotics and pus drainage. Additionally, the dentist may encourage you to drink plenty of fluids that’ll stimulate the salivary flow in the mouth.

Overview of oral pain

Oral pain includes a wide range of dental conditions that may contribute to the distress and discomfort of the patient. All the factors can be broadly categorized into three types – tooth pain, gum pain, and jaw or facial pain. Tooth pain typically is caused by dental conditions that affect the vitality of the tooth. Some of these conditions may include tooth decay, pulp infection, and dental abscess. Gum pain is typically caused by inadequate oral hygiene that leads to increased accumulation of plaque and bacteria in the mouth.

Failure to maintain good oral health may lead to gum infection and inflammatory disease of the periodontal tissue. Conditions affecting the jaw and face cause another common type of oral pain. Oral conditions causing jaw pain include temporomandibular joint disorder, trigeminal neuralgia, dry socket, sinusitis, and salivary gland infection.

Typically, all the conditions mentioned above are symptomatically treated. Dental check-ups and detailed examination of the oral health help to plan the best treatment for pain relief. If you are suffering from oral pain, visit your dentist immediately to find the right solution.