A dental nerve pain will go away

Tooth nerve inflammation and root suppuration

Tooth nerve inflammation(Pulpitis, inflammation of the dental pulp): inflammation with possible death of the dental nerve.

Root suppuration: Purulent decomposition of the dead tooth nerve.

Caries that break through into the pulp cavity and external stimuli such as pressure or heat damage the sensitive tooth nerve, it becomes inflamed and painful. In the beginning a tooth nerve inflammation is still reversible and the nerve can often be saved with timely treatment. If the stimulus was too great, or persistent, or if the bacteria are not removed, the inflammation will spread to the nerve and root canal. The nerve eventually dies. But even a dead tooth can still serve you well for many years to come.

If there is no treatment, the dead tooth nerve causes further problems - depending on whether bacteria are present or not. Under the influence of bacteria, it begins to decompose purulent. After a few days, the bone around the tip of the tooth, where the supply ducts leave the tooth, becomes inflamed and dissolves. Root suppuration forms. Even now, treatment is still useful to prevent the otherwise safe loss of the tooth.

Leading complaints

  • Initially short pains triggered by special stimuli
  • Later intense, throbbing pain.

In the case of root suppuration, additionally:

  • Bite pain
  • Sensitivity to heat (cold is perceived as pleasant)
  • Swelling of the jawbone
  • Pus bladder.

When to the doctor

Even today if there is a suspicion of tooth nerve inflammation or severe pain.

The illness

Dental nerve inflammation can have many causes: It often occurs when caries has worked its way through the dentine to the pulp cavity and bacteria penetrate (deep dental caries). Crowns or fillings that are too tall and the heat that arises when the dentist drills too quickly or does not cool properly can also trigger tooth nerve inflammation. The inflammation begins in a small area and spreads from there. If left untreated, the blood vessels that supply the tooth through the tips of the roots often swell. This disrupts the blood circulation and the tissue dies (pulp necrosis).

The dead tooth nerve does not cause any visible problems as long as there are no bacteria present (silent gangrene). However, when bacteria enter the pulp cavity or the root canal, the dental nerve rots and forms pus and decomposition gases (pulp gander). If these gases can escape, the patient may notice bad breath or a foul taste. If they do not come out, the pressure in the pulp cavity increases all the more and causes severe pain. If left untreated, the inflammation will develop into an abscess.

Unless the tooth has a hole or is not opened by the dentist, the pus will find its way out through the bone. The jawbone swells in the area of ​​the affected tooth and a small pus bubble forms, which bursts and empties after a while. On its way through the bone, the inflammation must also pass through the periosteum. This process is extremely painful, after which the symptoms subside again. However, the inflammation does not heal, but continues to destroy the bone around the tooth. A soft tissue abscess develops that can spread to the head area.

That's what the doctor does

If the dentist can eliminate the cause of the inflammation in good time (e.g. grind down a crown that is too high), the pain often disappears without a root canal treatment and the dental nerve heals. If the disorder has lasted too long, the tooth nerve is permanently inflamed and a root canal treatment is unavoidable.

Root canal treatment. At the beginning of Root canal treatment The dentist uses cold stimuli to check whether the tooth is still alive (sensitivity test). In order to better assess the condition of the root and the surrounding bone, he also takes an X-ray. The doctor then begins the actual root canal treatment - if necessary under local anesthesia. So that the germs from the oral cavity cannot penetrate the treated tooth, the affected tooth is sealed off all around with a rubber dam. The dentist drills the affected tooth through the tooth crown and removes the inflamed or dead tissue as completely as possible. Then he looks for the entrances to the fine root canals through which the tooth was supplied via the root tip. Sometimes he needs magnifying glasses or a microscope to do this. There are different numbers of root canals depending on the shape of the tooth.

In this upper molar tooth, pronounced secondary caries has formed under a plastic filling. The dentist first drills away the carious dentin and then prepares the root canals. The root filling can be clearly seen in the final X-ray.
Georg Thieme Verlag, Stuttgart

All root canals found are cleaned and smoothed from the inside with small, flexible files - this takes a long time, especially with the curved roots of the molars. The aim of this root canal preparation is to prepare for a later root filling. After the nerve tissue has been removed, the patient normally does not feel anything from the treatment, as the tooth is now "dead". After a thorough rinse, the canals are dried and filled with a root filling paste up to the tip of the root, usually gutta-percha is used Natural rubber-like material The filling paste is inserted into the canal either cold or warm with a carrier pen.

The dentist will take x-rays during and after the root canal treatment. The first is used to determine the necessary file length, the final to assess the finished root filling. A modern method of determining the file length is electronic resistance measurement (no cash benefit). A small device is used to measure the resistance between the tooth and its surroundings. This method is usually very precise and saves the patient one or more x-ray procedures. However, a final X-ray is still absolutely necessary. On the one hand, it can only be assessed in this way whether the Root canal filling turned out well. On the other hand, the X-ray shows what the bone around the tip of the tooth looks like and also serves as legal evidence of the root filling. The comparison of the area around the tip of the tooth root is particularly interesting when the inflammation of the bone is already clearly visible. A comparison picture about 3–6 months later shows very nicely whether the inflammatory process is healing.

In children and adolescents, the dentist may only remove the diseased part of the tooth nerve and try to keep the intact part alive (vital amputation). Since their root growth is often not yet complete, a root canal filling would be problematic.

Complications. Not all teeth have roots like in the textbook. Some roots are twisted, twisted, or have very thin canals. Even a carefully working dentist cannot guarantee a successful root filling. The success of a root canal treatment can be seen well on X-rays after a while. If the inflammation does not go away completely or if it gets bigger, there can be various causes. It is possible that the root filling does not reach far enough to the root tip or the root tip is shaped like a river delta and, with the best will in the world, cannot be completely filled. In both cases the root canal is not completely closed and germs may still be present.

The last option to save the tooth is a renewed root treatment (revision of the root canal filling) or a Apicectomy(WSR). With the tip resection, access is created from the outside (through the gums) towards the tip of the root. To do this, the dentist drills a small hole through the bone in the upper jaw and in the front of the lower jaw and exposes the tip of the root. This is then cut off at a slight angle. To protect the nerves (a branch of the trigeminal nerve runs here) on the lower jaw sides, a piece of bone is cut out like a window and then reinserted.

The success of a root tip resection can also be assessed on an X-ray after 3–6 months. Possible complications are an abscess or a cyst. If the apicectomy fails too, all that remains is to remove the tooth.

Your pharmacy recommends

Cool the affected area and, even if the pain subsides, be sure to see a doctor to eliminate the cause. A pain pill with Ibuprofen® and / or Paracetamol® (NSAID) helps against acute pain.

Special text: Herd infection

Why do teeth hurt especially at night? The typical throbbing toothache occurs when the nerve is attacked. He often calls in at night when you are in a warm bed and most dentists and pharmacies are closed. The reason is that the inflamed tissue expands from the heat and then hurts more. Fortunately, there is an emergency dental service in Germany that also provides treatment on weekends and public holidays.

Authors

Dr. med. dent. Gisbert Hennessen, Thilo Machotta, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:52


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.