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class="vector-toc-link" href="#Pulpal"> <div class="vector-toc-text"> 1.1.1 Pulpal </div> </a> <ul id="toc-Pulpal-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pulpitis" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Pulpitis"> <div class="vector-toc-text"> 1.1.2 Pulpitis </div> </a> <ul id="toc-Pulpitis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dentin_hypersensitivity" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Dentin_hypersensitivity"> <div class="vector-toc-text"> 1.1.3 Dentin hypersensitivity </div> </a> <ul id="toc-Dentin_hypersensitivity-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Periodontal" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Periodontal"> <div class="vector-toc-text"> 1.1.4 Periodontal </div> </a> <ul id="toc-Periodontal-sublist" class="vector-toc-list"> <li id="toc-Apical_periodontitis" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Apical_periodontitis"> <div class="vector-toc-text"> 1.1.4.1 Apical periodontitis </div> </a> <ul id="toc-Apical_periodontitis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Food_impaction" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Food_impaction"> <div class="vector-toc-text"> 1.1.4.2 Food impaction </div> </a> <ul id="toc-Food_impaction-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Periodontal_abscess" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Periodontal_abscess"> <div class="vector-toc-text"> 1.1.4.3 Periodontal abscess </div> </a> <ul id="toc-Periodontal_abscess-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Acute_necrotizing_ulcerative_gingivitis" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Acute_necrotizing_ulcerative_gingivitis"> <div class="vector-toc-text"> 1.1.4.4 Acute necrotizing ulcerative gingivitis </div> </a> <ul id="toc-Acute_necrotizing_ulcerative_gingivitis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pericoronitis" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Pericoronitis"> <div class="vector-toc-text"> 1.1.4.5 Pericoronitis </div> </a> <ul id="toc-Pericoronitis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Occlusal_trauma" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Occlusal_trauma"> <div class="vector-toc-text"> 1.1.4.6 Occlusal trauma </div> </a> <ul id="toc-Occlusal_trauma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Alveolar_osteitis" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Alveolar_osteitis"> <div class="vector-toc-text"> 1.1.4.7 Alveolar osteitis </div> </a> <ul id="toc-Alveolar_osteitis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Combined_pulpal-periodontal" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Combined_pulpal-periodontal"> <div class="vector-toc-text"> 1.1.5 Combined pulpal-periodontal </div> </a> <ul id="toc-Combined_pulpal-periodontal-sublist" class="vector-toc-list"> <li id="toc-Dental_trauma_and_cracked_tooth_syndrome" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Dental_trauma_and_cracked_tooth_syndrome"> <div class="vector-toc-text"> 1.1.5.1 Dental trauma and cracked tooth syndrome </div> </a> <ul id="toc-Dental_trauma_and_cracked_tooth_syndrome-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Periodontic-endodontic_lesion" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Periodontic-endodontic_lesion"> <div class="vector-toc-text"> 1.1.5.2 Periodontic-endodontic lesion </div> </a> <ul id="toc-Periodontic-endodontic_lesion-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Non-dental" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Non-dental"> <div class="vector-toc-text"> 1.2 Non-dental </div> </a> <ul id="toc-Non-dental-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> 2 Pathophysiology </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 3 Diagnosis </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Diagnosis subsection </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Symptoms" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Symptoms"> <div class="vector-toc-text"> 3.1 Symptoms </div> </a> <ul id="toc-Symptoms-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Examination" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Examination"> <div class="vector-toc-text"> 3.2 Examination </div> </a> <ul id="toc-Examination-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Investigations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Investigations"> <div class="vector-toc-text"> 3.3 Investigations </div> </a> <ul id="toc-Investigations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Differential_diagnoses" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Differential_diagnoses"> <div class="vector-toc-text"> 3.4 Differential diagnoses </div> </a> <ul id="toc-Differential_diagnoses-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> 4 Prevention </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Management" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Management"> <div class="vector-toc-text"> 5 Management </div> </a> <button aria-controls="toc-Management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Management subsection </button> <ul id="toc-Management-sublist" class="vector-toc-list"> <li id="toc-Pulpitis_and_its_sequalae" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pulpitis_and_its_sequalae"> <div class="vector-toc-text"> 5.1 Pulpitis and its sequalae </div> </a> <ul id="toc-Pulpitis_and_its_sequalae-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dental_abscesses" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Dental_abscesses"> <div class="vector-toc-text"> 5.2 Dental abscesses </div> </a> <ul id="toc-Dental_abscesses-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Antibiotics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antibiotics"> <div class="vector-toc-text"> 5.3 Antibiotics </div> </a> <ul id="toc-Antibiotics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 6 Prognosis </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 7 Epidemiology </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History,_society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History,_society_and_culture"> <div class="vector-toc-text"> 8 History, society and culture </div> </a> <ul id="toc-History,_society_and_culture-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Notes" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Notes"> <div class="vector-toc-text"> 9 Notes </div> </a> <ul id="toc-Notes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 10 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 11 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Toothache</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 48 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-48" aria-hidden="true" > 48 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A3%D9%84%D9%85_%D8%A7%D9%84%D8%A3%D8%B3%D9%86%D8%A7%D9%86" title="ألم الأسنان – Arabic" lang="ar" hreflang="ar" data-title="ألم الأسنان" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%A6%E0%A6%BE%E0%A6%81%E0%A6%A4%E0%A7%87%E0%A6%B0_%E0%A6%AC%E0%A7%8D%E0%A6%AF%E0%A6%A5%E0%A6%BE" title="দাঁতের ব্যথা – Bangla" lang="bn" hreflang="bn" data-title="দাঁতের ব্যথা" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target">বাংলা</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Zubobolja" title="Zubobolja – Bosnian" lang="bs" hreflang="bs" data-title="Zubobolja" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Odont%C3%A0lgia" title="Odontàlgia – Catalan" lang="ca" hreflang="ca" data-title="Odontàlgia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Dannodd" title="Dannodd – Welsh" lang="cy" hreflang="cy" data-title="Dannodd" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Zahnschmerzen" title="Zahnschmerzen – German" lang="de" hreflang="de" data-title="Zahnschmerzen" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%8B%DE%A6%DE%8C%DE%AA%DE%8E%DE%A6%DE%87%DE%A8_%DE%83%DE%A8%DE%80%DE%AA%DE%82%DE%B0" title="ދަތުގައި ރިހުން – Divehi" lang="dv" hreflang="dv" data-title="ދަތުގައި ރިހުން" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Hambavalu" title="Hambavalu – Estonian" lang="et" hreflang="et" data-title="Hambavalu" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Dolor_de_muela" title="Dolor de muela – Spanish" lang="es" hreflang="es" data-title="Dolor de muela" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Dentodoloro" title="Dentodoloro – Esperanto" lang="eo" hreflang="eo" data-title="Dentodoloro" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Hortz-haginetako_min" title="Hortz-haginetako min – Basque" lang="eu" hreflang="eu" data-title="Hortz-haginetako min" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AF%D9%86%D8%AF%D8%A7%D9%86%E2%80%8C%D8%AF%D8%B1%D8%AF" title="دندان‌درد – Persian" lang="fa" hreflang="fa" data-title="دندان‌درد" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Mal_de_dent" title="Mal de dent – French" lang="fr" hreflang="fr" data-title="Mal de dent" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Odontalxia" title="Odontalxia – Galician" lang="gl" hreflang="gl" data-title="Odontalxia" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%B9%98%ED%86%B5" title="치통 – Korean" lang="ko" hreflang="ko" data-title="치통" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%A6%E0%A4%BE%E0%A4%81%E0%A4%A4_%E0%A4%A6%E0%A4%B0%E0%A5%8D%E0%A4%A6" title="दाँत दर्द – Hindi" lang="hi" hreflang="hi" data-title="दाँत दर्द" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Zubobolja" title="Zubobolja – Croatian" lang="hr" hreflang="hr" data-title="Zubobolja" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Sakit_gigi" title="Sakit gigi – Indonesian" lang="id" hreflang="id" data-title="Sakit gigi" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Odontalgia" title="Odontalgia – Italian" lang="it" hreflang="it" data-title="Odontalgia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9B%D7%90%D7%91_%D7%A9%D7%99%D7%A0%D7%99%D7%99%D7%9D" title="כאב שיניים – Hebrew" lang="he" hreflang="he" data-title="כאב שיניים" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-lg mw-list-item"><a href="https://lg.wikipedia.org/wiki/Amannyo" title="Amannyo – Ganda" lang="lg" hreflang="lg" data-title="Amannyo" data-language-autonym="Luganda" data-language-local-name="Ganda" class="interlanguage-link-target">Luganda</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%AA%E0%B4%B2%E0%B5%8D%E0%B4%B2%E0%B5%81%E0%B4%B5%E0%B5%87%E0%B4%A6%E0%B4%A8" title="പല്ലുവേദന – Malayalam" lang="ml" hreflang="ml" data-title="പല്ലുവേദന" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-my mw-list-item"><a href="https://my.wikipedia.org/wiki/%E1%80%9E%E1%80%BD%E1%80%AC%E1%80%B8%E1%80%80%E1%80%AD%E1%80%AF%E1%80%80%E1%80%BA%E1%80%81%E1%80%BC%E1%80%84%E1%80%BA%E1%80%B8" title="သွားကိုက်ခြင်း – Burmese" lang="my" hreflang="my" data-title="သွားကိုက်ခြင်း" data-language-autonym="မြန်မာဘာသာ" data-language-local-name="Burmese" class="interlanguage-link-target">မြန်မာဘာသာ</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Kiespijn_(gebitsaandoening)" title="Kiespijn (gebitsaandoening) – Dutch" lang="nl" hreflang="nl" data-title="Kiespijn (gebitsaandoening)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%A6%E0%AC%BE%E0%AC%A8%E0%AD%8D%E0%AC%A4%E0%AC%AC%E0%AC%BF%E0%AC%A8%E0%AD%8D%E0%AC%A7%E0%AC%BE" title="ଦାନ୍ତବିନ୍ଧା – Odia" lang="or" hreflang="or" data-title="ଦାନ୍ତବିନ୍ଧା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%A6%E0%A9%B0%E0%A8%A6_%E0%A8%AA%E0%A9%80%E0%A9%9C" title="ਦੰਦ ਪੀੜ – Punjabi" lang="pa" hreflang="pa" data-title="ਦੰਦ ਪੀੜ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target">ਪੰਜਾਬੀ</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/B%C3%B3le_z%C4%99b%C3%B3w" title="Bóle zębów – Polish" lang="pl" hreflang="pl" data-title="Bóle zębów" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Dor_de_dente" title="Dor de dente – Portuguese" lang="pt" hreflang="pt" data-title="Dor de dente" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Durerea_dentar%C4%83" title="Durerea dentară – Romanian" lang="ro" hreflang="ro" data-title="Durerea dentară" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-qu mw-list-item"><a href="https://qu.wikipedia.org/wiki/Kiru_nanay" title="Kiru nanay – Quechua" lang="qu" hreflang="qu" data-title="Kiru nanay" data-language-autonym="Runa Simi" data-language-local-name="Quechua" class="interlanguage-link-target">Runa Simi</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%97%D1%83%D0%B1%D0%BD%D0%B0%D1%8F_%D0%B1%D0%BE%D0%BB%D1%8C" title="Зубная боль – Russian" lang="ru" hreflang="ru" data-title="Зубная боль" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Toothache" title="Toothache – Simple English" lang="en-simple" hreflang="en-simple" data-title="Toothache" 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Click here for more information." src="//upload.wikimedia.org/wikipedia/en/thumb/9/94/Symbol_support_vote.svg/19px-Symbol_support_vote.svg.png" decoding="async" width="19" height="20" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/94/Symbol_support_vote.svg/29px-Symbol_support_vote.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/94/Symbol_support_vote.svg/39px-Symbol_support_vote.svg.png 2x" data-file-width="180" data-file-height="185" /></a></div></div> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition of the teeth</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Toothache</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Odontalgia,<a href="#cite_note-Mosby2008-1">[1]</a> dentalgia,<a href="#cite_note-Mosby2008-1">[1]</a> odontodynia,<a href="#cite_note-Mosby2008-1">[1]</a> odontogenic pain<a href="#cite_note-Tollison2001-2">[2]</a>: 396 </td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Address_to_the_toothache.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/en/thumb/7/7a/Address_to_the_toothache.jpg/220px-Address_to_the_toothache.jpg" decoding="async" width="220" height="286" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/7/7a/Address_to_the_toothache.jpg/330px-Address_to_the_toothache.jpg 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/7/7a/Address_to_the_toothache.jpg/440px-Address_to_the_toothache.jpg 2x" data-file-width="889" data-file-height="1157" /></a></td></tr><tr><td colspan="2" class="infobox-full-data">"Thou hell o' a' diseases" – <a href="/wiki/William_Hole_(artist)" title="William Hole (artist)">William Hole</a>'s illustration for <a href="/wiki/Robert_Burns" title="Robert Burns">Robert Burns</a>' poem "Address to the Toothache" (1897, poem c. 1786).</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Dentistry" title="Dentistry">Dentistry</a></td></tr></tbody></table> Toothaches, also known as dental pain or tooth pain,<a href="#cite_note-McGraw-Hill2002-3">[3]</a> is <a href="/wiki/Pain" title="Pain">pain</a> in the <a href="/wiki/Teeth" class="mw-redirect" title="Teeth">teeth</a> or their supporting structures, caused by <a href="/wiki/Dental_disease" class="mw-redirect" title="Dental disease">dental diseases</a> or <a href="/wiki/Referred_pain" title="Referred pain">pain referred</a> to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities. Common causes include <a href="/wiki/Pulpitis" title="Pulpitis">inflammation of the pulp</a>, (usually in response to <a href="/wiki/Dental_caries" class="mw-redirect" title="Dental caries">tooth decay</a>, <a href="/wiki/Dental_trauma" title="Dental trauma">dental trauma</a>, or other factors), <a href="/wiki/Dentin_hypersensitivity" title="Dentin hypersensitivity">dentin hypersensitivity</a>, <a href="/wiki/Apical_periodontitis" class="mw-redirect" title="Apical periodontitis">apical periodontitis</a> (inflammation of the <a href="/wiki/Periodontal_ligament" class="mw-redirect" title="Periodontal ligament">periodontal ligament</a> and <a href="/wiki/Alveolar_bone" class="mw-redirect" title="Alveolar bone">alveolar bone</a> around the <a href="/wiki/Root_apex_(dental)" class="mw-redirect" title="Root apex (dental)">root apex</a>), <a href="/wiki/Dental_abscess" title="Dental abscess">dental abscesses</a> (localized collections of <a href="/wiki/Pus" title="Pus">pus</a>), <a href="/wiki/Alveolar_osteitis" title="Alveolar osteitis">alveolar osteitis</a> ("dry socket", a possible complication of <a href="/wiki/Dental_extraction" title="Dental extraction">tooth extraction</a>), <a href="/wiki/Acute_necrotizing_ulcerative_gingivitis" class="mw-redirect" title="Acute necrotizing ulcerative gingivitis">acute necrotizing ulcerative gingivitis</a> (a gum infection), and <a href="/wiki/Temporomandibular_disorder" class="mw-redirect" title="Temporomandibular disorder">temporomandibular disorder</a>.<a href="#cite_note-4">[4]</a> Pulpitis is reversible when the pain is mild to moderate and lasts for a short time after a stimulus (for instance cold); or irreversible when the pain is severe, spontaneous, and lasts a long time after a stimulus. Left untreated, pulpitis may become irreversible, then progress to <a href="/wiki/Pulp_necrosis" title="Pulp necrosis">pulp necrosis</a> (death of the pulp) and apical periodontitis. Abscesses usually cause throbbing pain. The apical abscess usually occurs after pulp necrosis, the pericoronal abscess is usually associated with acute <a href="/wiki/Pericoronitis" title="Pericoronitis">pericoronitis</a> of a lower <a href="/wiki/Wisdom_tooth" title="Wisdom tooth">wisdom tooth</a>, and periodontal abscesses usually represent a complication of <a href="/wiki/Chronic_periodontitis" title="Chronic periodontitis">chronic periodontitis</a> (gum disease). Less commonly, non-dental conditions can cause toothache, such as <a href="/wiki/Sinusitis" title="Sinusitis">maxillary sinusitis</a>, which can cause pain in the upper back teeth, or <a href="/wiki/Angina_pectoris" class="mw-redirect" title="Angina pectoris">angina pectoris</a>, which can cause pain in the lower teeth. Correct diagnosis can sometimes be challenging. Proper <a href="/wiki/Oral_hygiene" title="Oral hygiene">oral hygiene</a> helps to prevent toothache by preventing dental disease. The treatment of a toothache depends upon the exact cause, and may involve a <a href="/wiki/Dental_restoration" title="Dental restoration">filling</a>, <a href="/wiki/Root_canal_treatment" title="Root canal treatment">root canal treatment</a>, <a href="/wiki/Tooth_extraction" class="mw-redirect" title="Tooth extraction">extraction</a>, drainage of pus, or other remedial action. The relief of toothache is considered one of the main responsibilities of dentists.<a href="#cite_note-Wolf2012-5">[5]</a> Toothache is the most common type of <a href="/wiki/Orofacial_pain" title="Orofacial pain">pain in the mouth or face</a>.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  It is one of the most common reasons for emergency dental appointments.<a href="#cite_note-Fedorowicz2016-7">[7]</a> In 2013, 223 million cases of toothache occurred as a result of dental caries in permanent teeth and 53 million cases occurred in baby teeth.<a href="#cite_note-8">[8]</a> Historically, the demand for treatment of toothache is thought to have led to the emergence of <a href="/wiki/Dentistry" title="Dentistry">dental surgery</a> as the first specialty of medicine.<a href="#cite_note-Suddick1990-9">[9]</a> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=1" title="Edit section: Causes">edit</a>]</div> Toothache may be caused by dental (odontogenic) conditions (such as those involving the dentin-pulp complex or <a href="/wiki/Periodontium" title="Periodontium">periodontium</a>), or by non-dental (non-odontogenic) conditions (such as <a href="/wiki/Sinusitis" title="Sinusitis">maxillary sinusitis</a> or <a href="/wiki/Angina_pectoris" class="mw-redirect" title="Angina pectoris">angina pectoris</a>). There are many possible non-dental causes, but the vast majority of toothache is dental in origin.<a href="#cite_note-Hargreaves2011-10">[10]</a> Both the pulp and periodontal ligament have <a href="/wiki/Nociceptor" title="Nociceptor">nociceptors</a> (pain receptors),<a href="#cite_note-Shephard2014-11">[11]</a> but the pulp lacks <a href="/wiki/Proprioceptor" class="mw-redirect" title="Proprioceptor">proprioceptors</a> (motion or position receptors) and <a href="/wiki/Mechanoreceptor" title="Mechanoreceptor">mechanoreceptors</a> (mechanical pressure receptors).<a href="#cite_note-Scully2013-6">[6]</a>: 125–135 <a href="#cite_note-Cawson2008-12">[12]</a> Consequently, pain originating from the dentin-pulp complex tends to be poorly localized,<a href="#cite_note-Cawson2008-12">[12]</a> whereas pain from the periodontal ligament will typically be well localized,<a href="#cite_note-Hargreaves2011-10">[10]</a>: 55  although not always.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  For instance, the periodontal ligament can detect the pressure exerted when biting on something smaller than a grain of sand (10–30 μm).<a href="#cite_note-Lindhe2008-13">[13]</a>: 48  When a tooth is intentionally stimulated, about 33% of people can correctly identify the tooth, and about 20% cannot narrow the stimulus location down to a group of three teeth.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 31  Another typical difference between pulpal and periodontal pain is that the latter is not usually made worse by thermal stimuli.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  <div class="mw-heading mw-heading3"><h3 id="Dental">Dental</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=2" title="Edit section: Dental">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Pulpitis-gif.gif" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Pulpitis-gif.gif/220px-Pulpitis-gif.gif" decoding="async" width="220" height="225" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Pulpitis-gif.gif/330px-Pulpitis-gif.gif 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Pulpitis-gif.gif/440px-Pulpitis-gif.gif 2x" data-file-width="576" data-file-height="588" /></a><figcaption><a href="/wiki/Natural_history_of_disease" title="Natural history of disease">Natural history</a> of dental caries and resultant toothache and odontogenic infection.</figcaption></figure> <div class="mw-heading mw-heading4"><h4 id="Pulpal">Pulpal</h4>[<a href="/w/index.php?title=Toothache&action=edit&section=3" title="Edit section: Pulpal">edit</a>]</div> The majority of pulpal toothache falls into one of the following types; however, other rare causes (which do not always fit neatly into these categories) include <a href="/wiki/Galvanic_pain" class="mw-redirect" title="Galvanic pain">galvanic pain</a> and <a href="/wiki/Barodontalgia" title="Barodontalgia">barodontalgia</a>. <div class="mw-heading mw-heading4"><h4 id="Pulpitis">Pulpitis</h4>[<a href="/w/index.php?title=Toothache&action=edit&section=4" title="Edit section: Pulpitis">edit</a>]</div> <a href="/wiki/Pulpitis" title="Pulpitis">Pulpitis</a> (inflammation of the pulp) can be triggered by various stimuli (insults), including mechanical, thermal, chemical, and bacterial irritants, or rarely <a href="/wiki/Aerodontalgia" class="mw-redirect" title="Aerodontalgia">barometric changes</a> and <a href="/wiki/Ionizing_radiation" title="Ionizing radiation">ionizing radiation</a>.<a href="#cite_note-Neville2001-14">[14]</a> Common causes include tooth decay, dental trauma (such as a crack or fracture), or a filling with an imperfect seal. Because the pulp is encased in a rigid outer shell, there is no space to accommodate swelling caused by inflammation. Inflammation therefore increases pressure in the pulp system, potentially compressing the blood vessels which supply the pulp. This may lead to <a href="/wiki/Ischemia" title="Ischemia">ischemia</a> (lack of oxygen) and <a href="/wiki/Necrosis" title="Necrosis">necrosis</a> (tissue death). Pulpitis is termed reversible when the inflamed pulp is capable of returning to a state of health, and irreversible when <a href="/wiki/Pulp_necrosis" title="Pulp necrosis">pulp necrosis</a> is inevitable.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 36–37  Reversible pulpitis is characterized by short-lasting pain triggered by cold and sometimes heat.<a href="#cite_note-Cawson2008-12">[12]</a> The symptoms of reversible pulpitis may disappear, either because the noxious stimulus is removed, such as when dental decay is removed and a filling placed, or because new layers of dentin (<a href="/wiki/Tertiary_dentin" title="Tertiary dentin">tertiary dentin</a>) have been produced inside the pulp chamber, insulating against the stimulus. Irreversible pulpitis causes spontaneous or lingering pain in response to cold.<a href="#cite_note-Hupp_2008-15">[15]</a>: 619–627  <div class="mw-heading mw-heading4"><h4 id="Dentin_hypersensitivity">Dentin hypersensitivity</h4>[<a href="/w/index.php?title=Toothache&action=edit&section=5" title="Edit section: Dentin hypersensitivity">edit</a>]</div> <a href="/wiki/Dentin_hypersensitivity" title="Dentin hypersensitivity">Dentin hypersensitivity</a> is a sharp, short-lasting dental pain occurring in about 15% of the population,<a href="#cite_note-Poulsen2006-16">[16]</a> which is triggered by cold (such as liquids or air), sweet or spicy foods, and beverages.<a href="#cite_note-17">[17]</a> Teeth will normally have some sensation to these triggers,<a href="#cite_note-Napenas2013-18">[18]</a> but what separates hypersensitivity from regular tooth sensation is the intensity of the pain. Hypersensitivity is most commonly caused by a lack of insulation from the triggers in the mouth due to <a href="/wiki/Gingival_recession" title="Gingival recession">gingival recession</a> (receding gums) exposing the roots of the teeth, although it can occur after <a href="/wiki/Scaling_and_root_planing" title="Scaling and root planing">scaling and root planing</a> or <a href="/wiki/Dental_bleaching" class="mw-redirect" title="Dental bleaching">dental bleaching</a>, or as a result of <a href="/wiki/Acid_erosion" class="mw-redirect" title="Acid erosion">erosion</a>.<a href="#cite_note-Petersson2013-19">[19]</a> The pulp of the tooth remains normal and healthy in dentin hypersensitivity.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 510  Many topical treatments for dentin hypersensitivity are available, including desensitizing toothpastes and protective varnishes that coat the exposed dentin surface.<a href="#cite_note-Poulsen2006-16">[16]</a> Treatment of the <a href="/wiki/Root_cause_analysis" title="Root cause analysis">root cause</a> is critical, as topical measures are typically short lasting.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 510  Over time, the pulp usually adapts by producing new layers of dentin inside the pulp chamber called tertiary dentin, increasing the thickness between the pulp and the exposed dentin surface and lessening the hypersensitivity.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 510  <div class="mw-heading mw-heading4"><h4 id="Periodontal">Periodontal</h4>[<a href="/w/index.php?title=Toothache&action=edit&section=6" title="Edit section: Periodontal">edit</a>]</div> In general, chronic periodontal conditions do not cause any pain. Rather, it is acute inflammation which is responsible for the pain.<a href="#cite_note-Napenas2013-18">[18]</a> <div class="mw-heading mw-heading5"><h5 id="Apical_periodontitis">Apical periodontitis</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=7" title="Edit section: Apical periodontitis">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Abscessed_tooth_periapical_radiograph.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Abscessed_tooth_periapical_radiograph.jpg/220px-Abscessed_tooth_periapical_radiograph.jpg" decoding="async" width="220" height="211" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Abscessed_tooth_periapical_radiograph.jpg/330px-Abscessed_tooth_periapical_radiograph.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Abscessed_tooth_periapical_radiograph.jpg/440px-Abscessed_tooth_periapical_radiograph.jpg 2x" data-file-width="2400" data-file-height="2304" /></a><figcaption>Apical abscess associated with roots of a lower molar.</figcaption></figure> <a href="/wiki/Apical_periodontitis" class="mw-redirect" title="Apical periodontitis">Apical periodontitis</a> is acute or chronic inflammation around the apex of a tooth caused by an <a href="/wiki/Immune_response" title="Immune response">immune response</a> to bacteria within an infected pulp.<a href="#cite_note-Segura-Egea2012-20">[20]</a> It does not occur because of pulp necrosis, meaning that a tooth that tests as if it's alive (vital) may cause apical periodontitis, and a pulp which has become non-vital due to a <a href="/wiki/Sterilization_(microbiology)" title="Sterilization (microbiology)">sterile</a>, non-infectious processes (such as trauma) may not cause any apical periodontitis.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 225  Bacterial <a href="/wiki/Cytotoxin" class="mw-redirect" title="Cytotoxin">cytotoxins</a> reach the region around the roots of the tooth via the apical foramina and lateral canals, causing <a href="/wiki/Vasodilation" title="Vasodilation">vasodilation</a>, sensitization of nerves, <a href="/wiki/Osteolysis" title="Osteolysis">osteolysis</a> (bone resorption) and potentially abscess or cyst formation.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 228  The periodontal ligament becomes inflamed and there may be pain when biting or tapping on the tooth. On an X-ray, bone resorption appears as a <a href="/wiki/Radiodensity" title="Radiodensity">radiolucent</a> area around the end of the root, although this does not manifest immediately.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 228  Acute apical periodontitis is characterized by well-localized, spontaneous, persistent, moderate to severe pain.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  The alveolar process may be tender to <a href="/wiki/Palpation" title="Palpation">palpation</a> over the roots. The tooth may be raised in the socket and feel more prominent than the adjacent teeth.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  <div class="mw-heading mw-heading5"><h5 id="Food_impaction">Food impaction</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=8" title="Edit section: Food impaction">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Open_contact.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Open_contact.jpg/220px-Open_contact.jpg" decoding="async" width="220" height="117" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f5/Open_contact.jpg/330px-Open_contact.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/f/f5/Open_contact.jpg 2x" data-file-width="407" data-file-height="217" /></a><figcaption>An <a href="/wiki/Open_contact" title="Open contact">open contact</a> of approximately 1.5 mm shown between two posterior teeth. The meat, at right, was recovered from the open contact more than 8 hours after the person had last eaten meat, even though they had brushed the teeth twice since.</figcaption></figure> Food impaction occurs when food debris, especially fibrous food such as meat, becomes trapped between two teeth and is pushed into the gums during chewing.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  The usual cause of food impaction is disruption of the normal <a href="/wiki/Embrasure_(dentistry)" title="Embrasure (dentistry)">interproximal contour</a> or drifting of teeth so that a gap is created (an <a href="/wiki/Open_contact" title="Open contact">open contact</a>). Decay can lead to collapse of part of the tooth, or a dental restoration may not accurately reproduce the contact point. Irritation, localized discomfort or mild pain and a feeling of pressure from between the two teeth results. The gingival papilla is swollen, tender and bleeds when touched. The pain occurs during and after eating, and may slowly disappear before being evoked again at the next meal,<a href="#cite_note-21">[nb 1]</a> or relieved immediately by using a tooth pick or dental floss in the involved area.<a href="#cite_note-Scully2013-6">[6]</a>: 125–135  A gingival or periodontal abscess may develop from this situation.<a href="#cite_note-Carranza11th-22">[21]</a>: 444–445  <div class="mw-heading mw-heading5"><h5 id="Periodontal_abscess">Periodontal abscess</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=9" title="Edit section: Periodontal abscess">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Cracked_tooth_lateral_periodontal_abscess.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Cracked_tooth_lateral_periodontal_abscess.jpg/220px-Cracked_tooth_lateral_periodontal_abscess.jpg" decoding="async" width="220" height="213" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Cracked_tooth_lateral_periodontal_abscess.jpg/330px-Cracked_tooth_lateral_periodontal_abscess.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Cracked_tooth_lateral_periodontal_abscess.jpg/440px-Cracked_tooth_lateral_periodontal_abscess.jpg 2x" data-file-width="2478" data-file-height="2400" /></a><figcaption>Lateral periodontal abscess (blue arrows) due to a fracture (green arrows)</figcaption></figure> A <a href="/wiki/Periodontal_abscess" title="Periodontal abscess">periodontal abscess</a> (lateral abscess) is a collection of pus that forms in the <a href="/wiki/Gingival_sulcus" title="Gingival sulcus">gingival crevices</a>, usually as a result of chronic periodontitis where the pockets are pathologically deepened greater than 3mm. A healthy gingival pocket will contain bacteria and some <a href="/wiki/Calculus_(dental)" title="Calculus (dental)">calculus</a> kept in check by the <a href="/wiki/Immune_system" title="Immune system">immune system</a>. As the pocket deepens, the balance is disrupted, and an acute inflammatory response results, forming pus. The debris and swelling then disrupt the normal flow of fluids into and out of the pocket, rapidly accelerating the inflammatory cycle. Larger pockets also have a greater likelihood of collecting food debris, creating additional sources of infection.<a href="#cite_note-Carranza11th-22">[21]</a>: 443  Periodontal abscesses are less common than apical abscesses, but are still frequent. The key difference between the two is that the pulp of the tooth tends to be alive, and will respond normally to pulp tests. However, an untreated periodontal abscess may still cause the pulp to die if it reaches the tooth apex in a <a href="/wiki/Periodontic-endodontic_lesion" class="mw-redirect" title="Periodontic-endodontic lesion">periodontic-endodontic lesion</a>. A periodontal abscess can occur as the result of tooth fracture, food packing into a periodontal pocket (with poorly shaped fillings), calculus build-up, and lowered immune responses (such as in <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>). Periodontal abscess can also occur after periodontal scaling, which causes the gums to tighten around the teeth and trap debris in the pocket.<a href="#cite_note-Carranza11th-22">[21]</a>: 444–445  Toothache caused by a periodontal abscess is generally deep and throbbing. The <a href="/wiki/Oral_mucosa" title="Oral mucosa">oral mucosa</a> covering an early periodontal abscess appears <a href="/wiki/Erythema" title="Erythema">erythematous</a> (red), <a href="/wiki/Swelling_(medical)" class="mw-redirect" title="Swelling (medical)">swollen</a>, shiny, and <a href="/wiki/Hyperalgesia" title="Hyperalgesia">painful to touch</a>.<a href="#cite_note-AAP2000-23">[22]</a> A variant of the periodontal abscess is the gingival abscess, which is limited to the gingival margin, has a quicker onset, and is typically caused by trauma from items such as a fishbone, toothpick, or toothbrush, rather than chronic periodontitis.<a href="#cite_note-Carranza11th-22">[21]</a>: 446–447  The treatment of a periodontal abscess is similar to the management of dental abscesses in general (see: <a class="mw-selflink-fragment" href="#Treatment">Treatment</a>). However, since the tooth is typically alive, there is no difficulty in accessing the source of infection and, therefore, antibiotics are more routinely used in conjunction with <a href="/wiki/Scaling_and_root_planing" title="Scaling and root planing">scaling and root planing</a>.<a href="#cite_note-herrera2002-24">[23]</a> The occurrence of a periodontal abscess usually indicates advanced periodontal disease, which requires correct management to prevent recurrent abscesses, including daily cleaning below the gumline to prevent the buildup of subgingival <a href="/wiki/Dental_plaque" title="Dental plaque">plaque</a> and calculus. <div class="mw-heading mw-heading5"><h5 id="Acute_necrotizing_ulcerative_gingivitis">Acute necrotizing ulcerative gingivitis</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=10" title="Edit section: Acute necrotizing ulcerative gingivitis">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Ulcerative_necrotizing_gingivitis.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Ulcerative_necrotizing_gingivitis.jpg/220px-Ulcerative_necrotizing_gingivitis.jpg" decoding="async" width="220" height="77" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Ulcerative_necrotizing_gingivitis.jpg/330px-Ulcerative_necrotizing_gingivitis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Ulcerative_necrotizing_gingivitis.jpg/440px-Ulcerative_necrotizing_gingivitis.jpg 2x" data-file-width="2116" data-file-height="743" /></a><figcaption>Mild presentation of ANUG on the gums of the lower front teeth</figcaption></figure> Common marginal <a href="/wiki/Gingivitis" title="Gingivitis">gingivitis</a> in response to subgingival plaque is usually a painless condition. However, an acute form of gingivitis/periodontitis, termed <a href="/wiki/Acute_necrotizing_ulcerative_gingivitis" class="mw-redirect" title="Acute necrotizing ulcerative gingivitis">acute necrotizing ulcerative gingivitis</a> (ANUG), can develop, often suddenly. It is associated with severe periodontal pain, bleeding gums, "punched out" ulceration, loss of the <a href="/wiki/Dental_papilla" title="Dental papilla">interdental papillae</a>, and possibly also <a href="/wiki/Halitosis" class="mw-redirect" title="Halitosis">halitosis</a> (bad breath) and a bad taste. Predisposing factors include poor <a href="/wiki/Oral_hygiene" title="Oral hygiene">oral hygiene</a>, smoking, malnutrition, psychological stress, and immunosuppression.<a href="#cite_note-Carranza11th-22">[21]</a>: 97–98  This condition is not contagious, but multiple cases may simultaneously occur in populations who share the same risk factors (such as students in a dormitory during a period of examination).<a href="#cite_note-Lindhe2008_2-25">[24]</a> ANUG is treated over several visits, first with <a href="/wiki/Debridement" title="Debridement">debridement</a> of the necrotic gingiva, homecare with <a href="/wiki/Hydrogen_peroxide" title="Hydrogen peroxide">hydrogen peroxide</a> mouthwash, analgesics and, when the pain has subsided sufficiently, cleaning below the gumline, both professionally and at home. Antibiotics are not indicated in ANUG management unless there is underlying systemic disease.<a href="#cite_note-Carranza11th-22">[21]</a>: 437–438  <div class="mw-heading mw-heading5"><h5 id="Pericoronitis">Pericoronitis</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=11" title="Edit section: Pericoronitis">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1237032888/mw-parser-output/.tmulti">.mw-parser-output .tmulti .multiimageinner{display:flex;flex-direction:column}.mw-parser-output .tmulti .trow{display:flex;flex-direction:row;clear:left;flex-wrap:wrap;width:100%;box-sizing:border-box}.mw-parser-output .tmulti .tsingle{margin:1px;float:left}.mw-parser-output .tmulti .theader{clear:both;font-weight:bold;text-align:center;align-self:center;background-color:transparent;width:100%}.mw-parser-output .tmulti .thumbcaption{background-color:transparent}.mw-parser-output .tmulti .text-align-left{text-align:left}.mw-parser-output .tmulti .text-align-right{text-align:right}.mw-parser-output .tmulti .text-align-center{text-align:center}@media all and (max-width:720px){.mw-parser-output .tmulti .thumbinner{width:100%!important;box-sizing:border-box;max-width:none!important;align-items:center}.mw-parser-output .tmulti .trow{justify-content:center}.mw-parser-output .tmulti .tsingle{float:none!important;max-width:100%!important;box-sizing:border-box;text-align:center}.mw-parser-output .tmulti .tsingle .thumbcaption{text-align:left}.mw-parser-output .tmulti .trow>.thumbcaption{text-align:center}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .tmulti .multiimageinner img{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .tmulti .multiimageinner img{background-color:white}}</style><div class="thumb tmulti tright"><div class="thumbinner multiimageinner" style="width:179px;max-width:179px"><div class="trow"><div class="theader">Clinical & xray correlation of pericoronitis</div></div><div class="trow"><div class="tsingle" style="width:177px;max-width:177px"><div class="thumbimage"><a href="/wiki/File:38_pericoronitis_with_pus.jpg" class="mw-file-description"><img alt="clinical shot of pericoronitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e2/38_pericoronitis_with_pus.jpg/175px-38_pericoronitis_with_pus.jpg" decoding="async" width="175" height="160" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e2/38_pericoronitis_with_pus.jpg/263px-38_pericoronitis_with_pus.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e2/38_pericoronitis_with_pus.jpg/350px-38_pericoronitis_with_pus.jpg 2x" data-file-width="2712" data-file-height="2480" /></a></div><div class="thumbcaption">An operculum (green arrow) over a partially erupted lower left third molar tooth. There is minimal inflammation and recurrent swelling.</div></div></div><div class="trow"><div class="tsingle" style="width:177px;max-width:177px"><div class="thumbimage"><a href="/wiki/File:38_pericornitis_xray.jpg" class="mw-file-description"><img alt="xray of pericoronitis" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/38_pericornitis_xray.jpg/175px-38_pericornitis_xray.jpg" decoding="async" width="175" height="146" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/38_pericornitis_xray.jpg/263px-38_pericornitis_xray.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c5/38_pericornitis_xray.jpg/350px-38_pericornitis_xray.jpg 2x" data-file-width="2400" data-file-height="2003" /></a></div><div class="thumbcaption">A radiograph of the above tooth showing chronic pericoronitis, operculum (blue arrow) and bone destruction (red arrow) from chronic inflammation. Tooth is slightly disto-angular.</div></div></div></div></div> <a href="/wiki/Pericoronitis" title="Pericoronitis">Pericoronitis</a> is inflammation of the soft tissues surrounding the crown of a partially erupted tooth.<a href="#cite_note-Douglass2003-26">[25]</a> The lower <a href="/wiki/Wisdom_tooth" title="Wisdom tooth">wisdom tooth</a> is the last tooth to erupt into the mouth, and is, therefore, more frequently impacted, or stuck, against the other teeth. This leaves the tooth partially erupted into the mouth, and there frequently is a flap of gum (an operculum), overlying the tooth. Bacteria and food debris accumulate beneath the operculum, which is an area that is difficult to keep clean because it is hidden and far back in the mouth. The opposing upper wisdom tooth also tends to have sharp cusps and over-erupt because it has no opposing tooth to bite into, and instead traumatizes the operculum further. Periodontitis and dental caries may develop on either the third or second molars, and chronic inflammation develops in the soft tissues. Chronic pericoronitis may not cause any pain, but an acute pericoronitis episode is often associated with pericoronal abscess formation. Typical signs and symptoms of a pericoronal abscess include severe, throbbing pain, which may radiate to adjacent areas in the head and neck,<a href="#cite_note-Carranza11th-22">[21]</a><a href="#cite_note-Fragiskos_2007-27">[26]</a>: 122  redness, swelling and tenderness of the gum over the tooth.<a href="#cite_note-Wray_2003-28">[27]</a>: 220–222  There may be <a href="/wiki/Trismus" title="Trismus">trismus</a> (difficulty opening the mouth),<a href="#cite_note-Wray_2003-28">[27]</a>: 220–222  facial swelling, and <a href="/wiki/Rubor" class="mw-redirect" title="Rubor">rubor</a> (flushing) of the cheek that overlies the angle of the jaw.<a href="#cite_note-Carranza11th-22">[21]</a><a href="#cite_note-Fragiskos_2007-27">[26]</a>: 122  Persons typically develop pericoronitis in their late teens and early 20s,<a href="#cite_note-Zakrzewska2009-29">[28]</a>: 6  as this is the age that the wisdom teeth are erupting. Treatment for acute conditions includes cleaning the area under the operculum with an antiseptic solution, painkillers, and antibiotics if indicated. After the acute episode has been controlled, the definitive treatment is usually by tooth extraction or, less commonly, the soft tissue is removed (operculectomy). If the tooth is kept, good oral hygiene is required to keep the area free of debris to prevent recurrence of the infection.<a href="#cite_note-Carranza11th-22">[21]</a>: 440–441  <div class="mw-heading mw-heading5"><h5 id="Occlusal_trauma">Occlusal trauma</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=12" title="Edit section: Occlusal trauma">edit</a>]</div> <a href="/wiki/Occlusal_trauma" title="Occlusal trauma">Occlusal trauma</a> results from excessive biting forces exerted on teeth, which overloads the periodontal ligament, causing periodontal pain and a reversible increase in tooth mobility. Occlusal trauma may occur with <a href="/wiki/Bruxism" title="Bruxism">bruxism</a>, the <a href="/wiki/Parafunctional_habit" class="mw-redirect" title="Parafunctional habit">parafunctional</a> (abnormal) clenching and grinding of teeth during sleep or while awake. Over time, there may be <a href="/wiki/Attrition_(dental)" class="mw-redirect" title="Attrition (dental)">attrition</a> (<a href="/wiki/Tooth_wear" title="Tooth wear">tooth wear</a>), which may also cause dentin hypersensitivity, and possibly formation of a periodontal abscess, as the occlusal trauma causes adaptive changes in the <a href="/wiki/Alveolar_bone" class="mw-redirect" title="Alveolar bone">alveolar bone</a>.<a href="#cite_note-Carranza11th-22">[21]</a>: 153–154  Occlusal trauma often occurs when a newly placed <a href="/wiki/Dental_restoration" title="Dental restoration">dental restoration</a> is built too "high", concentrating the biting forces on one tooth. Height differences measuring less than a millimeter can cause pain. Dentists, therefore, routinely check that any new restoration is in harmony with the bite and forces are distributed correctly over many teeth using <a href="/wiki/Articulating_paper" title="Articulating paper">articulating paper</a>. If the high spot is quickly eliminated, the pain disappears and there is no permanent harm.<a href="#cite_note-Carranza11th-22">[21]</a>: 153, 753  Over-tightening of <a href="/wiki/Dental_braces" title="Dental braces">braces</a> can cause periodontal pain and, occasionally, a periodontal abscess.<a href="#cite_note-Carranza11th-22">[21]</a>: 503  <div class="mw-heading mw-heading5"><h5 id="Alveolar_osteitis">Alveolar osteitis</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=13" title="Edit section: Alveolar osteitis">edit</a>]</div> <a href="/wiki/Alveolar_osteitis" title="Alveolar osteitis">Alveolar osteitis</a> is a complication of tooth extraction (especially lower wisdom teeth) in which the blood clot is not formed or is lost, leaving the socket where the tooth used to be empty, and bare bone is exposed to the mouth.<a href="#cite_note-:0-30">[29]</a> The pain is moderate to severe, and dull, aching, and throbbing in character. The pain is localized to the socket, and may radiate. It normally starts two to four days after the extraction, and may last 10–40 days.<a href="#cite_note-Neville2001-14">[14]</a><a href="#cite_note-Fragiskos_2007-27">[26]</a>: 122 <a href="#cite_note-Wray_2003-28">[27]</a>: 216–217 <a href="#cite_note-:0-30">[29]</a> Healing is delayed, and it is treated with local anesthetic dressings, which are typically required for five to seven days.<a href="#cite_note-Wray_2003-28">[27]</a>: 216–217  There is some evidence that <a href="/wiki/Chlorhexidine" title="Chlorhexidine">chlorhexidine</a> mouthwash used prior to extractions prevents alveolar osteitis.<a href="#cite_note-:0-30">[29]</a> <div class="mw-heading mw-heading4"><h4 id="Combined_pulpal-periodontal">Combined pulpal-periodontal</h4>[<a href="/w/index.php?title=Toothache&action=edit&section=14" title="Edit section: Combined pulpal-periodontal">edit</a>]</div> <div class="mw-heading mw-heading5"><h5 id="Dental_trauma_and_cracked_tooth_syndrome">Dental trauma and cracked tooth syndrome</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=15" title="Edit section: Dental trauma and cracked tooth syndrome">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Cracked_tooth.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Cracked_tooth.png/220px-Cracked_tooth.png" decoding="async" width="220" height="182" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Cracked_tooth.png/330px-Cracked_tooth.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/ac/Cracked_tooth.png/440px-Cracked_tooth.png 2x" data-file-width="3096" data-file-height="2556" /></a><figcaption>Crown-root fracture with pulp involvement (left). Extracted (right).</figcaption></figure> <a href="/wiki/Cracked_tooth_syndrome" title="Cracked tooth syndrome">Cracked tooth syndrome</a> refers to a highly variable<a href="#cite_note-Mathew2012-31">[30]</a> set of pain-sensitivity symptoms that may accompany a tooth fracture, usually sporadic, sharp pain that occurs during biting or with release of biting pressure,<a href="#cite_note-Banerji2010-32">[31]</a> or relieved by releasing pressure on the tooth.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 24  The term is falling into disfavor and has given way to the more generalized description of fractures and cracks of the tooth, which allows for the wide variations in signs, symptoms, and prognosis for traumatized teeth. A fracture of a tooth can involve the enamel, dentin, and/or pulp, and can be orientated horizontally or vertically.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 24–25  Fractured or cracked teeth can cause pain via several mechanisms, including dentin hypersensitivity, pulpitis (reversible or irreversible), or periodontal pain. Accordingly, there is no single test or combination of symptoms that accurately diagnose a fracture or crack, although when pain can be stimulated by causing separation of the cusps of the tooth, it's highly suggestive of the disorder.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 27–31  Vertical fractures can be very difficult to identify because the crack can rarely be probed<a href="#cite_note-Hargreaves2011-10">[10]</a>: 27  or seen on radiographs, as the fracture runs in the plane of conventional films (similar to how the split between two adjacent panes of glass is invisible when facing them).<a href="#cite_note-Hargreaves2011-10">[10]</a>: 28–9  When toothache results from <a href="/wiki/Dental_trauma" title="Dental trauma">dental trauma</a> (regardless of the exact pulpal or periodontal diagnosis), the treatment and prognosis is dependent on the extent of damage to the tooth, the stage of development of the tooth, the degree of displacement or, when the tooth is avulsed, the time out of the socket and the starting health of the tooth and bone. Because of the high variation in treatment and prognosis, dentists often use trauma guides to help determine prognosis and direct treatment decisions.<a href="#cite_note-AAETrauma-33">[32]</a><a href="#cite_note-traumaguide-34">[33]</a> The prognosis for a cracked tooth varies with the extent of the fracture. Those cracks that are irritating the pulp but do not extend through the pulp chamber can be amenable to stabilizing dental restorations such as a crown or <a href="/wiki/Dental_composite" title="Dental composite">composite resin</a>. Should the fracture extend though the pulp chamber and into the root, the prognosis of the tooth is hopeless.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 25  <div class="mw-heading mw-heading5"><h5 id="Periodontic-endodontic_lesion">Periodontic-endodontic lesion</h5>[<a href="/w/index.php?title=Toothache&action=edit&section=16" title="Edit section: Periodontic-endodontic lesion">edit</a>]</div> Apical abscesses can spread to involve periodontal pockets around a tooth, and periodontal pockets cause eventual pulp necrosis via accessory canals or the apical foramen at the bottom of the tooth. Such lesions are termed <a href="/wiki/Combined_periodontic-endodontic_lesions" title="Combined periodontic-endodontic lesions">periodontic-endodontic lesions</a>, and they may be acutely painful, sharing similar signs and symptoms with a periodontal abscess, or they may cause mild pain or no pain at all if they are chronic and free-draining.<a href="#cite_note-35">[34]</a> Successful root canal therapy is required before periodontal treatment is attempted.<a href="#cite_note-Carranza11th-22">[21]</a>: 49  Generally, the long-term prognosis of perio-endo lesions is poor. <div class="mw-heading mw-heading3"><h3 id="Non-dental">Non-dental</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=17" title="Edit section: Non-dental">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Angina_pectoris.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c3/Angina_pectoris.png/220px-Angina_pectoris.png" decoding="async" width="220" height="230" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c3/Angina_pectoris.png/330px-Angina_pectoris.png 1.5x, //upload.wikimedia.org/wikipedia/commons/c/c3/Angina_pectoris.png 2x" data-file-width="410" data-file-height="428" /></a><figcaption>Discomfort caused by coronary artery disease can radiate to the neck, lower jaw and teeth</figcaption></figure> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Orofacial_pain" title="Orofacial pain">Orofacial pain</a></div> Non-dental causes of toothache are much less common as compared with dental causes. In a toothache of neurovascular origin, pain is reported in the teeth in conjunction with a <a href="/wiki/Migraine" title="Migraine">migraine</a>. Local and distant structures (such as ear, brain, <a href="/wiki/Carotid_artery" title="Carotid artery">carotid artery</a>, or heart) can also <a href="/wiki/Referred_pain" title="Referred pain">refer pain</a> to the teeth.<a href="#cite_note-Sharav2008-36">[35]</a>: 80, 81  Other non-dental causes of toothache include <a href="/wiki/Myofascial_pain" class="mw-redirect" title="Myofascial pain">myofascial pain</a> (muscle pain) and <a href="/wiki/Angina_pectoris" class="mw-redirect" title="Angina pectoris">angina pectoris</a> (which classically refers pain to the lower jaw). Very rarely, toothache can be <a href="/wiki/Psychogenic_pain" title="Psychogenic pain">psychogenic</a> in origin.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 57–58  Disorders of the <a href="/wiki/Maxillary_sinus" title="Maxillary sinus">maxillary sinus</a> can be referred to the upper back teeth. The posterior, middle and anterior superior alveolar nerves are all closely associated with the lining of the sinus. The bone between the floor of the maxillary sinus and the roots of the upper back teeth is very thin, and frequently the apices of these teeth disrupt the contour of the sinus floor. Consequently, acute or chronic maxillary <a href="/wiki/Sinusitis" title="Sinusitis">sinusitis</a> can be perceived as maxillary toothache,<a href="#cite_note-Renton2012-37">[36]</a> and <a href="/wiki/Neoplasm" title="Neoplasm">neoplasms</a> of the sinus (such as <a href="/wiki/Adenoid_cystic_carcinoma" title="Adenoid cystic carcinoma">adenoid cystic carcinoma</a>)<a href="#cite_note-Barnes2009-38">[37]</a>: 390  can cause similarly perceived toothache if malignant invasion of the superior alveolar nerves occurs.<a href="#cite_note-Regezi2011-39">[38]</a>: 72  Classically, sinusitis pain increases upon <a href="/wiki/Valsalva_maneuver" title="Valsalva maneuver">Valsalva maneuvers</a> or tilting the head forward.<a href="#cite_note-Ferguson2014-40">[39]</a> Painful conditions which do not originate from the teeth or their supporting structures may affect the oral mucosa of the gums and be interpreted by the individual as toothache. Examples include neoplasms of the gingival or <a href="/wiki/Alveolar_mucosa" class="mw-redirect" title="Alveolar mucosa">alveolar mucosa</a> (usually <a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">squamous cell carcinoma</a>),<a href="#cite_note-Barnes2009-38">[37]</a>: 299  conditions which cause <a href="/wiki/Gingivostomatitis" class="mw-redirect" title="Gingivostomatitis">gingivostomatitis</a> and <a href="/wiki/Desquamative_gingivitis" title="Desquamative gingivitis">desquamative gingivitis</a>. Various conditions may involve the alveolar bone, and cause non-odontogenic toothache, such as <a href="/wiki/Burkitt%27s_lymphoma" class="mw-redirect" title="Burkitt's lymphoma">Burkitt's lymphoma</a>,<a href="#cite_note-Regezi2011-39">[38]</a>: 340  <a href="/wiki/Infarction" title="Infarction">infarcts</a> in the jaws caused by <a href="/wiki/Sickle_cell_disease" title="Sickle cell disease">sickle cell disease</a>,<a href="#cite_note-Scully2010-41">[40]</a>: 214  and <a href="/wiki/Osteomyelitis_of_the_jaws" title="Osteomyelitis of the jaws">osteomyelitis</a>.<a href="#cite_note-Shafer2010-42">[41]</a>: 497  Various conditions of the trigeminal nerve can masquerade as toothache, including trigeminal <a href="/wiki/Zoster" class="mw-redirect" title="Zoster">zoster</a> (maxillary or mandibular division),<a href="#cite_note-Scully2010-41">[40]</a>: 487  <a href="/wiki/Trigeminal_neuralgia" title="Trigeminal neuralgia">trigeminal neuralgia</a>,<a href="#cite_note-Renton2012-37">[36]</a> <a href="/wiki/Cluster_headache" title="Cluster headache">cluster headache</a>,<a href="#cite_note-Renton2012-37">[36]</a> and trigeminal <a href="/wiki/Neuropathy" class="mw-redirect" title="Neuropathy">neuropathies</a>.<a href="#cite_note-Renton2012-37">[36]</a> Very rarely, a <a href="/wiki/Brain_tumor" title="Brain tumor">brain tumor</a> might cause toothache.<a href="#cite_note-Sharav2008-36">[35]</a>: 80, 81  Another chronic facial pain syndrome which can mimic toothache is <a href="/wiki/Temporomandibular_disorder" class="mw-redirect" title="Temporomandibular disorder">temporomandibular disorder</a> (temporomandibular joint pain-dysfunction syndrome),<a href="#cite_note-Renton2012-37">[36]</a> which is very common. Toothache which has no identifiable dental or medical cause is often termed <a href="/wiki/Atypical_odontalgia" class="mw-redirect" title="Atypical odontalgia">atypical odontalgia</a>, which, in turn, is usually considered a type of atypical facial pain (or persistent idiopathic facial pain).<a href="#cite_note-Renton2012-37">[36]</a> Atypical odontalgia may give very unusual symptoms, such as pain which migrates from one tooth to another and which crosses anatomical boundaries (such as from the left teeth to the right teeth). [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=18" title="Edit section: Pathophysiology">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1237032888/mw-parser-output/.tmulti"><div class="thumb tmulti tright"><div class="thumbinner multiimageinner" style="width:184px;max-width:184px"><div class="trow"><div class="tsingle" style="width:182px;max-width:182px"><div class="thumbimage"><a href="/wiki/File:Cross_sections_of_teeth_labels.png" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Cross_sections_of_teeth_labels.png/180px-Cross_sections_of_teeth_labels.png" decoding="async" width="180" height="180" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Cross_sections_of_teeth_labels.png/270px-Cross_sections_of_teeth_labels.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Cross_sections_of_teeth_labels.png/360px-Cross_sections_of_teeth_labels.png 2x" data-file-width="3453" data-file-height="3453" /></a></div><div class="thumbcaption">1: crown, 2: root, 3: enamel, 4: dentin and dentin tubules, 5: pulp chamber, 6: blood vessels and nerve within root canal, 7: periodontal ligament, 8: apex and periapical region, 9: alveolar bone.</div></div></div><div class="trow"><div class="tsingle" style="width:182px;max-width:182px"><div class="thumbimage"><a href="/wiki/File:Innervation_of_the_dentition.png" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/27/Innervation_of_the_dentition.png/180px-Innervation_of_the_dentition.png" decoding="async" width="180" height="180" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/27/Innervation_of_the_dentition.png/270px-Innervation_of_the_dentition.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/27/Innervation_of_the_dentition.png/360px-Innervation_of_the_dentition.png 2x" data-file-width="988" data-file-height="988" /></a></div><div class="thumbcaption">V2: <a href="/wiki/Maxillary_nerve" title="Maxillary nerve">maxillary division</a> of trigeminal nerve, V3: <a href="/wiki/Mandibular_nerve" title="Mandibular nerve">mandibular division</a> of trigeminal nerve, A: the <a href="/wiki/Superior_alveolar_nerves" class="mw-redirect" title="Superior alveolar nerves">superior alveolar nerves</a> and <a href="/wiki/Superior_dental_plexus" title="Superior dental plexus">plexus</a>, B: the <a href="/wiki/Inferior_alveolar_nerve" title="Inferior alveolar nerve">inferior alveolar nerve</a> and <a href="/wiki/Inferior_dental_plexus" title="Inferior dental plexus">plexus</a> running in the body of the mandible.</div></div></div><div class="trow"><div class="tsingle" style="width:182px;max-width:182px"><div class="thumbimage"><a href="/wiki/File:Pulpal_dentin_junction.png" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Pulpal_dentin_junction.png/180px-Pulpal_dentin_junction.png" decoding="async" width="180" height="225" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Pulpal_dentin_junction.png/270px-Pulpal_dentin_junction.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Pulpal_dentin_junction.png/360px-Pulpal_dentin_junction.png 2x" data-file-width="2400" data-file-height="3000" /></a></div><div class="thumbcaption">Dentin-pulp complex. 1: tooth/enamel, 2: dentin tubule, 3: dentin, 4: odontoblastic process, 5: predentin, 6: <a href="/wiki/Odontoblast" title="Odontoblast">odontoblast</a>, 7: capillaries, 8: <a href="/wiki/Fibroblast" title="Fibroblast">fibroblasts</a>, 9: nerve, 10: artery/vein, 11: cell-rich zone, 12: cell-poor zone, 13: pulp chamber.</div></div></div></div></div> A tooth is composed of an outer shell of <a href="/wiki/Calcification" title="Calcification">calcified</a> hard <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">tissues</a> (from hardest to softest: <a href="/wiki/Tooth_enamel" title="Tooth enamel">enamel</a>, <a href="/wiki/Dentin" title="Dentin">dentin</a>, and <a href="/wiki/Cementum" title="Cementum">cementum</a>), and an inner <a href="/wiki/Soft_tissue" title="Soft tissue">soft tissue</a> core (the pulp system), which contains <a href="/wiki/Nerve" title="Nerve">nerves</a> and <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessels</a>. The visible parts of the teeth in the mouth – the crowns (covered by enamel) – are anchored into the bone by the <a href="/wiki/Dental_anatomy#Crown_and_root" title="Dental anatomy">roots</a> (covered by cementum). Underneath the cementum and enamel layers, dentin forms the bulk of the tooth and surrounds the pulp system. The part of the pulp inside the crown is the <a href="/wiki/Pulp_chamber" class="mw-redirect" title="Pulp chamber">pulp chamber</a>, and the central soft tissue nutrient canals within each root are <a href="/wiki/Root_canal" title="Root canal">root canals</a>, exiting through one or more holes at the root end (<a href="/wiki/Apical_foramen" title="Apical foramen">apical foramen</a>/foramina). The <a href="/wiki/Periodontal_ligament" class="mw-redirect" title="Periodontal ligament">periodontal ligament</a> connects the roots to the bony socket. The <a href="/wiki/Gingiva" class="mw-redirect" title="Gingiva">gingiva</a> covers the <a href="/wiki/Alveolar_process" title="Alveolar process">alveolar processes</a>, the tooth-bearing arches of the jaws.<a href="#cite_note-Kumar2004-43">[42]</a>: 1–5  Enamel is not a vital tissue, as it lacks blood vessels, nerves, and living cells.<a href="#cite_note-Napenas2013-18">[18]</a> Consequently, pathologic processes involving only enamel, such as shallow cavities or cracks, tend to be painless.<a href="#cite_note-Napenas2013-18">[18]</a> Dentin contains many microscopic tubes containing fluid and the processes of <a href="/wiki/Odontoblast" title="Odontoblast">odontoblast</a> cells, which communicate with the pulp. Mechanical, <a href="/wiki/Osmosis" title="Osmosis">osmotic</a>, or other stimuli cause movement of this fluid, triggering nerves in the pulp (the "<a href="/wiki/Fluid_dynamics" title="Fluid dynamics">hydrodynamic</a> theory" of pulp sensitivity).<a href="#cite_note-Petersson2013-19">[19]</a> Due to the close relationship between dentin and pulp, they are frequently considered together as the dentin-pulp complex.<a href="#cite_note-Tencate2008-44">[43]</a>: 118  The teeth and gums exhibit normal sensations in health. Such sensations are generally sharp, lasting as long as the stimulus.<a href="#cite_note-Napenas2013-18">[18]</a> There is a continuous spectrum from physiologic sensation to pain in disease.<a href="#cite_note-Napenas2013-18">[18]</a> Pain is an unpleasant sensation caused by intense or damaging events. In a toothache, nerves are stimulated by either <a href="/wiki/Exogenous" class="mw-redirect" title="Exogenous">exogenous</a> sources (for instance, bacterial toxins, <a href="/wiki/Metabolism" title="Metabolism">metabolic</a> byproducts, chemicals, or trauma) or <a href="/wiki/Endogenous" class="mw-redirect" title="Endogenous">endogenous</a> factors (such as <a href="/wiki/Inflammation" title="Inflammation">inflammatory mediators</a>).<a href="#cite_note-Hargreaves2011-10">[10]</a>: 532–534  The pain pathway is mostly transmitted via <a href="/wiki/Myelin" title="Myelin">myelinated</a> <a href="/wiki/A_delta_fiber" class="mw-redirect" title="A delta fiber">Aδ</a> (sharp or stabbing pain) and unmyelinated <a href="/wiki/Group_C_nerve_fiber" title="Group C nerve fiber">C</a> <a href="/wiki/Nerve_fiber" class="mw-redirect" title="Nerve fiber">nerve fibers</a> (slow, dull, aching, or burning pain) of the <a href="/wiki/Trigeminal_nerve" title="Trigeminal nerve">trigeminal nerve</a>, which supplies sensation to the teeth and gums via many divisions and branches.<a href="#cite_note-Napenas2013-18">[18]</a> Initially, pain is felt while noxious stimuli are applied (such as cold). Continued exposure decreases firing thresholds of the nerves, allowing normally non-painful stimuli to trigger pain (<a href="/wiki/Allodynia" title="Allodynia">allodynia</a>). Should the insult continue, noxious stimuli produce larger discharges in the nerve, perceived as more intense pain. Spontaneous pain may occur if the firing threshold is decreased so it can fire without stimulus (<a href="/wiki/Hyperalgesia" title="Hyperalgesia">hyperalgesia</a>). The physical component of pain is processed in the <a href="/wiki/Brainstem" title="Brainstem">medullary spinal cord</a> and perceived in the <a href="/wiki/Frontal_cortex" class="mw-redirect" title="Frontal cortex">frontal cortex</a>. Because pain perception involves overlapping sensory systems and an emotional component, individual responses to identical stimuli are variable.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 474–475  <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=19" title="Edit section: Diagnosis">edit</a>]</div> The diagnosis of toothache can be challenging,<a href="#cite_note-Sharav2008-36">[35]</a>: 80, 81  not only because the list of potential causes is extensive, but also because dental pain may be extremely variable,<a href="#cite_note-Fishman2010-45">[44]</a>: 975  and pain can be referred to and from the teeth. Dental pain can simulate virtually any facial pain syndrome.<a href="#cite_note-Fishman2010-45">[44]</a> However, the vast majority of toothache is caused by dental, rather than non-dental, sources.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 40  Consequently, the saying "<a href="/wiki/Horses,_not_zebras" class="mw-redirect" title="Horses, not zebras">horses, not zebras</a>" has been applied to the <a href="/wiki/Differential_diagnosis" title="Differential diagnosis">differential diagnosis</a> of orofacial pain. That is, everyday dental causes (such as pulpitis) should always be considered before unusual, non-dental causes (such as myocardial infarction). In the wider context of orofacial pain, all cases of orofacial pain may be considered as having a dental origin until proven otherwise.<a href="#cite_note-Fishman2010-45">[44]</a>: 975  The diagnostic approach for toothache is generally carried out in the following sequence: <a href="/wiki/Medical_history" title="Medical history">history</a>, followed by <a href="/wiki/Physical_examination" title="Physical examination">examination</a>, and <a href="/wiki/Medical_test" title="Medical test">investigations</a>. All this information is then collated and used to build a clinical picture, and a differential diagnosis can be carried out. <div class="mw-heading mw-heading3"><h3 id="Symptoms">Symptoms</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=20" title="Edit section: Symptoms">edit</a>]</div> The <a href="/wiki/Chief_complaint" title="Chief complaint">chief complaint</a>, and the onset of the complaint, are usually important in the diagnosis of toothache. For example, the key distinction between reversible and irreversible pulpitis is given in the history, such as pain following a stimulus in the former, and lingering pain following a stimulus and spontaneous pain in the latter. History is also important in recent filling or other dental treatment, and trauma to the teeth. Based on the most common causes of toothache (dentin hypersensitivity, periodontitis, and pulpitis), the key indicators become localization of the pain (whether the pain is perceived as originating in a specific tooth), thermal sensitivity, pain on biting, spontaneity of the pain, and factors that make the pain worse.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 50 The various qualities of the toothache, such as the effect of biting and chewing on the pain, the effect of thermal stimuli, and the effect of the pain on sleep, are verbally established by the clinician, usually in a systematic fashion, such as using the <a href="/wiki/Socrates_(pain_assessment)" class="mw-redirect" title="Socrates (pain assessment)">Socrates pain assessment method</a> (see table).<a href="#cite_note-Hargreaves2011-10">[10]</a>: 2–9  From the history, indicators of pulpal, periodontal, a combination of both, or non-dental causes can be observed. Periodontal pain is frequently localized to a particular tooth, which is made much worse by biting on the tooth, sudden in onset, and associated with bleeding and pain when brushing. More than one factor may be involved in the toothache. For example, a pulpal abscess (which is typically severe, spontaneous and localized) can cause periapical periodontitis (which results in pain on biting). Cracked tooth syndrome may also cause a combination of symptoms. Lateral periodontitis (which is usually without any thermal sensitivity and sensitive to biting) can cause pulpitis and the tooth becomes sensitive to cold.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 2–9  Non-dental sources of pain often cause multiple teeth to hurt and have an epicenter that is either above or below the jaws. For instance, cardiac pain (which can make the bottom teeth hurt) usually radiates up from the chest and neck, and sinusitis (which can make the back top teeth hurt) is worsened by bending over.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 56, 61  As all of these conditions may mimic toothache, it is possible that dental treatment, such as fillings, root canal treatment, or tooth extraction may be carried out unnecessarily by dentists in an attempt to relieve the individual's pain, and as a result the correct diagnosis is delayed. A hallmark is that there is no obvious dental cause, and signs and symptoms elsewhere in the body may be present. As migraines are typically present for many years, the diagnosis is easier to make. Often the character of the pain is the differentiator between dental and non-dental pain.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Irreversible pulpitis progresses to pulp necrosis, wherein the nerves are non-functional, and a pain-free period following the severe pain of irreversible pulpitis may be experienced. However, it is common for irreversible pulpitis to progress to apical periodontitis, including an acute apical abscess, without treatment. As irreversible pulpitis generates an apical abscess, the character of the toothache may simply change without any pain-free period. For instance, the pain becomes well localized, and biting on the tooth becomes painful. Hot drinks can make the tooth feel worse because they expand the gases and likewise, cold can make it feel better, thus some will sip cold water.<a href="#cite_note-Hargreaves2011-10">[10]</a><a href="#cite_note-Neville2001-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Examination">Examination</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=21" title="Edit section: Examination">edit</a>]</div> The clinical examination narrows the source down to a specific tooth, teeth, or a non-dental cause. Clinical examination moves from the outside to the inside, and from the general to the specific. Outside of the mouth, the <a href="/wiki/Paranasal_sinuses" title="Paranasal sinuses">sinuses</a>, muscles of the <a href="/wiki/Muscles_of_mastication" title="Muscles of mastication">face</a> and <a href="/wiki/Sternocleidomastoid_muscle" title="Sternocleidomastoid muscle">neck</a>, the <a href="/wiki/Temporomandibular_joint" title="Temporomandibular joint">temporomandibular joints</a>, and <a href="/wiki/Cervical_lymph_node" class="mw-redirect" title="Cervical lymph node">cervical lymph nodes</a> are palpated for pain or swelling.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 9  In the mouth, the soft tissues of the <a href="/wiki/Gingiva" class="mw-redirect" title="Gingiva">gingiva</a>, <a href="/wiki/Mucosa" class="mw-redirect" title="Mucosa">mucosa</a>, <a href="/wiki/Tongue" title="Tongue">tongue</a>, and <a href="/wiki/Pharynx" title="Pharynx">pharynx</a> are examined for redness, swelling or deformity. Finally, the teeth are examined. Each tooth that may be painful is percussed (tapped), palpated at the base of the root, and probed with a <a href="/wiki/Dental_explorer" title="Dental explorer">dental explorer</a> for dental caries and a periodontal probe for <a href="/wiki/Periodontitis" class="mw-redirect" title="Periodontitis">periodontitis</a>, then wiggled for mobility.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 10  Sometimes the symptoms reported in the history are misleading and point the examiner to the wrong area of the mouth. For instance, sometimes people may mistake pain from pulpitis in a lower tooth as pain in the upper teeth, and vice versa. In other instances, the apparent examination findings may be misleading and lead to the wrong diagnosis and wrong treatment. Pus from a pericoronal abscess associated with a lower third molar may drain along the <a href="/wiki/Submucosa" title="Submucosa">submucosal</a> plane and discharge as a <a href="/wiki/Parulis" class="mw-redirect" title="Parulis">parulis</a> over the roots of the teeth towards the front of the mouth (a "migratory abscess"). Another example is decay of the tooth root which is hidden from view below the gumline, giving the casual appearance of a sound tooth if careful periodontal examination is not carried out. [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Factors indicating infection include movement of fluid in the tissues during palpation (fluctuance), <a href="/wiki/Cervical_lymphadenopathy" title="Cervical lymphadenopathy">swollen lymph nodes in the neck</a>, and fever with an oral temperature more than 37.7 °C.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Investigations">Investigations</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=22" title="Edit section: Investigations">edit</a>]</div> Any tooth that is identified, in either the history of pain or base clinical exam, as a source for toothache may undergo further testing for vitality of the dental pulp, infection, fractures, or periodontitis. These tests may include:<a href="#cite_note-Hargreaves2011-10">[10]</a>: 10–19  <ul><li>Pulp sensitivity tests, usually carried out with a cotton wool <a href="https://en.wiktionary.org/wiki/pledget" class="extiw" title="wikt:pledget">pledget</a> sprayed with <a href="/wiki/Ethyl_chloride" class="mw-redirect" title="Ethyl chloride">ethyl chloride</a> to serve as a cold stimulus, or with an <a href="/wiki/Electric_pulp_test" class="mw-redirect" title="Electric pulp test">electric pulp tester</a>. The air spray from a three-in-one syringe may also be used to demonstrate areas of dentin hypersensitivity. Heat tests can also be applied with hot <a href="/wiki/Gutta-percha" title="Gutta-percha">Gutta-percha</a>. A healthy tooth will feel the cold but the pain will be mild and disappear once the stimulus is removed. The accuracy of these tests has been reported as 86% for cold testing, 81% for electric pulp testing, and 71% for heat testing. Because of the lack of <a href="/wiki/Test_sensitivity" class="mw-redirect" title="Test sensitivity">test sensitivity</a>, a second symptom should be present or a positive test before making a diagnosis.</li> <li><a href="/wiki/Radiograph" class="mw-redirect" title="Radiograph">Radiographs</a> utilized to find dental caries and bone loss laterally or at the apex.</li> <li>Assessment of biting on individual teeth (which sometimes helps to localize the problem) or the separate cusps (may help to detect cracked cusp syndrome).</li></ul> Less commonly used tests might include trans-illumination (to detect congestion of the maxillary sinus or to highlight a crack in a tooth), dyes (to help visualize a crack), a test cavity, selective anaesthesia and <a href="/wiki/Laser_Doppler_velocimetry" title="Laser Doppler velocimetry">laser doppler flowmetry</a>. <ul class="gallery mw-gallery-packed"> <li class="gallerybox" style="width: 142.66666666667px"> <div class="thumb" style="width: 140.66666666667px;"><a href="/wiki/File:Cold_test_with_ethyl_chloride.jpg" class="mw-file-description" title="Pulp sensibility test using ethyl chloride (cold stimulus)"><img alt="Pulp sensibility test using ethyl chloride (cold stimulus)" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/82/Cold_test_with_ethyl_chloride.jpg/211px-Cold_test_with_ethyl_chloride.jpg" decoding="async" width="141" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/82/Cold_test_with_ethyl_chloride.jpg/317px-Cold_test_with_ethyl_chloride.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/82/Cold_test_with_ethyl_chloride.jpg/421px-Cold_test_with_ethyl_chloride.jpg 2x" data-file-width="1827" data-file-height="1431" /></a></div> <div class="gallerytext">Pulp sensibility test using ethyl chloride (cold stimulus)</div> </li> <li class="gallerybox" style="width: 126px"> <div class="thumb" style="width: 124px;"><a href="/wiki/File:Electric-pulp-testing.gif" class="mw-file-description" title="Electric pulp tester"><img alt="Electric pulp tester" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/df/Electric-pulp-testing.gif/186px-Electric-pulp-testing.gif" decoding="async" width="124" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/df/Electric-pulp-testing.gif/280px-Electric-pulp-testing.gif 1.5x, //upload.wikimedia.org/wikipedia/commons/d/df/Electric-pulp-testing.gif 2x" data-file-width="288" data-file-height="255" /></a></div> <div class="gallerytext">Electric pulp tester</div> </li> <li class="gallerybox" style="width: 146.66666666667px"> <div class="thumb" style="width: 144.66666666667px;"><a href="/wiki/File:Tooth_sleuth.jpg" class="mw-file-description" title="Plastic wedge to identify pain on biting from a fractured tooth"><img alt="Plastic wedge to identify pain on biting from a fractured tooth" src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Tooth_sleuth.jpg/217px-Tooth_sleuth.jpg" decoding="async" width="145" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Tooth_sleuth.jpg/326px-Tooth_sleuth.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Tooth_sleuth.jpg/433px-Tooth_sleuth.jpg 2x" data-file-width="4788" data-file-height="3648" /></a></div> <div class="gallerytext">Plastic wedge to identify pain on biting from a fractured tooth</div> </li> <li class="gallerybox" style="width: 100.66666666667px"> <div class="thumb" style="width: 98.666666666667px;"><a href="/wiki/File:Transillumination_of_tooth_marked.jpg" class="mw-file-description" title="Transillumination demonstrating fracture"><img alt="Transillumination demonstrating fracture" src="//upload.wikimedia.org/wikipedia/commons/thumb/6/65/Transillumination_of_tooth_marked.jpg/148px-Transillumination_of_tooth_marked.jpg" decoding="async" width="99" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/65/Transillumination_of_tooth_marked.jpg/222px-Transillumination_of_tooth_marked.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/65/Transillumination_of_tooth_marked.jpg/296px-Transillumination_of_tooth_marked.jpg 2x" data-file-width="1997" data-file-height="2229" /></a></div> <div class="gallerytext">Transillumination demonstrating fracture</div> </li> <li class="gallerybox" style="width: 141.33333333333px"> <div class="thumb" style="width: 139.33333333333px;"><a href="/wiki/File:Tooth_decay_and_abscess_xray.png" class="mw-file-description" title="Decay (green) with apical abscess (blue)"><img alt="Decay (green) with apical abscess (blue)" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/34/Tooth_decay_and_abscess_xray.png/209px-Tooth_decay_and_abscess_xray.png" decoding="async" width="140" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/34/Tooth_decay_and_abscess_xray.png/315px-Tooth_decay_and_abscess_xray.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/34/Tooth_decay_and_abscess_xray.png/419px-Tooth_decay_and_abscess_xray.png 2x" data-file-width="525" data-file-height="414" /></a></div> <div class="gallerytext">Decay (green) with apical abscess (blue)</div> </li> <li class="gallerybox" style="width: 125.33333333333px"> <div class="thumb" style="width: 123.33333333333px;"><a href="/wiki/File:Sinugram_abscessed_tooth.jpg" class="mw-file-description" title="Gutta-percha point indicating abscess origin"><img alt="Gutta-percha point indicating abscess origin" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Sinugram_abscessed_tooth.jpg/185px-Sinugram_abscessed_tooth.jpg" decoding="async" width="124" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Sinugram_abscessed_tooth.jpg/278px-Sinugram_abscessed_tooth.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/99/Sinugram_abscessed_tooth.jpg/370px-Sinugram_abscessed_tooth.jpg 2x" data-file-width="388" data-file-height="346" /></a></div> <div class="gallerytext">Gutta-percha point indicating abscess origin</div> </li> </ul> Establishing a diagnosis of nondental toothache is initially done by careful questioning about the site, nature, aggravating and relieving factors, and referral of the pain, then ruling out any dental causes. There are no specific treatments for nondental pain (each treatment is directed at the cause of the pain, rather than the toothache itself), but a dentist can assist in offering potential sources of the pain and direct the patient to appropriate care. The most critical nondental source is the radiation of <a href="/wiki/Angina_pectoris" class="mw-redirect" title="Angina pectoris">angina pectoris</a> into the lower teeth and the potential need for urgent cardiac care.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 68  <div class="mw-heading mw-heading3"><h3 id="Differential_diagnoses">Differential diagnoses</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=23" title="Edit section: Differential diagnoses">edit</a>]</div> <table class="wikitable" style="border:1px solid #BBB; font-size:80%; margin:0.46em 0.2em"> <tbody><tr> <th>Parameter</th> <th>Dentin hypersensitivity<a href="#cite_note-Hargreaves2011-10">[10]</a>: 36 </th> <th>Reversible pulpitis<a href="#cite_note-Hargreaves2011-10">[10]</a>: 36 </th> <th>Irreversible pulpitis<a href="#cite_note-Hargreaves2011-10">[10]</a>: 36–37 </th> <th>Pulp necrosis<a href="#cite_note-Hargreaves2011-10">[10]</a>: 37 </th> <th>Apical periodontitis<a href="#cite_note-Hargreaves2011-10">[10]</a>: 37–38 </th> <th>Periodontal abscess</th> <th>Pericoronitis</th> <th>Myofascial pain</th> <th>Maxillary sinusitis </th></tr> <tr> <td>Site</td> <td>Poorly localized</td> <td>Poorly localized</td> <td>Variable; localized or diffuse</td> <td>No pain</td> <td>Well localized</td> <td>Usually well localized</td> <td>Well localized, associated with partially impacted tooth</td> <td>Diffuse, often over many muscles</td> <td>Back teeth top jaw </td></tr> <tr> <td>Onset</td> <td>Gradual</td> <td>Variable</td> <td>Variable</td> <td>From pain of reversible pulpitis to no pain in days</td> <td>Gradual, typically follows weeks of thermal pain in tooth</td> <td>Sudden, no episode of thermal sensitivity</td> <td>Sudden</td> <td>Very slow; weeks to months</td> <td>Sudden </td></tr> <tr> <td>Character</td> <td>Sharp, quickly reversible</td> <td>Sharp, shooting</td> <td>Dull, continuous pain. Can also be sharp</td> <td>No pain</td> <td>Dull, continuous throbbing pain</td> <td>Dull, continuous throbbing pain</td> <td>Sharp, with continuous dull</td> <td>Dull, aching</td> <td>Dull, aching, occasional thermal sensitivity in back top teeth </td></tr> <tr> <td>Radiation</td> <td>Does not cross midline</td> <td>Does not cross midline</td> <td>Does not cross midline</td> <td>N/A</td> <td>Does not cross midline</td> <td>Little, well localized</td> <td>Moderate, into jaw/neck</td> <td>Extensive, neck/temple</td> <td>Moderate, into other facial sinus areas </td></tr> <tr> <td>Associated symptoms</td> <td>Patient may complain of receding gums and/or toothbrush abrasion cavities</td> <td>Can follow restorative dental work or trauma</td> <td>Follows period of pain that does not linger</td> <td>Follows period of spontaneous pain</td> <td>Tooth may feel raised in socket</td> <td>May follow report of something getting "stuck" in gum</td> <td>Tooth eruption ("cutting") or impacted tooth</td> <td>Tension headaches, neck pain, periods of stress or episode of mouth open for long period</td> <td>Symptoms of <a href="/wiki/Upper_respiratory_tract_infection" title="Upper respiratory tract infection">URTI</a> </td></tr> <tr> <td>Time pattern</td> <td>Hypersensitivity as long as stimulus is applied; often worse in cold weather</td> <td>Pain as long as stimulus is applied</td> <td>Lingering pain to hot or cold or spontaneous pain</td> <td>Absence of pain following days or weeks of intense, well localized pain</td> <td>Pain on biting following constant dull, aching pain development</td> <td>Dull ache with acute increase in pain when tooth is moved, minimal thermal sensitivity</td> <td>Constant dull ache without stimulus</td> <td>Spontaneous, worse with eating, chewing, or movement of jaw</td> <td>Spontaneous, worse when head is tipped forward </td></tr> <tr> <td>Exacerbating and relieving factors</td> <td>Exacerbating: thermal, particularly cold</td> <td>Exacerbating: thermal, sweet</td> <td>Simple analgesics have little effect</td> <td>Prolonged heat may elicit pain</td> <td>Same as irreversible pulpitis, or no response to cold, lingering pain to hot, pain with biting or lying down</td> <td>Tapping tooth makes worse, cleansing area may improve pain</td> <td>Cleansing area can improve pain</td> <td>Rest or ice makes pain better, movement and chewing make it worse</td> <td>Tilting head forward, jarring movements (jumping) make pain worse </td></tr> <tr> <td>Severity</td> <td>Less severe than pulpitis</td> <td>Severe, for short periods</td> <td>Variable; pain dissipates until periapical tissue affected</td> <td>Severe</td> <td>Severe</td> <td>Severe</td> <td>Mild to severe</td> <td>Mild to moderate</td> <td>Mild to severe </td></tr> <tr> <td>Effect on sleep</td> <td>None</td> <td>None usually</td> <td>Disrupts sleep</td> <td>None</td> <td>Disrupts sleep</td> <td>Variable, can disrupt sleep</td> <td>If moderate to severe, will disrupt</td> <td>Unusual</td> <td>Unusual </td></tr></tbody></table> When it becomes extremely painful and decayed the tooth may be known as a <a href="/wiki/Hot_tooth_syndrome" class="mw-redirect" title="Hot tooth syndrome">hot tooth</a>.<a href="#cite_note-endoexperience.com-46">[45]</a> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=24" title="Edit section: Prevention">edit</a>]</div> Since most toothache is the result of <a href="/wiki/Dental_plaque" title="Dental plaque">plaque-related diseases</a>, such as tooth decay and periodontal disease, the majority of cases could be prevented by avoidance of a <a href="/wiki/Cariogenic" class="mw-redirect" title="Cariogenic">cariogenic</a> diet and maintenance of good <a href="/wiki/Oral_hygiene" title="Oral hygiene">oral hygiene</a>. That is, reduction in the number times that refined sugars are consumed per day and brushing the teeth twice a day with <a href="/wiki/Fluoride" title="Fluoride">fluoride</a> toothpaste and <a href="/wiki/Oral_hygiene#Interdental_brushes" title="Oral hygiene">interdental cleaning</a>. Regular visits to a dentist also increases the likelihood that problems are detected early and averted before toothache occurs. Dental trauma could also be significantly reduced by routine use of <a href="/wiki/Mouthguard" title="Mouthguard">mouthguards</a> in <a href="/wiki/Contact_sport" title="Contact sport">contact sports</a>.<a href="#cite_note-Douglass2003-26">[25]</a> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=25" title="Edit section: Management">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Root_canal_treatment.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Root_canal_treatment.jpg/220px-Root_canal_treatment.jpg" decoding="async" width="220" height="206" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Root_canal_treatment.jpg/330px-Root_canal_treatment.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Root_canal_treatment.jpg/440px-Root_canal_treatment.jpg 2x" data-file-width="2568" data-file-height="2400" /></a><figcaption>Root canal treatment (blue arrows) carried out on the lower right first molar with temporary restoration in place</figcaption></figure> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Incision_and_drainage_mouth.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Incision_and_drainage_mouth.png/220px-Incision_and_drainage_mouth.png" decoding="async" width="220" height="148" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Incision_and_drainage_mouth.png/330px-Incision_and_drainage_mouth.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Incision_and_drainage_mouth.png/440px-Incision_and_drainage_mouth.png 2x" data-file-width="962" data-file-height="646" /></a><figcaption>Incision of an abscess above a front tooth and insertion of a <a href="/wiki/Surgical_drain" class="mw-redirect" title="Surgical drain">surgical drain</a></figcaption></figure> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Abces_dentaire.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Abces_dentaire.jpg/220px-Abces_dentaire.jpg" decoding="async" width="220" height="318" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Abces_dentaire.jpg/330px-Abces_dentaire.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/43/Abces_dentaire.jpg/440px-Abces_dentaire.jpg 2x" data-file-width="900" data-file-height="1300" /></a><figcaption>Odontogenic infection involving the <a href="/wiki/Buccal_space" title="Buccal space">buccal space</a>. Above, deformation of the cheek on the second day. Below, deformation on the third day.</figcaption></figure> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Dental_emergency#Treatment" title="Dental emergency">Dental emergency § Treatment</a></div> There are many causes of toothache and its diagnosis is a specialist topic, meaning that attendance at a dentist is usually required. Since many cases of toothache are inflammatory in nature, <a href="/wiki/Over-the-counter_drug" title="Over-the-counter drug">over the counter</a> <a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">non-steroidal anti-inflammatory drugs</a> (NSAIDs) may help (unless <a href="/wiki/Contraindication" title="Contraindication">contraindicated</a>, such as with a <a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">peptic ulcer</a>). Generally, NSAIDs are as effective as <a href="/wiki/Aspirin" title="Aspirin">aspirin</a> alone or in combination with <a href="/wiki/Codeine" title="Codeine">codeine</a>.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 41–43  However, simple analgesics may have little effect on some causes of toothache, and the severe pain can drive individuals to exceed the maximum dose. For example, when <a href="/wiki/Acetaminophen" class="mw-redirect" title="Acetaminophen">acetaminophen</a> (paracetamol) is taken for toothache, an accidental overdose is more likely to occur when compared to people who are taking acetaminophen for other reasons.<a href="#cite_note-Vogel2011-47">[46]</a> Another risk in persons with toothache is a painful chemical burn of the <a href="/wiki/Oral_mucosa" title="Oral mucosa">oral mucosa</a> caused by holding a caustic substance such as aspirin tablets and toothache remedies containing <a href="/wiki/Eugenol" title="Eugenol">eugenol</a> (such as <a href="/wiki/Oil_of_cloves" class="mw-redirect" title="Oil of cloves">clove oil</a>) against the gum.<a href="#cite_note-Neville2001-14">[14]</a> Although the logic of placing a tablet against the painful tooth is understandable, an aspirin tablet needs to be swallowed to have any pain-killing effect. Caustic toothache remedies require careful application to the tooth only, without coming into excessive contact with the soft tissues of the mouth.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] For the dentist, the goal of treatment generally is to relieve the pain, and wherever possible to preserve or restore function. The treatment depends on the cause of the toothache, and frequently a clinical decision regarding the current state and long-term prognosis of the affected tooth, as well as the individual's wishes and ability to cope with dental treatment, will influence the treatment choice. Often, administration of an intra-oral local anesthetic such as <a href="/wiki/Lidocaine" title="Lidocaine">lidocaine</a> and <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> is indicated in order to carry out pain-free treatment. Treatment may range from simple advice, removal of dental decay with a <a href="/wiki/Dental_drill" title="Dental drill">dental drill</a> and subsequent placement of a filling, to root canal treatment, tooth extraction, or debridement. <div class="mw-heading mw-heading3"><h3 id="Pulpitis_and_its_sequalae">Pulpitis and its sequalae</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=26" title="Edit section: Pulpitis and its sequalae">edit</a>]</div> In pulpitis, an important distinction in regard to treatment is whether the inflammation is reversible or irreversible. Treatment of reversible pulpitis is by removing or correcting the causative factor. Usually, the decay is removed, and a sedative dressing is used to encourage the pulp to return to a state of health,<a href="#cite_note-Hargreaves2011-10">[10]</a>: 41  either as a base underneath a permanent filling or as a temporary filling intended to last for a period while the tooth is observed to see if pulpitis resolves. Irreversible pulpitis and its sequalae pulp necrosis and apical periodontitis require treatment with root canal therapy or tooth extraction, as the pulp acts as a <a href="/wiki/Locus_of_infection#Locus" class="mw-redirect" title="Locus of infection">nidus</a> of infection, which will lead to a chronic infection if not removed. Generally, there is no difference in outcomes between whether the root canal treatment is completed in one or multiple appointments.<a href="#cite_note-48">[47]</a> The field of <a href="/wiki/Regenerative_endodontics" title="Regenerative endodontics">regenerative endodontics</a> is now developing ways to clean the pulp chamber and regenerate the soft and hard tissues to either regrow or simulate pulp structure. This has proved especially helpful in children where the tooth root has not yet finished developing and root canal treatments have lower success rates.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 602–618  Reversible/irreversible pulpitis is a distinct concept from whether the tooth is restorable or unrestorable, e.g. a tooth may only have reversible pulpitis, but has been structurally weakened by decay or trauma to the point that it is impossible to restore the tooth in the long term.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Dental_abscesses">Dental abscesses</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=27" title="Edit section: Dental abscesses">edit</a>]</div> A general principle concerning dental abscesses is <a href="/wiki/Ubi_pus,_ibi_evacua" title="Ubi pus, ibi evacua">ubi pus, ibi evacua</a> ("where there is pus, drain it"), which applies to any case where there is a collection of pus in the tissues (such as a periodontal abscess, pericoronal abscess, or apical abscess). The pus within the abscess is under pressure, and the surrounding tissues are deformed and stretched to accommodate the swelling. This leads to a sensation of throbbing (often in time with the pulse) and constant pain. Pus may be evacuated via the tooth by drilling into the pulp chamber (an endodontic access cavity). Such a treatment is sometimes termed open drainage. Drainage can also be performed via the tooth socket, once the causative tooth is extracted. If neither of those measures succeeds, or they are impossible, <a href="/wiki/Incision_and_drainage" title="Incision and drainage">incision and drainage</a> may be required, in which a small incision is made in the soft tissues directly over the abscess at the most dependent point. A surgical instrument such as a pair of tweezers is gently inserted into the incision and opened, while the abscess is massaged to encourage the pus to drain out. Usually, the reduction in pain when the pus drains is immediate and marked as the built up pressure is relieved. If the pus drains into the mouth, there is usually a bad or offensive taste.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Antibiotics">Antibiotics</h3>[<a href="/w/index.php?title=Toothache&action=edit&section=28" title="Edit section: Antibiotics">edit</a>]</div> Antibiotics tend to be extensively used for emergency dental problems.<a href="#cite_note-Poveda_Roda2007-49">[48]</a><a href="#cite_note-Palmer2003-50">[49]</a> As samples for microbiologic <a href="/wiki/Culture_and_sensitivity" class="mw-redirect" title="Culture and sensitivity">culture and sensitivity</a> are hardly ever carried out in general dental practice, <a href="/wiki/Broad-spectrum_antibiotic" title="Broad-spectrum antibiotic">broad-spectrum antibiotics</a> such as <a href="/wiki/Amoxicillin" title="Amoxicillin">amoxicillin</a> are typically used for a short course of about three to seven days.<a href="#cite_note-Poveda_Roda2007-49">[48]</a> Antibiotics are seen as a "quick fix" by both dentists, who generally only have a very short time to manage dental emergencies, and by patients, who tend to want to avoid treatments (such as tooth extraction) which are perceived negatively. However, antibiotics typically only temporarily suppress an infection, and the need for definitive treatment is only postponed for an unpredictable length of time. An estimated 10% of all antibiotic prescriptions are made by dentists, a major factor in <a href="/wiki/Antibiotic_resistance" class="mw-redirect" title="Antibiotic resistance">antibiotic resistance</a>.<a href="#cite_note-Poveda_Roda2007-49">[48]</a><a href="#cite_note-Palmer2003-50">[49]</a> They are often used inappropriately,<a href="#cite_note-Palmer2003-50">[49]</a> in conditions for which they are ineffective, or their risks outweigh the benefits, such as irreversible pulpitis,<a href="#cite_note-Fedorowicz2013-51">[50]</a>[<a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers">needs update</a>] apical abscess,<a href="#cite_note-Hupp_2008-15">[15]</a>: 303  dry socket,<a href="#cite_note-Hupp_2008-15">[15]</a>: 303  or mild pericoronitis.<a href="#cite_note-Hupp_2008-15">[15]</a>: 303  However, the reality is that antibiotics are rarely needed,<a href="#cite_note-Odell2010-52">[51]</a>: 230  and they should be used restrictively in dentistry.<a href="#cite_note-Koch2009-53">[52]</a>: 164  Local measures such as incision and drainage, and removal of the cause of the infection (such as a necrotic tooth pulp) have a greater therapeutic benefit and are much more important.<a href="#cite_note-Odell2010-52">[51]</a>: 230  If abscess drainage has been achieved, antibiotics are not usually necessary.<a href="#cite_note-Hupp_2008-15">[15]</a>: 303  Antibiotics tend to be used when local measures cannot be carried out immediately.<a href="#cite_note-Hupp_2008-15">[15]</a>: 303  In this role, antibiotics suppress the infection until local measures can be carried out. Severe trismus may occur in when the <a href="/wiki/Muscles_of_mastication" title="Muscles of mastication">muscles of mastication</a> are involved in an odontogenic infection, making any surgical treatment impossible. <a href="/wiki/Immunocompromised" class="mw-redirect" title="Immunocompromised">Immunocompromised</a> individuals are less able to fight off infections, and antibiotics are usually given.<a href="#cite_note-Odell2010-52">[51]</a>: 232  Evidence of systemic involvement (such as a fever higher than 38.5 °C, cervical lymphadenopathy, or <a href="/wiki/Malaise" title="Malaise">malaise</a>) also indicates antibiotic therapy, as do rapidly spreading infections, <a href="/wiki/Cellulitis" title="Cellulitis">cellulitis</a>, or severe pericoronitis.<a href="#cite_note-Hupp_2008-15">[15]</a>: 303 <a href="#cite_note-Odell2010-52">[51]</a>: 232  <a href="/wiki/Drooling" title="Drooling">Drooling</a> and <a href="/wiki/Dysphagia" title="Dysphagia">difficulty swallowing</a> are signs that the airway may be threatened, and may precede <a href="/wiki/Dyspnoea" class="mw-redirect" title="Dyspnoea">difficulty in breathing</a>. <a href="/wiki/Ludwig%27s_angina" title="Ludwig's angina">Ludwig's angina</a> and <a href="/wiki/Cavernous_sinus_thrombosis" title="Cavernous sinus thrombosis">cavernous sinus thrombosis</a> are rare but serious complications of odontogenic infections. Severe infections tend to be managed in hospital.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=29" title="Edit section: Prognosis">edit</a>]</div> Most dental pain can be treated with routine dentistry. In rare cases, toothache can be a symptom representing a life-threatening condition, such as a deep neck infection (compression of the <a href="/wiki/Airway" class="mw-redirect" title="Airway">airway</a> by a spreading <a href="/wiki/Odontogenic_infection" title="Odontogenic infection">odontogenic infection</a>) or something more remote like a heart attack.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Dental caries, if left untreated, follows a predictable <a href="/wiki/Natural_history_of_disease" title="Natural history of disease">natural history</a> as it nears the pulp of the tooth. First it causes reversible pulpitis, which transitions to irreversible pulpitis, then to necrosis, then to necrosis with periapical periodontitis and, finally, to necrosis with periapical abscess. Reversible pulpitis can be stopped by removal of the cavity and the placement of a <a href="/wiki/Pulp_capping" title="Pulp capping">sedative dressing</a> of any part of the cavity that is near the pulp chamber. Irreversible pulpitis and pulp necrosis are treated with either root canal therapy or extraction. Infection of the periapical tissue will generally resolve with the treatment of the pulp, unless it has expanded to <a href="/wiki/Cellulitis" title="Cellulitis">cellulitis</a> or a <a href="/wiki/Radicular_cyst" class="mw-redirect" title="Radicular cyst">radicular cyst</a>. The success rate of restorative treatment and sedative dressings in reversible pulpitis, depends on the extent of the disease, as well as several technical factors, such as the sedative agent used and whether a rubber dam was used. The success rate of root canal treatment also depends on the degree of disease (root canal therapy for irreversible pulpitis has a generally higher success rate than necrosis with periapical abscess) and many other technical factors.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 77–82  <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=30" title="Edit section: Epidemiology">edit</a>]</div> In the United States, an estimated 12% of people reported that they had a toothache at some point in the six months before questioning.<a href="#cite_note-Hargreaves2011-10">[10]</a>: 40  Individuals aged 18–34 reported much higher rates toothache than those aged 75 or over.<a href="#cite_note-Zakrzewska2009-29">[28]</a>: 6  In a survey of Australian schoolchildren, 12% had experienced toothache before the age of five, and 32% by the age of 12.<a href="#cite_note-Zakrzewska2009-29">[28]</a>: 6  Dental trauma is extremely common and tends to occur more often in children than adults.<a href="#cite_note-Douglass2003-26">[25]</a> Toothache may occur at any age, in any gender and in any geographic region. Diagnosing and relieving toothache is considered one of the main responsibilities of dentists.<a href="#cite_note-Wolf2012-5">[5]</a> Irreversible pulpitis is thought to be the most common reason that people seek emergency dental treatment.<a href="#cite_note-Fedorowicz2013-51">[50]</a> Since dental caries associated with pulpitis is the most common cause, toothache is more common in populations that are at higher risk of dental caries. The prevalence of caries in a population is dependent upon factors such as diet (refined sugars), socioeconomic status, and exposure to fluoride (such as areas without <a href="/wiki/Water_fluoridation" title="Water fluoridation">water fluoridation</a>).<a href="#cite_note-Zakrzewska2009-29">[28]</a>: 6  <div class="mw-heading mw-heading2"><h2 id="History,_society_and_culture">History, society and culture</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=31" title="Edit section: History, society and culture">edit</a>]</div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Nuremberg_chronicles_f_120r_2.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/38/Nuremberg_chronicles_f_120r_2.png/220px-Nuremberg_chronicles_f_120r_2.png" decoding="async" width="220" height="279" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/3/38/Nuremberg_chronicles_f_120r_2.png 1.5x" data-file-width="230" data-file-height="292" /></a><figcaption><a href="/wiki/Saint_Apollonia" title="Saint Apollonia">Saint Apollonia</a>, patron saint for toothaches, holds one of her own extracted teeth in a pair of forceps (<a href="/wiki/Nuremberg_Chronicle" title="Nuremberg Chronicle">Nuremberg Chronicle</a>, <a href="/wiki/Hartmann_Schedel" title="Hartmann Schedel">Hartmann Schedel</a>, 1493)</figcaption></figure> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Cocaine_for_kids.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/6d/Cocaine_for_kids.png/220px-Cocaine_for_kids.png" decoding="async" width="220" height="135" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/6d/Cocaine_for_kids.png/330px-Cocaine_for_kids.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/6d/Cocaine_for_kids.png/440px-Cocaine_for_kids.png 2x" data-file-width="792" data-file-height="486" /></a><figcaption>American advertisement from 1885 offering "instantaneous cure" for toothache with "Cocaine toothache drops".<a href="#cite_note-54">[53]</a> <a href="/wiki/Cocaine" title="Cocaine">Cocaine</a> was the first <a href="/wiki/Local_anesthetic" title="Local anesthetic">local anesthetic</a>, but its addictive and other dangerous side effects eventually led to its use being virtually abandoned by modern health care.</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Carl_Bloch,_En_munk,_der_spejler_sig,_1875,_0073NMK,_Nivaagaards_Malerisamling.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/10/Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg/220px-Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg" decoding="async" width="220" height="288" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/10/Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg/330px-Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/10/Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg/440px-Carl_Bloch%2C_En_munk%2C_der_spejler_sig%2C_1875%2C_0073NMK%2C_Nivaagaards_Malerisamling.jpg 2x" data-file-width="3209" data-file-height="4196" /></a><figcaption>A monk with a toothache examines himself in a mirror, painting by <a href="/wiki/Carl_Bloch" title="Carl Bloch">Carl Bloch</a> from 1875.<a href="#cite_note-55">[54]</a> </figcaption></figure> The first known mention of tooth decay and toothache occurs on a <a href="/wiki/Sumer" title="Sumer">Sumerian</a> clay tablet now referred to as the "Legend of the worm". It was written in <a href="/wiki/Cuneiform" title="Cuneiform">cuneiform</a>, recovered from the <a href="/wiki/Euphrates" title="Euphrates">Euphrates</a> valley, and dates from around 5000 BC.<a href="#cite_note-Suddick1990-9">[9]</a> The belief that tooth decay and dental pain is caused by <a href="/wiki/Tooth_worm" title="Tooth worm">tooth worms</a> is found in ancient India, Egypt, Japan, and China,<a href="#cite_note-Suddick1990-9">[9]</a> and persists until the <a href="/wiki/Age_of_Enlightenment" title="Age of Enlightenment">Age of Enlightenment</a>. Although toothache is an ancient problem,<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  it is thought that ancient people suffered less dental decay due to a lack of refined sugars in their diet. On the other hand, diets were frequently coarser, leading to more tooth wear.<a href="#cite_note-Ancient_dentistry-57">[56]</a> For example, hypotheses hold that ancient Egyptians had a lot of tooth wear due to desert sand blown on the wind mixing with the dough of their bread.<a href="#cite_note-58">[57]</a> The ancient Egyptians also wore <a href="/wiki/Amulet" title="Amulet">amulets</a> to prevent toothache.<a href="#cite_note-Ancient_dentistry-57">[56]</a> The <a href="/wiki/Ebers_papyrus" class="mw-redirect" title="Ebers papyrus">Ebers papyrus</a> (1500 BC) details a recipe to treat "gnawing of the blood in the tooth", which included fruit of the gebu plant, onion, cake, and dough, to be chewed for four days.<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  <a href="/wiki/Archigenes" title="Archigenes">Archigenes</a> of Apamea describes use of a mouthwash made by boiling <a href="/wiki/Gallnut" class="mw-redirect" title="Gallnut">gallnuts</a> and hallicacabum in vinegar, and a mixture of roasted earthworms, <a href="/wiki/Spikenard" title="Spikenard">spikenard</a> ointment, and crushed spider eggs.<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  <a href="/wiki/Pliny_the_Elder" title="Pliny the Elder">Pliny</a> advises toothache sufferers to ask a frog to take away the pain by moonlight. <a href="/wiki/Claudius" title="Claudius">Claudius</a>' physician <a href="/wiki/Scribonius_Largus" title="Scribonius Largus">Scribonius Largus</a> recommends "fumigations made with the seeds of the <a href="/wiki/Hyoscyamus" title="Hyoscyamus">hyoscyamus</a> scattered on burning charcoal  ... followed by rinsings of the mouth with hot water, in this way  ... small worms are expelled."<a href="#cite_note-Ancient_dentistry-57">[56]</a> In Christianity, <a href="/wiki/Saint_Apollonia" title="Saint Apollonia">Saint Apollonia</a> is the patron saint of toothache and other dental problems. She was an early Christian <a href="/wiki/Martyr" title="Martyr">martyr</a> who was persecuted for her beliefs in <a href="/wiki/Alexandria" title="Alexandria">Alexandria</a> during the <a href="/wiki/Roman_Empire" title="Roman Empire">Imperial Roman age</a>. A mob struck her repeatedly in the face until all her teeth were smashed. She was threatened with being burned alive unless she renounced Christianity, but she instead chose to throw herself onto the fire. Supposedly, toothache sufferers who invoke her name will find relief.<a href="#cite_note-Ancient_dentistry-57">[56]</a> In the 15th century, priest-physician <a href="/wiki/Andrew_Boorde" title="Andrew Boorde">Andrew Boorde</a> describes a "deworming technique" for the teeth: "And if it [toothache] do come by worms, make a candle of wax with Henbane seeds and light it and let the perfume of the candle enter into the tooth and gape over a dish of cold water and then you may take the worms out of the water and kill them on your nail."<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  <a href="/wiki/Albucasis" class="mw-redirect" title="Albucasis">Albucasis</a> (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) used <a href="/wiki/Cautery" class="mw-redirect" title="Cautery">cautery</a> for toothache, inserting a red-hot needle into the pulp of the tooth.<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  The medieval surgeon <a href="/wiki/Guy_de_Chauliac" title="Guy de Chauliac">Guy de Chauliac</a> used a <a href="/wiki/Camphor" title="Camphor">camphor</a>, <a href="/wiki/Sulfur" title="Sulfur">sulfur</a>, <a href="/wiki/Myrrh" title="Myrrh">myrrh</a>, and <a href="/wiki/Asafoetida" title="Asafoetida">asafetida</a> mixture to fill teeth and cure toothworm and toothache.<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  French anatomist <a href="/wiki/Ambroise_Par%C3%A9" title="Ambroise Paré">Ambroise Paré</a> recommended: "Toothache is, of all others, the most atrocious pain that can torment a man, being followed by death. Erosion (i.e. dental decay) is the effect of an acute and acrid humour. To combat this, one must recourse to cauterization  ... by means of cauterization  ... one burns the nerve, thus rendering it incapable of again feeling or causing pain."<a href="#cite_note-Ingle2008-56">[55]</a>: 48–52  In the <a href="/wiki/Elizabethan_era" title="Elizabethan era">Elizabethan era</a>, toothache was an ailment associated with lovers,<a href="#cite_note-59">[58]</a> as in <a href="/wiki/Philip_Massinger" title="Philip Massinger">Massinger</a> and <a href="/wiki/John_Fletcher_(playwright)" title="John Fletcher (playwright)">Fletcher</a>'s play <a href="/wiki/The_False_One" title="The False One">The False One</a>. Toothache also appears in a number of <a href="/wiki/William_Shakespeare" title="William Shakespeare">William Shakespeare</a>'s plays, such as <a href="/wiki/Othello" title="Othello">Othello</a> and <a href="/wiki/Cymbeline" title="Cymbeline">Cymbeline</a>. In <a href="/wiki/Much_Ado_About_Nothing" title="Much Ado About Nothing">Much Ado About Nothing</a>, Act III scene 2, when asked by his companions why he is feeling sad, a character replies that he has toothache so as not to admit the truth that he is in love. There is reference to "toothworm" as the cause of toothache and to tooth extraction as a cure ("draw it"). In Act V, scene 1, another character remarks: "For there was never yet philosopher That could endure the toothache patiently."<a href="#cite_note-60">[59]</a> In modern parlance, this translates to the observation that philosophers are still human and feel pain, even though they claim they have transcended human suffering and misfortune.<a href="#cite_note-61">[60]</a> In effect, the character is rebuking his friend for trying to make him feel better with philosophical platitudes. The Scottish poet, <a href="/wiki/Robert_Burns" title="Robert Burns">Robert Burns</a> wrote "Address to the Toothache" in 1786, inspired after he suffered from it. The poem elaborates on the severity of toothache, describing it as the "hell o' a' diseases" (hell of all diseases).<a href="#cite_note-62">[61]</a> A number of plants and trees include "toothache" in their common name. Prickly ash (<a href="/wiki/Zanthoxylum_americanum" title="Zanthoxylum americanum">Zanthoxylum americanum</a>) is sometimes termed "toothache tree", and its bark, "toothache bark"; whilst <a href="/w/index.php?title=Ctenium_Americanum&action=edit&redlink=1" class="new" title="Ctenium Americanum (page does not exist)">Ctenium Americanum</a> is sometimes termed "toothache grass", and <a href="/wiki/Acmella_oleracea" title="Acmella oleracea">Acmella oleracea</a> is called "toothache plant". Pellitory (<a href="/wiki/Anacyclus_pyrethrum" title="Anacyclus pyrethrum">Anacyclus pyrethrum</a>) was traditionally used to relieve toothache.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tooth_god(Wasya_Dyo).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Tooth_god%28Wasya_Dyo%29.jpg/220px-Tooth_god%28Wasya_Dyo%29.jpg" decoding="async" width="220" height="146" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Tooth_god%28Wasya_Dyo%29.jpg/330px-Tooth_god%28Wasya_Dyo%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/49/Tooth_god%28Wasya_Dyo%29.jpg/440px-Tooth_god%28Wasya_Dyo%29.jpg 2x" data-file-width="3216" data-file-height="2136" /></a><figcaption>"toothache tree", Vaishya Dev shrine, <a href="/wiki/Kathmandu" title="Kathmandu">Kathmandu</a>, <a href="/wiki/Nepal" title="Nepal">Nepal</a>.</figcaption></figure> In <a href="/wiki/Kathmandu" title="Kathmandu">Kathmandu</a>, <a href="/wiki/Nepal" title="Nepal">Nepal</a>, there is a shrine to Vaishya Dev, the <a href="/wiki/Newa_people" class="mw-redirect" title="Newa people">Newar</a> god of toothache. The shrine consists of part of an old tree to which sufferers of toothache nail a <a href="/wiki/Rupee" title="Rupee">rupee</a> coin in order to ask the god to relieve their pain. The lump of wood is called the "toothache tree" and is said to have been cut from the legendary tree, Bangemudha. On this street, many traditional tooth pullers still work and many of the city's dentists have advertisements placed next to the tree.<a href="#cite_note-63">[62]</a>[<a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources">page needed</a>]<a href="#cite_note-64">[63]</a>[<a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources">page needed</a>] The phrase toothache in the bones is sometimes used to describe the pain in certain types of <a href="/wiki/Diabetic_neuropathy" title="Diabetic neuropathy">diabetic neuropathy</a>.<a href="#cite_note-65">[64]</a>: 1342  <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading2"><h2 id="Notes">Notes</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=32" title="Edit section: Notes">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-21"><a href="#cite_ref-21">^</a> This pattern of pain should be distinguished from the "meal time syndrome" of certain <a href="/wiki/Salivary_gland_disease" title="Salivary gland disease">salivary gland diseases</a>. </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=33" title="Edit section: References">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Mosby2008-1">^ <a href="#cite_ref-Mosby2008_1-0">a</a> <a href="#cite_ref-Mosby2008_1-1">b</a> <a href="#cite_ref-Mosby2008_1-2">c</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFDuncanSprehe2008" class="citation book cs1">Duncan L, Sprehe C (2008). Mosby's dental dictionary (2nd ed.). St. Louis, Mo.: Mosby. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-04963-4" title="Special:BookSources/978-0-323-04963-4"><bdi>978-0-323-04963-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mosby%27s+dental+dictionary&rft.place=St.+Louis%2C+Mo.&rft.edition=2nd&rft.pub=Mosby&rft.date=2008&rft.isbn=978-0-323-04963-4&rft.aulast=Duncan&rft.aufirst=L&rft.au=Sprehe%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Tollison2001-2"><a href="#cite_ref-Tollison2001_2-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTollisonSatterthwaiteTollison2001" class="citation book cs1">Tollison CD, Satterthwaite JR, Tollison JW (2001). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=BbmI8FCssdEC&q=toothache+(odontogenic+pain)&pg=PA369">Practical pain management</a> (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-3160-7" title="Special:BookSources/978-0-7817-3160-7"><bdi>978-0-7817-3160-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Practical+pain+management&rft.place=Philadelphia&rft.edition=3rd&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2001&rft.isbn=978-0-7817-3160-7&rft.aulast=Tollison&rft.aufirst=CD&rft.au=Satterthwaite%2C+JR&rft.au=Tollison%2C+JW&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DBbmI8FCssdEC%26q%3Dtoothache%2B%28odontogenic%2Bpain%29%26pg%3DPA369&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-McGraw-Hill2002-3"><a href="#cite_ref-McGraw-Hill2002_3-0">^</a> Segen JC. (2002). McGraw-Hill Concise Dictionary of Modern Medicine. The McGraw-Hill Companies. </li> <li id="cite_note-4"><a href="#cite_ref-4">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAllisonStonePigg2020" class="citation journal cs1">Allison, J. R.; Stone, S. J.; Pigg, M. (November 2020). <a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fors.12481">"The painful tooth: mechanisms, presentation and differential diagnosis of odontogenic pain"</a>. 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Australian Dental Journal. 59 (3): 289–295. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fadj.12193">10.1111/adj.12193</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24861778">24861778</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Australian+Dental+Journal&rft.atitle=Rhinosinusitis+in+oral+medicine+and+dentistry.&rft.volume=59&rft.issue=3&rft.pages=289-295&rft.date=2014-05-23&rft_id=info%3Adoi%2F10.1111%2Fadj.12193&rft_id=info%3Apmid%2F24861778&rft.aulast=Ferguson&rft.aufirst=M&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fadj.12193&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Scully2010-41">^ <a href="#cite_ref-Scully2010_41-0">a</a> <a href="#cite_ref-Scully2010_41-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFScully_C2010" class="citation book cs1">Scully C (2010). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=PHLvOVaB0AEC&q=medical+problems+in+dentistry">Medical problems in dentistry</a> (6th ed.). Edinburgh: Churchill Livingstone. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7020-3057-4" title="Special:BookSources/978-0-7020-3057-4"><bdi>978-0-7020-3057-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Medical+problems+in+dentistry&rft.place=Edinburgh&rft.edition=6th&rft.pub=Churchill+Livingstone&rft.date=2010&rft.isbn=978-0-7020-3057-4&rft.au=Scully+C&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPHLvOVaB0AEC%26q%3Dmedical%2Bproblems%2Bin%2Bdentistry&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Shafer2010-42"><a href="#cite_ref-Shafer2010_42-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRajendran_R2010" class="citation book cs1">Rajendran R (2010). Shafer's textbook of oral pathology. [S.l.]: Reed Elsevier. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-81-312-1570-8" title="Special:BookSources/978-81-312-1570-8"><bdi>978-81-312-1570-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Shafer%27s+textbook+of+oral+pathology.&rft.place=%5BS.l.%5D&rft.pub=Reed+Elsevier&rft.date=2010&rft.isbn=978-81-312-1570-8&rft.au=Rajendran+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Kumar2004-43"><a href="#cite_ref-Kumar2004_43-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKumar_PS2004" class="citation book cs1">Kumar PS (2004). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=vWgQ28cQtRQC&q=Textbook+of+Dental+Anatomy+and+Tooth+Morphology">Textbook of Dental Anatomy and Tooth Morphology</a>. Jaypee Brothers Publishers. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9788180612299" title="Special:BookSources/9788180612299"><bdi>9788180612299</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+Dental+Anatomy+and+Tooth+Morphology&rft.pub=Jaypee+Brothers+Publishers&rft.date=2004&rft.isbn=9788180612299&rft.au=Kumar+PS&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DvWgQ28cQtRQC%26q%3DTextbook%2Bof%2BDental%2BAnatomy%2Band%2BTooth%2BMorphology&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988">[<a href="/wiki/Wikipedia:Link_rot" title="Wikipedia:Link rot">permanent dead link</a>‍] </li> <li id="cite_note-Tencate2008-44"><a href="#cite_ref-Tencate2008_44-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNanci_A2008" class="citation book cs1">Nanci A (2008). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=nLW3Ts_TDpEC&q=dentin+pulp+complex&pg=PA191">Oral histology: development, structure, and function</a> (7th ed.). St. Louis, Mo.: Mosby. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-04557-5" title="Special:BookSources/978-0-323-04557-5"><bdi>978-0-323-04557-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oral+histology%3A+development%2C+structure%2C+and+function.&rft.place=St.+Louis%2C+Mo.&rft.edition=7th&rft.pub=Mosby&rft.date=2008&rft.isbn=978-0-323-04557-5&rft.au=Nanci+A&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DnLW3Ts_TDpEC%26q%3Ddentin%2Bpulp%2Bcomplex%26pg%3DPA191&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Fishman2010-45">^ <a href="#cite_ref-Fishman2010_45-0">a</a> <a href="#cite_ref-Fishman2010_45-1">b</a> <a href="#cite_ref-Fishman2010_45-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFishmanBallantyneRathmell2010" class="citation book cs1">Fishman S, Ballantyne J, Rathmell JP (2010). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=Pms0hxH8f-sC&q=many+painful+periodontal+conditions&pg=PA975">Bonica's management of pain</a> (4th ed.). Baltimore, MD: Lippincott, Williams & Wilkins. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-6827-6" title="Special:BookSources/978-0-7817-6827-6"><bdi>978-0-7817-6827-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Bonica%27s+management+of+pain.&rft.place=Baltimore%2C+MD&rft.edition=4th&rft.pub=Lippincott%2C+Williams+%26+Wilkins&rft.date=2010&rft.isbn=978-0-7817-6827-6&rft.aulast=Fishman&rft.aufirst=S&rft.au=Ballantyne%2C+J&rft.au=Rathmell%2C+JP&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPms0hxH8f-sC%26q%3Dmany%2Bpainful%2Bperiodontal%2Bconditions%26pg%3DPA975&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-endoexperience.com-46"><a href="#cite_ref-endoexperience.com_46-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://endoexperience.com/documents/HotToothanesthesia.PDF">"Looking for a File and were Directed Here?"</a> (PDF).</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Looking+for+a+File+and+were+Directed+Here%3F&rft_id=http%3A%2F%2Fendoexperience.com%2Fdocuments%2FHotToothanesthesia.PDF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Vogel2011-47"><a href="#cite_ref-Vogel2011_47-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFVogelHeardCarlsonLange2011" class="citation journal cs1">Vogel J, Heard KJ, Carlson C, Lange C, Mitchell G (November 2011). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033464">"Dental pain as a risk factor for accidental acetaminophen overdose: a case-control study"</a>. The American Journal of Emergency Medicine. 29 (9): 1125–9. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.ajem.2010.08.006">10.1016/j.ajem.2010.08.006</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033464">3033464</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20951526">20951526</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Emergency+Medicine&rft.atitle=Dental+pain+as+a+risk+factor+for+accidental+acetaminophen+overdose%3A+a+case-control+study.&rft.volume=29&rft.issue=9&rft.pages=1125-9&rft.date=2011-11&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3033464%23id-name%3DPMC&rft_id=info%3Apmid%2F20951526&rft_id=info%3Adoi%2F10.1016%2Fj.ajem.2010.08.006&rft.aulast=Vogel&rft.aufirst=J&rft.au=Heard%2C+KJ&rft.au=Carlson%2C+C&rft.au=Lange%2C+C&rft.au=Mitchell%2C+G&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3033464&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-48"><a href="#cite_ref-48">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMergoniGanimLodiFigini2022" class="citation journal cs1">Mergoni, Giovanni; Ganim, Martina; Lodi, Giovanni; Figini, Lara; Gagliani, Massimo; Manfredi, Maddalena (December 13, 2022). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9747194">"Single versus multiple visits for endodontic treatment of permanent teeth"</a>. The Cochrane Database of Systematic Reviews. 12 (12): CD005296. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2F14651858.CD005296.pub4">10.1002/14651858.CD005296.pub4</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1469-493X">1469-493X</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9747194">9747194</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/36512807">36512807</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Single+versus+multiple+visits+for+endodontic+treatment+of+permanent+teeth&rft.volume=12&rft.issue=12&rft.pages=CD005296&rft.date=2022-12-13&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC9747194%23id-name%3DPMC&rft.issn=1469-493X&rft_id=info%3Apmid%2F36512807&rft_id=info%3Adoi%2F10.1002%2F14651858.CD005296.pub4&rft.aulast=Mergoni&rft.aufirst=Giovanni&rft.au=Ganim%2C+Martina&rft.au=Lodi%2C+Giovanni&rft.au=Figini%2C+Lara&rft.au=Gagliani%2C+Massimo&rft.au=Manfredi%2C+Maddalena&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC9747194&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Poveda_Roda2007-49">^ <a href="#cite_ref-Poveda_Roda2007_49-0">a</a> <a href="#cite_ref-Poveda_Roda2007_49-1">b</a> <a href="#cite_ref-Poveda_Roda2007_49-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPoveda_Roda_R,_Bagan_JV,_Sanchis_Bielsa_JM,_Carbonell_Pastor,_E2007" class="citation journal cs1">Poveda Roda R, Bagan JV, Sanchis Bielsa JM, Carbonell Pastor, E (May 1, 2007). <a rel="nofollow" class="external text" href="http://www.medicinaoral.com/pubmed/medoralv12_i3_p186.pdf">"Antibiotic use in dental practice. 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Edinburgh: Churchill Livingstone. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-443-06784-6" title="Special:BookSources/978-0-443-06784-6"><bdi>978-0-443-06784-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Clinical+problem+solving+in+dentistry&rft.place=Edinburgh&rft.edition=3rd&rft.pub=Churchill+Livingstone&rft.date=2010&rft.isbn=978-0-443-06784-6&rft.au=Odell+EW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Koch2009-53"><a href="#cite_ref-Koch2009_53-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKochPoulsen2009" class="citation book cs1">Koch G, Poulsen S (2009). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=7Xdh8wb6zFsC&q=antibiotics+dentistry&pg=PA164">Pediatric dentistry a clinical approach</a> (2nd ed.). Chichester, UK: Wiley-Blackwell. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-118-68719-2" title="Special:BookSources/978-1-118-68719-2"><bdi>978-1-118-68719-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pediatric+dentistry+a+clinical+approach&rft.place=Chichester%2C+UK&rft.edition=2nd&rft.pub=Wiley-Blackwell&rft.date=2009&rft.isbn=978-1-118-68719-2&rft.aulast=Koch&rft.aufirst=G&rft.au=Poulsen%2C+S&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D7Xdh8wb6zFsC%26q%3Dantibiotics%2Bdentistry%26pg%3DPA164&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-54"><a href="#cite_ref-54">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.bonkersinstitute.org/medshow/cocainedrops.html">"Truly Marvelous Mental Medicine, Early remedies"</a>. Retrieved February 11, 2014.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Truly+Marvelous+Mental+Medicine%2C+Early+remedies&rft_id=http%3A%2F%2Fwww.bonkersinstitute.org%2Fmedshow%2Fcocainedrops.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-55"><a href="#cite_ref-55">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.nivaagaard.dk/en/samling-en/carl-bloch-1/">"Carl Bloch, A monk examines himself in a mirror, 1875"</a>. Nivaagaard Collection.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Carl+Bloch%2C+A+monk+examines+himself+in+a+mirror%2C+1875&rft.pub=Nivaagaard+Collection&rft_id=http%3A%2F%2Fwww.nivaagaard.dk%2Fen%2Fsamling-en%2Fcarl-bloch-1%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Ingle2008-56">^ <a href="#cite_ref-Ingle2008_56-0">a</a> <a href="#cite_ref-Ingle2008_56-1">b</a> <a href="#cite_ref-Ingle2008_56-2">c</a> <a href="#cite_ref-Ingle2008_56-3">d</a> <a href="#cite_ref-Ingle2008_56-4">e</a> <a href="#cite_ref-Ingle2008_56-5">f</a> <a href="#cite_ref-Ingle2008_56-6">g</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFIngleBaklandBaumgartner2008" class="citation book cs1">Ingle JI, Bakland LK, Baumgartner JC (2008). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=aV1kEf7mlckC&pg=PA392">Endodontics</a> (6th ed.). Hamilton, Ontario: BC Decker. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-55009-333-9" title="Special:BookSources/978-1-55009-333-9"><bdi>978-1-55009-333-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Endodontics&rft.place=Hamilton%2C+Ontario&rft.edition=6th&rft.pub=BC+Decker&rft.date=2008&rft.isbn=978-1-55009-333-9&rft.aulast=Ingle&rft.aufirst=JI&rft.au=Bakland%2C+LK&rft.au=Baumgartner%2C+JC&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DaV1kEf7mlckC%26pg%3DPA392&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-Ancient_dentistry-57">^ <a href="#cite_ref-Ancient_dentistry_57-0">a</a> <a href="#cite_ref-Ancient_dentistry_57-1">b</a> <a href="#cite_ref-Ancient_dentistry_57-2">c</a> <a href="#cite_ref-Ancient_dentistry_57-3">d</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20131214003101/http://www.bda.org/museum/the-story-of-dentistry/ancient-modern/ancient-dentistry.aspx">"Ancient dentistry"</a>. British Dental Association 2010. Archived from <a rel="nofollow" class="external text" href="http://www.bda.org/museum/the-story-of-dentistry/ancient-modern/ancient-dentistry.aspx">the original</a> on December 14, 2013. Retrieved December 13, 2013.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ancient+dentistry&rft.pub=British+Dental+Association+2010&rft_id=http%3A%2F%2Fwww.bda.org%2Fmuseum%2Fthe-story-of-dentistry%2Fancient-modern%2Fancient-dentistry.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-58"><a href="#cite_ref-58">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.bbc.co.uk/learningzone/clips/why-did-the-ancient-egyptians-suffer-from-toothache/5158.html">"Why did the Ancient Egyptians suffer from toothache?"</a>. British Broadcasting Company 2013. Retrieved December 13, 2013.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Why+did+the+Ancient+Egyptians+suffer+from+toothache%3F&rft.pub=British+Broadcasting+Company+2013&rft_id=https%3A%2F%2Fwww.bbc.co.uk%2Flearningzone%2Fclips%2Fwhy-did-the-ancient-egyptians-suffer-from-toothache%2F5158.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-59"><a href="#cite_ref-59">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20180326005015/http://nfs.sparknotes.com/muchado/page_106.html">"No Fear Shakespeare: Much Ado About Nothing: Act 3, Scene 2"</a>. nfs.sparknotes.com. Archived from <a rel="nofollow" class="external text" href="http://nfs.sparknotes.com/muchado/page_106.html">the original</a> on March 26, 2018. Retrieved April 2, 2018.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nfs.sparknotes.com&rft.atitle=No+Fear+Shakespeare%3A+Much+Ado+About+Nothing%3A+Act+3%2C+Scene+2&rft_id=http%3A%2F%2Fnfs.sparknotes.com%2Fmuchado%2Fpage_106.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-60"><a href="#cite_ref-60">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShakespeare_Wc._1599" class="citation book cs1">Shakespeare W (c. 1599). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=kwkOAAAAQAAJ&pg=PA129">"Act V, scene 1"</a>. Much Ado About Nothing. In: The Works of William Shakespeare, Globe Edition, London: Macmillan and Co. p. 129 (1866).</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Act+V%2C+scene+1&rft.btitle=Much+Ado+About+Nothing&rft.pub=In%3A+The+Works+of+William+Shakespeare%2C+Globe+Edition%2C+London%3A+Macmillan+and+Co.+p.+129+%281866%29&rft.au=Shakespeare+W&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DkwkOAAAAQAAJ%26pg%3DPA129&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-61"><a href="#cite_ref-61">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20180403065517/http://nfs.sparknotes.com/muchado/page_188.html">"No Fear Shakespeare: Much Ado About Nothing: Act 5, Scene 1, Page 2"</a>. nfs.sparknotes.com. Archived from <a rel="nofollow" class="external text" href="http://nfs.sparknotes.com/muchado/page_188.html">the original</a> on April 3, 2018. Retrieved April 2, 2018.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nfs.sparknotes.com&rft.atitle=No+Fear+Shakespeare%3A+Much+Ado+About+Nothing%3A+Act+5%2C+Scene+1%2C+Page+2&rft_id=http%3A%2F%2Fnfs.sparknotes.com%2Fmuchado%2Fpage_188.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-62"><a href="#cite_ref-62">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBurns_R" class="citation web cs1">Burns R. <a rel="nofollow" class="external text" href="https://www.bbc.co.uk/arts/robertburns/works/address_to_the_toothache/">"Address to the toothache"</a>. British Broadcasting Company. Retrieved December 13, 2013.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Address+to+the+toothache&rft.pub=British+Broadcasting+Company&rft.au=Burns+R&rft_id=https%3A%2F%2Fwww.bbc.co.uk%2Farts%2Frobertburns%2Fworks%2Faddress_to_the_toothache%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-63"><a href="#cite_ref-63">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBurdett_J2012" class="citation book cs1">Burdett J (2012). Godfather of Kathmandu. New York: Constable & Robinson. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4721-0094-8" title="Special:BookSources/978-1-4721-0094-8"><bdi>978-1-4721-0094-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Godfather+of+Kathmandu&rft.place=New+York&rft.pub=Constable+%26+Robinson&rft.date=2012&rft.isbn=978-1-4721-0094-8&rft.au=Burdett+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-64"><a href="#cite_ref-64">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFReedMcConnachieKnowlesStewart2002" class="citation book cs1">Reed D, McConnachie J, Knowles P, Stewart P (2002). Nepal (5th ed.). London: Rough Guides. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-85828-899-4" title="Special:BookSources/978-1-85828-899-4"><bdi>978-1-85828-899-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Nepal&rft.place=London&rft.edition=5th&rft.pub=Rough+Guides&rft.date=2002&rft.isbn=978-1-85828-899-4&rft.aulast=Reed&rft.aufirst=D&rft.au=McConnachie%2C+J&rft.au=Knowles%2C+P&rft.au=Stewart%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> <li id="cite_note-65"><a href="#cite_ref-65">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLeRoithTaylorOlefsky2004" class="citation book cs1">LeRoith D, Taylor SI, Olefsky JM (2004). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=hgiuDHVUuT4C&q=%22toothache+in+the+bones%22&pg=PA1342">Diabetes mellitus : a fundamental and clinical text</a> (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780781740975" title="Special:BookSources/9780781740975"><bdi>9780781740975</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Diabetes+mellitus+%3A+a+fundamental+and+clinical+text&rft.place=Philadelphia&rft.edition=3rd&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2004&rft.isbn=9780781740975&rft.aulast=LeRoith&rft.aufirst=D&rft.au=Taylor%2C+SI&rft.au=Olefsky%2C+JM&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DhgiuDHVUuT4C%26q%3D%2522toothache%2Bin%2Bthe%2Bbones%2522%26pg%3DPA1342&rfr_id=info%3Asid%2Fen.wikipedia.org%3AToothache" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Toothache&action=edit&section=34" title="Edit section: External links">edit</a>]</div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output .navbox-list{line-height:1.5em;border-color:#fdfdfd}.mw-parser-output .navbox-list-with-group{text-align:left;border-left-width:2px;border-left-style:solid}.mw-parser-output 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dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q143925" class="extiw" title="d:Q143925">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/K08.8">K08.8</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=525.9">525.9</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D014098">D014098</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb27698.htm">27698</a></li></ul></div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output 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.navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pain" title="Template:Pain"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pain" title="Template talk:Pain"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pain" title="Special:EditPage/Template:Pain"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pain" style="font-size:114%;margin:0 4em"><a href="/wiki/Pain" title="Pain">Pain</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">By region/system</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Head and neck</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Eye_strain" title="Eye strain">Eye strain</a></li> <li><a href="/wiki/Headache" title="Headache">Headache</a></li> <li><a href="/wiki/Neck_pain" title="Neck pain">Neck</a></li> <li><a href="/wiki/Odynophagia" title="Odynophagia">Odynophagia (swallowing)</a></li> <li><a class="mw-selflink selflink">Toothache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">Respiratory system</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sore_throat" title="Sore throat">Sore throat</a></li> <li><a href="/wiki/Bornholm_disease" title="Bornholm disease">Pleurodynia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_musculoskeletal_system" title="Human musculoskeletal system">Musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthralgia" title="Arthralgia">Arthralgia (joint)</a></li> <li><a href="/wiki/Bone_pain" title="Bone pain">Bone pain</a></li> <li><a href="/wiki/Myalgia" title="Myalgia">Myalgia (muscle)</a></li> <li><a href="/wiki/Acute_muscle_soreness" title="Acute muscle soreness">Acute</a></li> <li><a href="/wiki/Delayed_onset_muscle_soreness" title="Delayed onset muscle soreness">Delayed-onset</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurology" title="Neurology">Neurologic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Neuralgia" title="Neuralgia">Neuralgia</a></li> <li><a href="/wiki/Pain_asymbolia" title="Pain asymbolia">Pain asymbolia</a></li> <li><a href="/wiki/Pain_disorder" title="Pain disorder">Pain disorder</a></li> <li><a href="/wiki/Paroxysmal_extreme_pain_disorder" title="Paroxysmal extreme pain disorder">Paroxysmal extreme pain disorder</a></li> <li><a href="/wiki/Allodynia" title="Allodynia">Allodynia</a></li> <li><a href="/wiki/Chronic_pain" title="Chronic pain">Chronic pain</a></li> <li><a href="/wiki/Hyperalgesia" title="Hyperalgesia">Hyperalgesia</a></li> <li><a href="/wiki/Hypoalgesia" title="Hypoalgesia">Hypoalgesia</a></li> <li><a href="/wiki/Hyperpathia" title="Hyperpathia">Hyperpathia</a></li> <li><a href="/wiki/Phantom_pain" title="Phantom pain">Phantom pain</a></li> <li><a href="/wiki/Referred_pain" title="Referred pain">Referred pain</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain" title="Congenital insensitivity to pain">Congenital insensitivity to pain</a> <ul><li><a href="/wiki/Congenital_insensitivity_to_pain_with_anhidrosis" title="Congenital insensitivity to pain with anhidrosis">congenital insensitivity to pain with anhidrosis</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain_with_partial_anhidrosis" class="mw-redirect" title="Congenital insensitivity to pain with partial anhidrosis">congenital insensitivity to pain with partial anhidrosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pelvic_pain" title="Pelvic pain">Pelvic pain</a></li> <li><a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia</a></li> <li><a href="/wiki/Back_pain" title="Back pain">Back</a></li> <li><a href="/wiki/Low_back_pain" title="Low back pain">Low back pain</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Measurement and testing</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pain_scale" title="Pain scale">Pain scale</a></li> <li><a href="/wiki/Cold_pressor_test" title="Cold pressor test">Cold pressor test</a></li> <li><a href="/wiki/Dolorimeter" title="Dolorimeter">Dolorimeter</a></li> <li><a href="/wiki/Grimace_scale" title="Grimace scale">Grimace scale</a></li> <li><a href="/wiki/Hot_plate_test" title="Hot plate test">Hot plate test</a></li> <li><a href="/wiki/Tail_flick_test" title="Tail flick test">Tail flick test</a></li> <li><a href="/wiki/Visual_analogue_scale" title="Visual analogue scale">Visual analogue scale</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pathophysiology" title="Pathophysiology">Pathophysiology</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nociception" title="Nociception">Nociception</a></li> <li><a href="/wiki/Anterolateral_system" class="mw-redirect" title="Anterolateral system">Anterolateral system</a></li> <li><a href="/wiki/Marginal_nucleus_of_spinal_cord" title="Marginal nucleus of spinal cord">Posteromarginal nucleus</a></li> <li><a href="/wiki/Substance_P" title="Substance P">Substance P</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pain_management" title="Pain management">Management</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesia" class="mw-redirect" title="Analgesia">Analgesia</a></li> <li><a href="/wiki/Anesthesia" title="Anesthesia">Anesthesia</a></li> <li><a href="/wiki/Cordotomy" title="Cordotomy">Cordotomy</a></li> <li><a href="/wiki/Eradication_of_suffering" title="Eradication of suffering">Pain eradication</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related concepts</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Threshold_of_pain" title="Threshold of pain">Pain threshold</a></li> <li><a href="/wiki/Pain_tolerance" title="Pain tolerance">Pain tolerance</a></li> <li><a href="/wiki/Suffering" title="Suffering">Suffering</a></li> <li><a href="/wiki/SOCRATES_(pain_assessment)" title="SOCRATES (pain assessment)">SOCRATES</a></li> <li><a href="/wiki/Pain_(philosophy)" title="Pain (philosophy)">Philosophy of pain</a></li> <li><a href="/wiki/Cancer_pain" title="Cancer pain">Cancer pain</a></li> <li><a href="/wiki/Drug-seeking_behavior" class="mw-redirect" title="Drug-seeking behavior">Drug-seeking behavior</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Toothache&oldid=1256302874">https://en.wikipedia.org/w/index.php?title=Toothache&oldid=1256302874</a>"</div></div> <div id="catlinks" class="catlinks" data-mw="interface"><div id="mw-normal-catlinks" class="mw-normal-catlinks"><a href="/wiki/Help:Category" title="Help:Category">Categories</a>: <ul><li><a href="/wiki/Category:Pain" 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