Causes and Dental Conditions - Dental conditions involving the dentin-pulp complex or periodontium - Non-dental conditions such as maxillary sinusitis or angina pectoris - Nociceptors (pain receptors) present in the pulp and periodontal ligament - Poor localization of pain from the dentin-pulp complex - Well-localised pain from the periodontal ligament - Pulpitis, inflammation of the pulp triggered by various stimuli - Common causes of pulpitis include tooth decay, dental trauma, and imperfect seal of a filling - Reversible pulpitis can be treated and the pulp can return to a healthy state - Irreversible pulpitis leads to pulp necrosis - Dentin hypersensitivity, sharp pain triggered by cold, sweet, or spicy foods

Treatment and Prevention - Treatment depends on the exact cause of the toothache - Possible treatments include fillings, root canal treatment, extraction, and drainage of pus - Proper oral hygiene helps prevent toothache by preventing dental diseases - Dentists have a responsibility to provide relief for toothache - Topical treatments for dentin hypersensitivity are available, but addressing the root cause is critical

Prevalence and Impact - Toothache is the most common type of pain in the mouth or face - It is one of the most common reasons for emergency dental appointments - In 2013, there were 223 million cases of tooth pain due to dental caries in permanent teeth and 53 million cases in baby teeth - Severe toothache can impact sleep, eating, and daily activities - The demand for treatment of toothache led to the emergence of dental surgery as the first specialty of medicine

Periodontal Causes - Chronic periodontal conditions do not cause pain, but acute inflammation does - Apical periodontitis is inflammation around the apex of a tooth caused by an immune response to bacteria - Apical periodontitis can occur even in teeth that are vital and may not occur in non-vital teeth - Bacterial cytotoxins cause vasodilation, sensitization of nerves, osteolysis, and potential abscess or cyst formation - Acute apical periodontitis is characterised by well-localised, persistent, and moderate to severe pain

Other Dental Conditions - Food impaction occurs when food debris gets trapped between teeth during chewing - Symptoms include localised discomfort, mild pain, and a feeling of pressure between the affected teeth - Periodontal abscess is a collection of pus that forms in the gingival crevices - Acute Necrotizing Ulcerative Gingivitis (ANUG) is an acute form of gingivitis/periodontitis characterised by severe periodontal pain, bleeding gums, and punched out ulceration - Pericoronitis is inflammation of the soft tissues surrounding a partially erupted tooth, commonly the lower wisdom tooth