If your teeth could talk, what might they say?

One of the interesting things about teeth is that they can only provide one kind of response. If anything stimulates a tooth, the tooth hurts.

The other major organ in the mouth, the tongue, is able to discriminate between heat and cold, sweet and sour, acidic and salty, and so forth. But teeth cannot.

So, sometimes people will say: “When I eat something sweet, my tooth hurts.” Or: “When I drink hot tea and have hot soup, my tooth hurts.” That’s because the tooth doesn’t have the ability to discriminate between the kind of stimulus that is annoying it. Anything that stimulates the tooth makes the tooth hurt.

So, let’s review the major causes of tooth sensitivity, what they could mean, and what kinds of treatments they might make necessary.

Pain to cold:

Pain to cold is very commonly caused by these, among other, situations:

It is important to know that perfectly healthy, normal, intact teeth can hurt to extreme cold. For example: someone who participates in an ice-cream eating contest, and eats 15 scoops of ice-cream in less than 30 minutes shouldn’t be shocked that their teeth will probably hurt them. But everything should return to normal within a few days. Just stay away from extremes of temperature for a while.
Fresh tooth decay, a broken tooth, a cracked filling, a recent dental restoration are all reasons that a tooth may hurt to cold. Sometimes, even breathing in through the mouth in cold weather can make a tooth hurt. In such cases, a dental restoration is usually what is needed to address the problem. Dentists refer to what patients call a “filling” as a restoration. The reason is that a “filling” is something that fills-up a space, a hole, a gap. A restoration is something that attempts to restore what was originally there.
Another, often overlooked, reason that a tooth hurts to cold is because the tooth is in, what we call: occlusal trauma. One tooth may be closing against the opposing tooth a tiny bit ahead of how all the other teeth in the mouth are closing together. When that happens, the pressure on that one tooth is very great, there is a strain on the ligament that holds the tooth in place; and the tooth hurts to cold. It’s very much like a sprained ankle.
When a patient presents with a tooth that hurts to cold, these are the possible reasons. Dental treatment in the way of a “filling” involves a certain trauma to the tooth that it usually recovers from, but treatment can initiate a short period of cold-sensitivity that usually subsides within a week.

Pain to chewing:

Pain to chewing usually indicates one of these situations:

The tooth is in “occlusal trauma”, as explained above, especially if there is no pain to hot or cold.
There may have been a fracture of a tooth, and the broken part has not fallen-off, because it is still attached to the soft tissues. Sometimes patients present at the dentist and say things like: “I broke my tooth eating a potato chip.” Or: “I was only drinking some water, and my tooth broke.” It wasn’t the potato chip or the water. The tooth was broken from something that happened previously – maybe even weeks previously – and the potato chip or the water was just the last “straw,” so to speak.
A dental abscess can also make a tooth painful to chewing. Sometimes the tooth will feel like it is “higher” than the adjacent teeth, and the patient cannot close their teeth together without pain. In such cases, the remedy could be root canal therapy, or extraction.
Pain to sweet:

Pain to sweet drinks or foods usually correlates with tooth decay, a broken or leaking filling, or a fractured tooth. Such teeth usually require a restoration.

Pain to heat:

Pain to heat usually indicates the presence of an infected nerve. The nerve tissue is enclosed within the hard body of the tooth, in the central hollow space, called the pulp chamber and root canal. If it becomes infected, and pus develops, along with gas that is produced by the bacteria; if the tooth gets heated up by a hot food, the gas expands and the pressure causes pain on living tissue within the pulp chamber or root canal. In multirooted teeth, like molars, oftentimes the symptoms can be confusing because part of the root canal system is infected, while part isn’t yet at that stage.

The usual treatment for teeth with infected nerves is either root canal therapy that eliminates the infection and fills up the entire root canal-pulp chamber space; or such teeth require extraction.

Summary:

What I have presented here is a simplification of a complex topic. But, knowing these facts should help patients communicate more effectively with their dentist, and have an advance idea of what kind of problem they may be having, and the ideal treatment for it.

The important thing to remember is that when your teeth tell you something, it’s because there’s something amiss. Under ordinary circumstances our teeth help us articulate our own words and speech, but they don’t have much to say on their own. Simple problems, when they are ignored, or left alone, don’t get better on their own.

Dental problems don’t usually go away on their own. Sometimes people have a tooth, or teeth, that bother them from time to time, sometimes even getting quite painful. And then, almost magically, the pain seems to go away. But, it doesn’t mean that the problem has gone away. Often, the problem has gotten more complicated, even if it no longer hurts.