Overview

Toothaches and gum problems are common. But you can usually prevent them by taking good care of your teeth and gums. Keeping your teeth, gums, and the bones around your teeth healthy requires regular brushing, flossing, and good nutrition. Look for toothpastes that have been approved by the Canadian Dental Association. Clean between teeth daily with floss or an interdental cleaner.

Toothaches

Sometimes you may have tooth pain when you touch a tooth or when you eat or drink foods that are hot, cold, sweet, or sour (a sensitive tooth). Mild sensitivity can be caused by shrunken (receded) gums or a worn-down tooth. Moderate to severe sensitivity can mean that you have a cracked tooth, a dental cavity, or a lost filling. Seeing a dentist for treatment can prevent the tooth from dying.

The most common cause of a toothache is tooth decay. But you might not have a toothache in the early stages of decay. Other reasons for a toothache might include:

• An infection of or around the tooth (abscess). A red, swollen, painful bump may be found near or on the side of the sore tooth. The tooth may hurt more when you bite down.
• A tooth that has not broken through the gum (impacted tooth). Gums may be red, swollen, and sore. The area around this tooth can ache, throb, and be quite painful.
• Problems with or injury to the nerves in the centre of the tooth (pulp). These can be caused by an injury to the face or from grinding or gnashing the teeth.

Sometimes a toothache can be caused by another health problem, such as:

• A heart attack, a cluster headache, or a sinus infection. These can cause referred pain into the teeth or jaw.
• Viral infections, such as shingles.
• Diseases, such as diabetes.
• Nerve-related disease, such as trigeminal neuralgia.
• Alcohol or drug use, especially methamphetamines.
• Vitamin deficiencies, such as too little vitamin B12.

Gum problems

Healthy gums are pink and firm and don't bleed easily. Now and then, your gums may bleed if you brush your teeth and gums too hard, use a hard-bristled toothbrush, or snap dental floss hard against your gums. Be gentle with your teeth. Use a soft-bristled toothbrush and floss carefully to help prevent bleeding gums.

Gingivitis is a gum disease that causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people delay treatment. If not treated, gum disease can cause more serious problems with the gum tissue.

Periodontitis is severe gum disease. It's caused by long-term infection of the gums, bone, and other tissues that surround and support the teeth. It can progress until the bones that support the teeth are damaged. In this late stage, teeth may become loose and fall out or need to be removed. Early treatment of gum disease is important to prevent tooth loss.

Other causes of gum bleeding, swelling, and pain include:

• Pregnancy, blood-thinning medicines, and bleeding disorders. Each of these can cause gums to bleed easily.
• Lack of vitamins, such as vitamin K or vitamin C, or medical problems, such as anemia, that interfere with how well the body can absorb certain vitamins.
• Teething in babies and young children.
• Medicines such as phenytoin (Dilantin) or calcium channel blockers.
• Dentures or a dental appliance that irritates the gums.
• An infection around the root of the tooth. Swelling and redness, sometimes with pus, may appear at the base of a tooth.

Smoking and using other tobacco products increases your risk for gum disease. Smokers have a higher chance of having gum disease throughout their mouths than non-smokers. But you might not have symptoms of bleeding or swollen gums. That's because the normal bleeding immune response is affected by tobacco use. Chewing tobacco or using snuff may push back the gums in the area of the mouth where the tobacco is inserted. Constant irritation caused by tobacco products increases your risk of oral cancer.

Self-Care

Try these tips to help treat a sensitive tooth, toothache, or gum problem.

• Treat tooth sensitivity.

  You can reduce sensitivity to heat, cold, or brushing.

  • Use a toothpaste specifically designed for sensitive teeth.
  • Brush with it regularly, or rub a small amount of the paste on the sensitive area with your finger 2 or 3 times a day.
  • Floss gently between your teeth.
• Ease a toothache.
  • Use an ice pack on the outside of your cheek to reduce pain and swelling. Don't use heat.
  • Avoid very hot, cold, or sweet foods and drinks if they make your pain worse.
  • Adults can apply an over-the-counter benzocaine gel to the tooth for short–term relief. Ask your doctor before using mouth-numbing medicine for children of any age. Health Canada warns that some of these can be dangerous. Be safe with medicine. Read and follow all instructions on the label. If your pain lasts longer than a few days or it gets worse, call a doctor.
• Treat gum problems.
  • Use a tartar-control toothpaste that contains fluoride. And use a mouthwash that contains fluoride if your gums are mildly swollen and red.
  • Make sure to brush after meals and snacks and floss every day.
  • Chew sugar-free gum, use a toothpick, or rinse your mouth with warm salt water if you can't brush after eating. You can make your own salt water by mixing 1 teaspoon (5 mL) of salt with 1 cup (250 mL) of warm water.
  • Don't smoke or use other tobacco products. Tobacco can cause many gum problems, decrease your ability to fight infection of your gums, and delay healing.
  • Don't use illegal drugs, such as methamphetamines, that cause tooth and gum problems.

Caring for a loose tooth

Try these tips for caring for a loose tooth.

• Protect a slightly loose tooth.

  Teeth that are slightly loose but still in their normal position should tighten up in 1 to 2 weeks.

  • Eat a diet of soft foods for 1 to 2 weeks.
  • Be gentle when you brush or floss.
  • Wear a mouth guard or face protection if you play sports.
• Remove a very loose baby tooth in a child.
  • First, tilt your child's head forward and down so that when the tooth comes out, it doesn't fall to the back of the throat, causing your child to choke or swallow the tooth.
  • Grasp the tooth with gauze or a face cloth, and pull firmly with a twisting motion.

Caring for a knocked-out tooth

Mouth injuries that are forceful enough to knock out a tooth may also damage other teeth or other structures in the mouth or face, such as the roof of the mouth, gums, lips, or cheeks. A permanent tooth can sometimes be put back into its socket (reimplanted). The best results occur if a dentist puts the tooth back in the socket within 30 minutes. Chances of successful reimplantation are unlikely after 2 hours.

1. Find the tooth.
   • For a baby tooth (primary tooth): Apply clean gauze to the gum and socket for about 15 minutes to control the bleeding. A baby tooth is not reimplanted after it has been knocked out because the reimplantation may cause problems with later development of the permanent tooth. Your child will need to be checked by a dentist even if the tooth was getting ready to fall out soon.
   • For a permanent tooth: Apply clean gauze and continue with the steps listed below.
2. Rinse the tooth.
   • Rinse the tooth gently with tap water while holding it by the top of the tooth (crown). Do not rub or scrub the tooth or touch the root.
3. Store the tooth properly for transport to the dentist.
   • The best way to transport a tooth is to put it back into the socket. Gently place it back into its normal position. Do not be concerned if it sticks out slightly. Bite down gently on gauze or a moistened tea bag to help keep the tooth in place. Hold the tooth in the socket with your finger during transport.
   • An adult or older child may be able to keep the tooth in their mouth between the gums and the cheek or under the tongue, being careful not to swallow it.
   • A young child should not be expected to do this.
   • If the adult or child is too anxious to put the tooth in the socket or hold it between the gums and the cheek, place the tooth in milk. If milk is not available, use tap water or a non-prescription product, such as Save-A-Tooth.
   • Do not put the tooth in salt water, alcohol, or mouthwash.
4. Seek immediate care.
   • Call your dentist immediately to arrange for your care. If you are unable to talk with your dentist right away, go to a hospital emergency room immediately. Be sure to take the tooth with you.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
• New or worse dehydration.
• Symptoms occur more often or are more severe.

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