Assessment and Treatment for Tooth Pain
Tooth pain requires prompt dental referral for definitive diagnosis and treatment, with initial pain management using NSAIDs such as ibuprofen 400mg every 4-6 hours as needed. 1, 2
Diagnostic Assessment
History Taking
- Obtain detailed pain characteristics including onset, duration, periodicity, location, radiation, quality, severity, and factors that relieve or aggravate the pain 3
- Identify aggravating factors such as hot/cold/sweet foods, prolonged chewing, eating, brushing teeth, touching face, or weather changes 3
- Assess associated factors including taste changes, salivary flow, clenching/bruxing habits, jaw joint clicking/locking, or altered sensation 3
- Evaluate impact of pain on sleep, mood, concentration, and quality of life 3
Physical Examination
- Perform extraoral examination of head and neck region, inspecting for color changes, swellings, and skin lesions 3
- Palpate muscles of mastication, head and neck muscles for tenderness, trigger points, and muscle hypertrophy 3
- Conduct intraoral examination of teeth for obvious dental pathology including:
Diagnostic Testing
- Obtain appropriate dental radiographs (intraoral X-rays) to assess for dental pathology 3
- Use dental panoramic tomographs for evaluating bony lesions or cysts 3
- Consider MRI or CT imaging for specific conditions when indicated 3
Common Causes of Tooth Pain
Dental Causes
- Dental caries (tooth decay) - sharp pain with hot/cold/sweet stimuli 3
- Pulpitis (inflammation of dental pulp) - persistent, throbbing pain 3
- Dental abscess - severe, constant, throbbing pain with possible swelling 3
- Cracked tooth - pain on biting or temperature changes 1
- Dental trauma - pain, mobility, and possible displacement of teeth 3
Non-Dental Causes
- Temporomandibular disorders - pain in jaw muscles and joints 4
- Sinusitis - pain in upper teeth, especially molars 3
- Trigeminal neuralgia - severe, electric shock-like pain 3
- Atypical odontalgia/persistent dentoalveolar pain - continuous aching pain localized to tooth or tooth-bearing area 3, 5
- Referred pain from muscles or other structures 6, 7
Treatment Approach
Immediate Pain Management
- NSAIDs (ibuprofen) are first-line for dental pain management - 400mg every 4-6 hours as needed 1, 2
- For moderate to severe pain, consider higher doses of ibuprofen up to 800mg every 6 hours, not exceeding 3200mg daily 2
- Apply cold compresses to reduce swelling and discomfort 1
- Avoid temperature extremes with food and drink to prevent sensitivity 1
- Maintain a soft diet for the first 10 days after dental injury 3
Dental Referral Timing
- Immediate referral (same day):
- Referral within a few days:
- Less urgent (within a week):
- Enamel-only fractures with minimal symptoms 1
Specific Management for Dental Trauma
- For concussion (tender tooth without mobility) - observation only 3
- For subluxation (mobile tooth without displacement) - observation and soft diet 3
- For extrusive luxation (partially displaced tooth) - gentle digital pressure to reposition and immediate dental referral 3
- For intrusive luxation (tooth forced into socket) - immediate dental referral 3
- For lateral luxation (laterally displaced tooth) - gentle repositioning if possible and immediate dental referral 3
Common Pitfalls to Avoid
- Delaying referral for crown fractures with pulp exposure can lead to pulpal necrosis 1
- Mistaking non-dental pain (referred pain, neuropathic pain) for tooth pain, leading to unnecessary dental procedures 5, 7
- Failing to recognize potential airway compromise with severe dental infections and facial swelling 8
- Underestimating pain from dentin exposure, which requires prompt coverage to prevent bacterial contamination 1
- Overlooking the possibility of referred pain from muscles or other orofacial structures 6, 9