Toothache and Gum Problems

Topic Overview

Toothaches and gum problems are common but usually can be prevented by taking good care of your teeth and gums. Keeping your teeth , gums, and the bones around your teeth healthy requires regular brushing, flossing, and good nutrition. Brush your teeth twice a day with an ADA-accepted fluoride toothpaste. Clean between teeth daily with floss or an interdental cleaner. For more information on proper brushing and flossing techniques, see the topic Basic Dental Care.

Toothaches

Sometimes you may have tooth pain when you touch a tooth or when you eat or drink foods that are hot, cold, sweet, or sour (a sensitive tooth). Mild sensitivity can be caused by shrunken (receded) gums or a worn-down tooth. Moderate to severe sensitivity can mean a tooth has cracked, a dental cavity is present, or a filling has been lost. Seeing a dentist for treatment can prevent the tooth from dying.

The most common cause of a toothache is tooth decay , although toothache may not be present in the early stages of decay. Other reasons for a toothache might include:

• An infection of or around the tooth (abscess ). A red, swollen, painful bump may be found near or on the side of the sore tooth. The tooth may especially hurt when you bite down.
• A tooth that has not broken through the gum (impacted tooth). Gums may be red, swollen, and sore. The area around this tooth can ache, throb, and be quite painful.
• Problems with or injury to the nerves in the center of the tooth (pulp), which can be caused by an injury to the face or from grinding or gnashing the teeth.

Sometimes a toothache can be caused by a another health problem, such as:

• A heart attack, cluster headache, or sinus infection, which can cause referred pain into the teeth or jaw.
• Viral infections, such as shingles.
• Diseases such as diabetes.
• Nerve-related disease, such as trigeminal neuralgia.
• Alcohol or drug abuse, especially methamphetamines.
• Vitamin deficiencies, such as too little vitamin B12.

Gum problems

Healthy gums are pink and firm and do not bleed easily. Occasionally your gums may bleed if you brush your teeth and gums too hard, use a hard-bristled toothbrush, or snap dental floss hard against your gums. Be gentle with your teeth; use a soft-bristled tooth brush and floss carefully to help prevent this problem.

Early-stage gum disease (gingivitis ) causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people delay treatment. If not treated, gum disease can cause more serious problems with the gum tissue.

As gum disease gets worse, the gums pull away from the teeth, leaving deep pockets where plaque can hide and cause further damage. This stage of gum disease is called periodontitis or periodontal disease and is caused by long-term infection of the gums, bone, and other tissues that surround and support the teeth. It can progress until the bones that support the teeth are damaged. In this late stage, teeth may become loose and fall out or need to be removed. Early treatment of gum disease is important to prevent tooth loss. As gum disease gets more severe (periodontitis), it becomes harder to treat.

Other causes of gum bleeding, swelling, and pain include:

• Pregnancy, blood-thinning medicines, or bleeding disorders. Each of these can cause gums to bleed easily.
• Lack of vitamins, such as vitamin K or vitamin C, or medical problems, such as anemia, that interfere with the body's ability to absorb certain vitamins.
• Teething in babies and young children. For more information, see the topic Teething.
• Medicines such as Dilantin or calcium channel blockers.
• Dentures or a dental appliance that irritates the gums.
• An infection around the root of the tooth. Swelling and redness, sometimes with pus, may appear at the base of a tooth.

Smoking and using other tobacco products increases your risk for gum disease. Smokers have a higher chance of having gum disease throughout their mouths than nonsmokers. You may not have symptoms of bleeding or swollen gums because the normal bleeding immune response is affected by tobacco use. Chewing tobacco or using snuff may push the gums back in the area of the mouth where the tobacco is inserted. Constant irritation caused by tobacco products increases your risk of oral cancer.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: September 26, 2008
Medical Review:	Martin Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine William H. Blahd, Jr., MD, FACEP - Emergency Medicine Steven K. Patterson, BSc, DDS, MPH - Dentist
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