Toothache can be pulp pain—or a heart or sinus clue
Most facial pain starts in a tooth, yet pulp pain is poorly localized while ligament pain usually is not. In 2013, caries alone drove about 223 million toothache cases in permanent teeth and 53 million in baby teeth. Dentists treat the cause, not only the ache.
Toothache means pain in teeth or their supports from dental disease—or pain referred from elsewhere. Common odontogenic triggers include pulpitis after decay or trauma, dentin hypersensitivity, apical periodontitis around the root tip, abscesses, dry socket after extraction, acute necrotizing ulcerative gingivitis, and temporomandibular disorder. Pulp and periodontal ligament both have pain receptors, but pulp lacks proprioceptors and mechanoreceptors, so pulp pain often feels vague. Periodontal pain tends to localize better and rarely worsens with hot or cold. Intentionally stimulated, only about a third of people correctly name the tooth; about a fifth cannot even narrow it to three teeth.
Reversible pulpitis brings short cold-triggered pain that may fade once decay is cleaned and filled or tertiary dentin walls off the stimulus. Irreversible pulpitis brings spontaneous or lingering cold pain; trapped swelling in the rigid pulp chamber can cut blood supply and end in pulp necrosis. Abscesses often throb. Apical abscesses usually follow pulp death; periodontal abscesses deepen pockets beyond three millimeters while the pulp typically still tests vital. Dentin hypersensitivity—sharp brief pain to cold, air, or sweets in roughly fifteen percent of people—usually reflects exposed roots from gum recession, with a still-healthy pulp.
Non-dental mimics matter: maxillary sinusitis can ache in upper back teeth, and angina pectoris can refer pain to lower teeth, so diagnosis can be tricky. Care ranges from fillings and root canals to extraction or draining pus. Historically, demand for toothache relief is thought to have made dental surgery medicine's first specialty. In Brazil's 2023 national survey of adults aged 35–44, 23.7% reported toothache in the prior six months, and among those in pain 34.1% got no dental care—inequalities tied to race and education.
Source: Toothache
