What is dental neuralgia?

Dental neuralgia, more commonly known as toothache, is a fairly common problem among the general population. As the name suggests, dental neuralgia is pain (“algia”) in a nerve (“nevr”) within a tooth. If you are experiencing dental neuralgia, here is what you need to know about its causes and how you can manage the problem as effectively as possible. 

Toothache can have many causes, ranging from tooth decay to periodontitis and tooth sensitivity. Here’s what you need to know about the main causes of toothache:

• Tooth decay is one of the most common causes of toothache and manifests as localised destruction of the enamel, then the dentine, down to the nerve. The deeper the damage, the more intense the pain.
• A sharp pain on contact with cold or a sweet substance often indicates a cavity. 
• Pulpitis is an inflammation of the tooth’s nerve. It can be reversible (when the inflammation is mild and the tooth pulp can be saved) or irreversible (when the tooth pulp is severely affected and can no longer be saved). The pain caused by this condition can be very severe and increases in intensity when exposed to cold, heat or when lying down. 
• Periodontitis generally causes more diffuse and radiating pain. In this case, the tooth is sensitive to mechanical pressure, for example, during chewing. Periodontitis is associated with gum recession and bone resorption, which promotes the accumulation of food debris between the teeth and the development of interdental caries.
• Post-extraction pain is inevitable but can usually be managed with painkillers prescribed by the dentist. 
• Tooth sensitivity occurs when the enamel, the outer layer of the tooth, is damaged, exposing the dentine, which, due to its tubular structure, allows stimuli to reach the nerve. This hypersensitivity can also occur when large quantities of acidic and sweet foods and drinks are consumed, for example fizzy drinks, which lead to tooth demineralisation.
• An abscess is a bacterial infection caused by pulp gangrene associated with the development of apical periodontitis. The abscess may be accompanied by fever and can spread to the tissues surrounding the tooth. It is important that a dental abscess is treated promptly, as it may be located near teeth with important anatomical structures and formations, such as the maxillary sinuses and the brain.
• The eruption of wisdom teeth is a process that usually occurs between the ages of 18 and 25, but can happen later, and in some people, never at all. The eruption of these molars can cause pain and cavities in neighbouring teeth if they are misaligned, and can sometimes lead to infections. 
• Gingivitis, or inflammation of the gums, can result from inadequate brushing, which can lead to swollen and bleeding gums. Effective brushing and antiseptic mouthwashes can help reduce pain whilst awaiting a possible scaling and polishing appointment with the dentist. Untreated gingivitis can progress to periodontal disease.
• Stress can also have consequences for physical health. During very stressful periods, some people tend to clench their jaws very tightly, and this habit can lead to dental neuralgia and joint pain. Others suffer from bruxism, meaning they grind their teeth together whilst sleeping, causing damage and the development of areas that are more sensitive to stimuli. In this case, the underlying cause must be addressed. You may wish to consult a psychologist, who may prescribe anti-anxiety medication. Various relaxation techniques, such as meditation and breathing exercises, can also be used.
• Sinusitis is an inflammation of the sinus lining, associated with the build-up of mucus inside the sinuses. It can occur following a cold or dental conditions that have not been treated in time or properly. Pressure inside the sinuses can cause headaches and toothache. Treating sinusitis usually leads to the disappearance of toothache. 

There are several types of neuralgia, depending on their location and cause:

Essential dental neuralgia

This type of pain has no clear location; it is intermittent, short-lived, and begins and ends abruptly. It has no known cause.

Secondary dental neuralgia

This has a cause that can be localised and identified. The pain may be persistent and long-lasting, potentially leading the patient to seek emergency treatment.

Trigeminal neuralgia

Trigeminal neuralgia, also known as ‘painful tic’, is a sharp pain, like a stab or electric shock, felt in the lower jaw, upper jaw, but also around the nose and above the eye. It is caused by irritation of the trigeminal nerve and can be triggered by a simple action, such as brushing your teeth, shaving, eating or a draught. Initially, the attacks may be short-lived, but if left untreated, trigeminal neuralgia can gradually worsen.

This condition cannot be cured, but the available treatments – including anticonvulsants – are prescribed by a doctor. Surgery may also be performed on the affected area. There are two types of trigeminal neuralgia: primary and secondary. The primary form, also known as essential or idiopathic, has no obvious cause of compression of the trigeminal nerve. The secondary form may be caused by pressure from a tumour, a cyst, facial injuries, dental conditions, etc.

Trigeminal neuralgia affects women more than men and particularly people over the age of 50.

The main symptom of dental neuralgia is, as the name suggests, severe pain – either sharp or throbbing – which starts in the affected tooth and spreads to the surrounding tissues, and may radiate to the rest of the head. Toothache is sudden, occurring when the affected tooth comes into contact with cold, heat or sweet foods, whilst chewing, or even when the patient speaks. The pain can be intense and throbbing, like an electric shock or a needle prick. 

Apart from pain, symptoms of dental problems include:

• Bleeding;
• Fever;
• Swelling;
• Lesions in the infected area;
• Difficulty swallowing;
• Bad breath.

Regardless of the associated symptoms, dental neuralgia is a sign that you need to book an appointment with your dentist.

Toothache is often a symptom of a dental condition. Therefore, the risk factors include:

• A diet high in sweet or acidic foods;
• Smoking;
• Alcohol consumption;
• Poor oral hygiene;
• Lack of regular dental check-ups;
• Tooth decay and other dental conditions.

It is recommended that you visit your dentist at the first sign of pain, so as not to allow the condition to worsen. Some complications of dental conditions can be serious. For example, if an abscess is left untreated, the infection can spread throughout the body and cause endocarditis/myocarditis or septicaemia. 

There are numerous treatments for toothache, depending on its causes. First, the dentist will identify the causes and, based on these, devise a treatment plan, whilst also alleviating the pain by prescribing anaesthetic mouthwashes, anti-inflammatory medication and/or antibiotics. Thus:

• if it is a simple cavity, they will clean the area and place a filling. 
• if a tooth or molar needs to be extracted, they will perform the procedure and then replace it.
• in the case of an abscess or periodontitis, the dentist will prescribe the appropriate treatment for whichever condition is present. If not treated promptly, this can lead to serious complications.

As for medication, the dentist may prescribe painkillers (non-steroidal anti-inflammatory drugs). Ibuprofen and paracetamol are among the anti-inflammatory medicines for dental pain. Antibiotics may also be necessary if the dental pain is caused by a bacterial infection. In this case, too, medical advice and a prescription are required. However, certain antiseptic mouthwashes available over the counter in pharmacies may also be used.

There are numerous natural ways to manage toothache. However, prevention – specifically, at least one annual visit to the dentist – remains the best way to minimise the occurrence of toothache. Furthermore, proper brushing and the use of interdental brushes or floss can clear an area blocked by food debris, thereby relieving the pain. Whilst waiting for your dental appointment, here are some temporary remedies you can try:

• Chamomile, in the form of tea or granules, has pain-relieving properties.
• Cloves contain high levels of eugenol, an anti-inflammatory, antibacterial and analgesic substance. You can crush a clove and apply it to the painful area as needed. Alternatively, you can use clove essential oil, applying a few drops to a cotton pad which you then place on the painful area.
• Garlic has anti-infectious, anti-inflammatory and anaesthetic properties and is used as a compress. 
• Clay is antiseptic, anti-inflammatory and promotes healing, and can be applied as a poultice to the painful area. 
• Ginger is analgesic and can be used as a powder mixed with water. 
• Vinegar stimulates blood circulation, acting on the mucous membranes of the mouth. You can use it as a mouthwash. 
• Sage essential oil is useful for mouth inflammation, helping to heal wounds. It can be used mixed with a vegetable oil and applied to the mouth ulcer. 
• Aloe vera has anti-inflammatory properties. Applied as a gel, it is useful against inflammation and bleeding gums. 
• Salt water – a teaspoon of salt in a glass of water – can be used to rinse the mouth, removing food debris trapped in various areas, which can cause pain. 
• An ice pack, wrapped in a towel and applied to the cheek, can reduce swelling following a tooth extraction. 

It is important to remember that dental neuralgia is a symptom of various conditions, and its causes can only be determined by a specialist, ranging from a dentist to a neurologist. In the case of toothache, its onset can be prevented through impeccable oral hygiene, by limiting your intake of sugar, alcohol and acidic foods, and by having an annual dental scaling at the dentist’s surgery.

• If you are suffering from toothache, try to book an appointment with your dentist as soon as possible. In the meantime, you can try to reduce the pain using the following methods:
• Brush your teeth several times a day with a medium-firm toothbrush and bristles of varying lengths.
• Use an antiseptic mouthwash, as recommended by your dentist, without overdoing it. 
• Take the painkillers prescribed by your dentist, if you have managed to speak to them on the phone. It is not advisable to take painkillers for toothache for more than 48 hours without consulting your dentist. 
• Use natural remedies from those listed above.
• Manage tooth sensitivity by using specific products recommended by a specialist, such as toothpaste and mouthwash, and by treating bruxism (teeth grinding).

Toothache, or dental neuralgia, although a fairly common ailment, should not be ignored. It can be a symptom of conditions of varying severity, so do not hesitate to consult your dentist, who will provide you with a treatment plan and the best advice.

Bibliography

1. Mayo Clinic Staff. (n.d.). Trigeminal neuralgia: Symptoms and causes. Mayo Clinic.

2. National Health Service. (n.d.). Trigeminal neuralgia: Diagnosis.

3. American Association of Neurological Surgeons. (n.d.). Trigeminal neuralgia.
   

4. CDU Medical. (n.d.). Tooth pain? It could be trigeminal neuralgia.