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Toothache

ibuprofen-and-nsaids

Toothache

What is a toothache?

A toothache can often start suddenly and the pain and discomfort can range from mild to severe.1 The pain caused by a toothache may radiate out and effect the head, ear or jaw.2 If a toothache exists, you may experience:3

  • Swelling around the tooth and inside the mouth
  • Swelling in the jaw and face
  • Pain when chewing
  • Bleeding from your tooth or gums
  • Sensitivity to hot, cold or sweet food

Toothaches can also occur when there is inflammation amongst the innermost layer of the tooth (dental pulp), which is made of sensitive nerves and blood vessels.4

What causes a toothache?

Toothaches can have multiple causes. Below is a list of a few common causes of toothaches:5,6

  • Tooth decay
  • Fractured tooth
  • Damaged filling
  • Pain when chewing
  • Chewing gum or grinding teeth repetitively
  • Accumulation of food debris between teeth

There is also a number of other conditions that can cause pain in the mouth region even if there is no inflammation or infection in the direct area. The less frequent conditions that can also lead to toothaches include: 7

  • Injury to the joint that attaches the jaw to the skull
  • Sinusitis (the lining of the sinuses becomes inflamed)
  • Wisdom tooth pain
  • Ulcers on the gums

What are the symptoms of a toothache?

It can often be difficult to find the location of the pain when a toothache occurs.8 The pain can be mild to severe, sharp or dull, start suddenly or gradually get worse and it can be felt in the upper or lower teeth.9,10 For example, if the lower molar tooth is affected, the pain can be felt in the ear region.11

Other common symptoms of toothache include:12

  • Foul-tasting drainage from the affected tooth

What treatments help provide toothache pain relief?

Treatment options to provide toothache pain relief may vary depending on the type of toothache that exists.13 A dentist will normally conduct an x-ray to identify the problem. Once the problem has been identified, the following can be done to treat the problem and provide relief from the pain:14,15

  • Tooth decay – the dentist will remove the decayed area and use a filling to replace it
  • Loose or broken filling – the dentist will remove the filling, clean the decay and replace the filling
  • Tooth removal – teeth may need to be removed if the toothache can’t be treated
  • Gum swelling – antibiotics may be used to reduce fever or swelling of the gums
  • General toothache – over-the-counter medications like ibuprofen can be used to reduce inflammation and pain

Ibuprofen is the active ingredient in a range of over-the-counter (OTC) medicines in Australia.16 Ibuprofen is classed as non-steroidal anti-inflammatory drug (NSAID). NSAIDs are commonly used to manage mild to moderate pain and inflammation in both adults and children.17

Ibuprofen, like most NSAIDs, assist with blocking a specific enzyme called cyclooxygenase (or COX) which is used in the production of prostaglandins.18 Prostaglandins are chemicals generated by the body which cause inflammation, pain and fever by increasing the temperature and dilating the blood vessels at the location they are released from.19 By blocking the production of prostaglandins, ibuprofen and other NSAIDs can relieve the pain and inflammation associated with toothaches.20

What are other methods to help relieve toothache pain?

There are other ways to relieve pain associated with a non-serious toothache. These methods include:21,22

  • Use of cold icepacks to reduce swelling
  • OTC Pain relievers like ibuprofen (e.g. Advil) can help an individual manage the pain whilst waiting for an appointment with the dentist
  • Use of warm water to rinse an individual’s mouth
  • Use of dental floss to remove food particles and/or plaque from between the teeth
  • Sparingly apply an antiseptic containing benzocaine directly to an irritated tooth and gum for temporary relief

How can I prevent a toothache from occurring?

Regular teeth and gum hygiene is the best way to avoid dental problems. To avoid toothaches, an individual should:23

  • Brush their teeth at least twice a day using a fluoride toothpaste gently brushing their gums and tongue
  • Clean between teeth using dental floss and mouthwash if necessary
  • Limit sugar intake from foods and drinks
  • Not smoke as this can make some dental problems worse
  • Have regular dental check ups

Children require more frequent dental check-ups so tooth decay can be spotted and treated earlier.24

Are toothaches in children different to those experienced by adults?

Children may experience toothaches as part of their natural teething process. The teething process in babies can begin as early as three months.25 For some babies, teething is painless, however for others, it can be painful and babies can be in pain for weeks.26

There are numerous options to help improve the teething experience for a baby and help reduce teething pain. These include:26

  • Teething rings - Teething rings provide a distraction from pain and reduce gum swelling for babies
  • Teething gels – Teething sugar-free gel which help numb any pain or discomfort caused by teething
  • Chewing –Sugar-free teething biscuits and unsweetened teething rusks can be given to infants over 6 months who have started eating solids
  • OTC Pain Relievers – Providing children with specifically designed medication with small doses of ibuprofen can help ease any discomfort

Ibuprofen for babies and children should be administered as directed by the doctor and the label should be followed accordingly.

When should I see a dentist or a doctor?

The longer an individual leaves their toothache pain, the worse it will get. Those suffering with a toothache should see a dentist as soon as possible if the following has or does occur:28

  • Toothache lasts longer than 1 or 2 days
  • Toothache is severe
  • A fever, earache, or pain upon opening the mouth

When an individual has an appointment with a dentist, the dentist will typical ask the following questions:29

  • Can you determine the tooth that causes the pain?
  • Does the pain linger for seconds, minutes or hours?
  • Does the pain wake you up at night?
  • When did the pain begin?

If you experience severe pain or unusual toothache symptoms, it is best to visit your doctor or dentist as soon as possible.

References:

  1. 13Hersh E.V., Clin. Ther. 22(11) :1306-1318 (2 x 200mg Advil Liquid Capsules vs. 2 x 500mg paracetamol tablets)

References:

  1. 1 Health Direct, Toothache and swelling, [Accessed 09 February 2017]https://www.healthdirect.gov.au/toothache-and-swelling
  2. 2 Health Direct, Toothache and swelling, [Accessed 09 February 2017]https://www.healthdirect.gov.au/toothache-and-swelling
  3. 3 Health Direct, Toothache and swelling, [Accessed 09 February 2017]https://www.healthdirect.gov.au/toothache-and-swelling
  4. 4NHS UK, Toothache, [Accessed 7 February 2017]http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  5. 5WebMD, Dental Health and Toothaches, [Accessed 10 February 2017]http://www.webmd.com/oral-health/guide/toothaches
  6. 6 NHS UK, Toothache, [Accessed 7 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  7. 7 NHS UK, Toothache, [Accessed 7 February 2017]http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  8. 8NHS UK, Toothache, [Accessed 7 February 2017]http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  9. 9WebMD, Dental Health and Toothaches, [Accessed 10 February 2017]http://www.webmd.com/oral-health/guide/toothaches
  10. 10 NHS UK, Toothache, [Accessed 7 February 2017]http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  11. 11 NHS UK, Toothache, [Accessed 7 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  12. 12WebMD, Dental Health and Toothaches, [Accessed 10 February 2017]http://www.webmd.com/oral-health/guide/toothaches
  13. 13NHS UK, Toothache, [Accessed 07 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  14. 14 WebMD, Dental Health and Toothaches, [Accessed 10 February 2017]http://www.webmd.com/oral-health/guide/toothaches
  15. 15 NHS UK, Toothache, [Accessed 07 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  16. 16NPS Australia, Ibuprofen for pain and fever, [Accessed 11 January 2017] http://www.nps.org.au/medicines/muscles-bones-and-joints/anti-inflammatory-medicines-nsaids/ibuprofen
  17. 17Better Health Channel, Medications – non-steroidal anti-inflammatory drugs, [Accessed 11 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs
  18. 18 Better Health Channel, Medications – non-steroidal anti-inflammatory drugs, [Accessed 11 January 2017]https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs
  19. 19 Better Health Channel, Medications – non-steroidal anti-inflammatory drugs, [Accessed 11 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs
  20. 20Better Health Channel, Medications – non-steroidal anti-inflammatory drugs, [Accessed 11 January 2017]https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs
  21. 21NHS UK, Toothache, [Accessed 07 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  22. 22 Mayo Clinic, Toothache First Aid, [Accessed 10 February 2017] http://www.mayoclinic.org/first-aid/first-aid-toothache/basics/art-20056628
  23. 23NHS UK, Toothache, [Accessed 07 February 2017] http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  24. 24NHS UK, Toothache, [Accessed 07 February 2017]http://www.nhs.uk/conditions/toothache/Pages/Introduction.aspx
  25. 25 WebMD, Baby Teething, [Accessed 07 February 2017] http://www.webmd.com/parenting/baby/tc/teething-topic-overview#1
  26. 26KidsHealth, Teething Tots, [Accessed 08 February 2017],http://kidshealth.org/en/parents/teething.html
  27. 27 Pregnancy Birth and Baby, Teeth-Development and care, [Accessed 08 February 2017], http://www.pregnancybirthbaby.org.au/teeth-development-and-care
  28. 28 WebMD, Dental Health and Toothaches, [Accessed 08 February 2017],http://www.webmd.com/oral-health/guide/toothaches
  29. 29Virtual Medical Clinic, Dental Pain, [Accessed 08 February 2017], http://www.myvmc.com/diseases/dental-pain/