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Dental Pain Toothache

Go to the Dentist Before You Get a Toothache!This morning I saw a patient who had been in extreme pain for the last couple of weeks.  What started as a small cavity grew into a large cavity that eventually made its way to the tooth’s pulp.  We were able to take her out of pain by starting a root canal today.

If we end up fixing her tooth, rather than extracting it, it will cost her around $1200.  Even then, with the condition of the tooth, it may only last her 5-10 more years.

A bridge to replace that tooth would cost her $1350.  An implant to replace that tooth would cost her $2100.  And those are dental school prices.  It would probably be about twice that in a private practice. You can find the average dental fees in your area here.

Had she come in a couple of years ago, we could have easily removed the decayed portion of the tooth and put in a filling.  With the prices at my dental school, that would have cost her only $84 and would have most likely lasted her at least 20 years (she has several amalgam fillings that are still going strong after more than 15 years.)

Find out how long a silver filling lasts.

The Moral of the Story

What I’m trying to get across is that if your dentist recommends getting a filling in a tooth, get it (As long as you trust your dentist!)

If you put it off simply because the tooth doesn’t bother you, there’s a good chance both you and your wallet will be experiencing some pain in the future.

How to Make a Dental First Aid Kit

An Oral Answers reader, Rebecca recently asked the following question:

“In the wake of the earthquake in Japan, my friends and I have been checking/building our disaster kits. One thing that’s come up has been what should be packed in a dental first aid kit. None of our first aid kits contain dental first aid items so we thought we’d build our own. What would you suggest that we add for a family of four? We’re assuming that a toothbrush, toothpaste and floss is only the beginning.”

Dental First Aid KitRebecca brings up a good point about the importance of being prepared for dental emergencies when they occur.  We never know when one of our children might lose a tooth in an accident.

If you’re interested in making your own dental first aid kit, there are many items that you may choose to include, depending on your level of dental experience.  Also, you need to know if you want to pack regular oral hygiene items (such as toothpaste and floss) in with your main disaster kit, or if you want to include it in your dental first aid kit.

For the purposes of this article, I will simply go into the things that you may want to have on hand in case a dental emergency occurs and you are unable to make it to the dentist for whatever reason.

What to Put in a Dental First Aid Kit: A List of 14 Possible Dental First Aid Kit Items

You can use the list below to find some things that you may want to include in a dental first aid kit, broken up into a few categories.

Help with Examining the Dental Emergency

1 – Medical-Grade Exam Gloves – Even if you’re comfortable reaching into your child’s mouth without gloves, it may be a good idea to wear gloves anyway due to the germs that you have on your hands.

2 – Dental Mirror & Flashlight – If a piece of tooth chipped off, or if someone has lost a tooth, it’s a good idea to look inside of the mouth and see if there is anything remaining at the site of the accident.  A mirror can also help you visualize the tongue-side of the front teeth.

Saving a Knocked Out or Lost Tooth

Save a Tooth System

3 – Save-a-Tooth System – The Save-A-Tooth System is simply a saline solution that is compatible with our bodily fluids.  It is the best way to keep a tooth “alive” when it is knocked out and not immediately re-implanted.  It is important to remember that a tooth can only be outside of its socket for a few hours before the probability of successful re-implantion starts to go down-hill fast!


In short, you only need to get this if you’ll be able to make it to the dentist within a few hours of having a tooth accidentally knocked out so that the dentist can re-implant the tooth.

Helping with a Lost Crown, Lost Filling, or Chipped Tooth

4- Temporary Crown and Filling Material – These materials, which I talked about in a previous post about the best temporary crown cement can help you get by until you can see a dentist.  Note that it is always best to see a dentist first when a crown or filling falls out.

To learn more on this topic, read about what to do when a filling comes out and what to do when a crown falls off.

5 – Dental Wax – Wax can be used to help with irritation from braces or a chipped tooth.  Some people have also used it to temporarily fill in a lost filling.  Dental wax can be found for pretty cheap on Amazon.

6 – Toothbrush & Tweezers – When putting a loose crown back on and replacing a lost filling, it is important to make sure that the tooth is clean by using a toothbrush.  You’ll also need a good way to handle the filling material, which is where the tweezers come in.

Controlling Bleeding

7 – Sterile Gauze – Gauze placed over the site of bleeding can help stop bleeding. You can also use gauze to move the tongue (it’s usually pretty slippery with gloves on!) so that you can see what’s going on inside the mouth.

8 – Tea Bag – If bleeding hasn’t stopped with just gauze, it can sometimes help to place a wet tea bag inside of a piece of gauze and hold that over the wound to stop bleeding.

9 – Hydrogen Peroxide – If you need to disinfect and clean up blood, hydrogen peroxide good to have around in your dental first aid kit.

Alleviating Dental Pain

10 – Floss, Toothpicks – Sometimes tooth pain is simply caused by food that is stuck between teeth that can easily be removed with floss and/or toothpicks.

11 – Clove Oil – Clove oil (or eugenol in dental-speak) has a sedative effect on the dental pulp and can be used to help alleviate tooth pain.  Many dentists use eugenol in their offices to help calm down teeth after deep fillings.  This is why clove oil is commonly associated with the dental office smell.

If you’re looking for a quick way to get some clove oil into your dental first aid kit, it can be found along with sesame oil in these Red Cross Toothache Medication Drops over at Amazon.

12 – Ice Pack – An ice pack can help reduce swelling when a tooth is lost.  At my dental school, whenever we extract a tooth, we recommend that the patient place an ice pack on their face intermittently (20 minutes on, then 20 minutes off) to reduce swelling.

13 – Orajel or Anbesol – Sometimes Orajel or Anbesol can do a better job at relieving oral pain than clove oil.  When giving an oral anesthetic to your children, it’s important to be aware of methemoglobinemia, a serious side effect.

14 – Pain Medication – Over the counter pain medication, such as ibuprofen and acetaminophen can help relieve oral pain, but should only be taken as directed.

Where to Buy a Dental First Aid Kit

Some people don’t want to go through the hassle of making their own dental first aid kit and prefer a ready-made solution.  There are a variety of different dental first aid kits available for sale online.  Here are two from Amazon that grabbed some good customer reviews:

Dental First Aid Kit - Dental MedicDental Medic Dental First Aid Kit (Pictured to the left) – This kit includes dental wax, floss, a tea bag, and an oral pain reliever among other items.  It also has an instruction booklet for dealing with common dental emergencies and comes in a waterproof bag.

Emergency Dental Kit (Pictured below) – This dental first aid kit appears to include a few more things compared to the dental first aid kit above.  It includes a mirror and appears to also have a Dental First Aid Kit Emergency Kitcontainer of clove oil included.

If you’re looking for some other options, this Google Shopping results page and this page at Amazon both show many other dental first aid kits that are available.


Dental first aid kits can be valuable assets when it comes to your oral health and your children’s oral health.  Nobody knows when an emergency will occur, so it is always a good idea to be prepared to handle dental emergencies.

Do you have any questions or comments about dental first aid kits?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Tooth Pain and Sinus Infections

This past weekend, my wife told me that she was having the worst toothache of her life. When she came in for her checkup a few months ago, her teeth were in great shape.

Dental Sinus InfectionShe told me that the pain was constant and that it got worse when she stood up. I told her that I thought it was a sinus infection. She went to the doctor and found out that she did have a sinus infection.

Stories like my wife’s are fairly common — many people think that they have a problem with their teeth when they simply have sinusitis.

What Are Sinuses?

Each time you take a breath through your nose, air travels through your sinuses on its way down to your lungs.  Your sinuses are simply hollow, air-filled cavities in your upper jaw bone.  They are lined with a pink membrane that is similar to the pink lining on the inside of your mouth.

When the lining of your sinuses gets infected or inflamed, it is known as sinusitis.

Many people end up coming to the emergency room at our dental school with painful teeth.  Upon examination, we sometimes find that their teeth are healthy and that the real cause of their pain is a sinus infection or sinusitis.

How Your Sinuses Can Cause Tooth Pain

Below you’ll find a dental x-ray.  I outlined the floor of the maxillary sinus (the sinus located above your upper teeth) so that you can see how close it comes to the roots of your upper molars.

Maxillary Sinuses on a Dental X-Ray

On the left side, it looks like the sinus floor goes below the roots of the upper molars.  Usually this isn’t the case, and that illusion can be attributed to overlap as we are seeing a two dimensional image of a three dimensional object.  However, it does give you a pretty good idea of why sinus infections can make it seem like you have a toothache in your upper molars and premolars.

Want more details on how a tooth can cause a sinus infection? Then read this article: Can a Sinus Infection Be Caused by a Tooth?

How to Know If The Pain Is Coming From a Tooth or Your Sinuses

When a patient comes in with severe tooth pain, we normally take an x-ray of the offending tooth.  Tooth pain is usually caused by reversible and irreversible pulpitis.

We also do some tests on the tooth by feeling around it for an infection, tapping on it, and/or putting ice on it.  This allows us to better understand if the pain is coming from one tooth or not.

If the teeth don’t have any cavities in them and appear to be healthy, then we usually try to find another source of the pain, such as a sinus infection (sinusitis).

Symptoms of a Maxillary Sinus Infection

Although there are other sinuses, the main pair of sinuses that affect your upper teeth are the maxillary sinuses.  One of the main symptoms of maxillary sinusitis is continuous pain in your back upper teeth that changes (gets worse or better) when you move your head (such as lying down or standing up.)

Treatment of Maxillary Sinusitis

Maxillary sinusitis can be treated in a variety of ways.  Here are some common treatments for maxillary sinusitis:

  • Using a humidifier to moisten the air that you breathe in.  This helps to loosen any dried secretions that have accumulated in the sinuses.
  • Using nasal spray that contains phenylephrine or ephedrine.
  • Taking decongestants orally such as Sudafed (psedoephedrine)
  • Taking antibiotics if it is believed that the sinusitis is caused by bacteria.  Common antibiotics that are prescribed for sinusitis include amoxicillin, trimethoprimsulfamethoxazole, clavulanate with amoxicillin, azithromycin, and cefuroxime.


Although toothaches are generally caused by a problem with your tooth, it is important to understand that your teeth have neighbors, such as your sinuses, that can mimic a toothache.

Do you have any questions about sinusitis or sinus infections?  I’d love to hear what you have to say in the comments section below.  I’ll do my best to respond to your questions, comments, and/or concerns.  Thanks for reading!

Easy Ways to Crack or Chip Your Teeth

Many people end up cracking or chipping their teeth at some point in their lives. A majority of cracked and chipped teeth injuries are preventable.

Tongue Rings Can Crack Your TeethTo illustrate that point, I’ve come up with 10 easy ways that you can crack and chip your teeth.  A lot of the ways don’t even involve doing anything.

Here’s a tip: If you want to keep your teeth crack and chip free, don’t do anything on the list below!

10 Easy Ways to Crack or Chip Your Teeth

1 – Get your tongue pierced and wear a hard metal object in it.  The hard metal will constantly bump up against your teeth and can chip and/or cause cracks.  A major cause of chips in front teeth is from tongue barbells.

2 – Don’t wear a protective athletic mouth guard when playing sports.  This one’s pretty easy, since it involves doing nothing.  Just don’t go to your dentist and get a custom mouthguard made, and you’ll be at a much higher risk for getting a cracked or chipped tooth.

That’s not all mouth guards do!  Here’s six reasons to wear an athletic mouthguard.

3 – Chew on ice or any other hard object.  To read more about the damage that chewing on ice does to your teeth, read How Chewing on Ice Affects Your Teeth.

Another common culprit of cracked teeth is popcorn kernels.  For some reason, people like to finish the whole bag of popcorn, and if some kernels didn’t pop like they were supposed to, they feel like they need to get eaten too.  If your popcorn bowl looks like the one below when you’re done, then congratulations!

Cracked Teeth Can Occur from Chewing Unpopped Popcorn Kernels

4 – Use your teeth as tools – to open things, use them as scissors to cut tape or cut tags off of new clothes.  Pretty much any way you use your teeth as tools, you will be putting excessive wear on them that could cause small cracks.

5 – Grind your teeth and don’t do anything about it.  If you grind your teeth, you could end up cracking them or even wearing your teeth down to almost nothing.  If you think that you may be grinding your teeth while you sleep, it’s best to talk to your dentist about it.  Most dentists will make an appliance you can wear to help stop teeth grinding.

6 – Don’t brush, make sure you get a big cavity, then go to your dentist and have a really big filling put in your tooth.  By losing so much tooth structure to tooth decay, it will be a lot easier to get your tooth to crack.

7 – Don’t get braces.  By not having the teeth in proper alignment, it is easier to put stresses on them when you bite, which could lead to worn down teeth, or cracking in more extreme circumstances.

8 – Clench your teeth often.  A lot of people clench their teeth when they’re stressed out.  Well, clenching can also stress out your teeth!  That’s alright if you want to crack or chip your teeth, but if you want to keep your teeth nice and healthy for a lifetime, try to stop clenching.

9 – Keep on getting older.  After a lifetime of wear, teeth can get pretty worn down and cracked.  Some experts believe that as you get older, your teeth become more brittle, which makes them more prone to cracking.

10 – Eat rocks or bones.  It does happen.  A lot of people find rocks in a can of re-fried beans or don’t sort out rocks from dried beans.  Another culprit is finding a bone in a fast food hamburger or chicken sandwich.  When you unexpectedly bite into something hard with a lot of force, it can easily crack or chip a tooth.


Ideally, you should try to not do anything on the above list.  Alright…  Unless you can live forever like the Tuck family in Tuck Everlasting(4th grade reading assignment), you probably can’t avoid #9.  #10 is also pretty hard to avoid, but the rest of the list involves choices that we make that can wear down our teeth over time.

Do you have any questions or comments about cracked or chipped teeth?  Leave them in the comments section below!  Thanks for reading!

Putting Aspirin on Toothache
©Gos Photo Design/

You can’t cure a toothache by putting an aspirin on it.  In fact, if you hold aspirin against a tooth long enough, it can damage your gums and other soft tissues inside of your mouth.

Aspirin Can't Cure a ToothacheAspirin is able to damage the tissues in your mouth because it is an acid – acetylsalicylic acid to be exact.   Like most acids, it will damage your bodily tissues if you give it enough time.  If you’ve ever used an acidic bathroom cleaner without gloves on, you probably discovered that acids can burn your skin.

What an Aspirin Burn Looks Like

An aspirin burn turns your gums and cheek tissue to a charred-white color.  Aspirin burns can also be quite painful.  It is literally a burn inside of your mouth!

If you’re curious to see what an aspirin burn looks like, here’s a picture in an oral pathology book on Google Books and here’s another picture of an aspirin burn.

Don’t Put Aspirin Directly On a Toothache

If you need pain relief from your toothache, it is best to go to your dentist.  If you can remove the cause of your toothache, you can become pain-free and most likely keep your teeth and gums in a healthy state.

One of the most interesting classes I’ve taken in dental school was called Oral Pathology.  The book we used, Oral and Maxillofacial Pathology had an interesting quote in it regarding dental home remedies such as placing aspirin on a toothache:

Patients often can be their own worst enemies.  The array of chemicals that have been placed within the mouth in an attempt to resolve oral problems is amazing.  Aspirin, sodium perborate, hydrogen peroxide, gasoline, turpentine, rubbing alcohol, and battery acid are just a few of the more interesting examples.

It’s just not a good idea to apply aspirin to a tooth that hurts.  Even just chewing aspirin has been shown to hurt the teeth, you can read more about that here.

Swallow Aspirin, Don’t Apply It Topically

If you can’t make it to a dentist and you need some relief from your toothache then you can swallow some aspirin or your painkiller of choice.

Remember that this route will only provide temporary relief and it will not solve the underlying cause of the toothache (most likely, the bacteria that live in your mouth.)


Have you ever used an aspirin tablet to relieve a toothache?  If you have any questions or comments about this article or toothaches in general, please feel free to leave a comment below.  Thanks for reading!

High Filling Pain

If you’ve ever received a filling at the dentist’s office, you probably vaguely remember the dentist putting a piece of colored paper in your mouth and telling you to bite together.  Then, the dentist probably asked, “Does that feel too high?”

Filling is too HighSince the mouth is generally numbed during a filling, it’s often hard to tell if a filling is too high while you’re sitting in the dental chair.  Also, the sooner we tell the dentist that it feels alright, the faster we can get out of their office and on with our life!

Sometimes, a few days after receiving a filling you may notice that your filling is a little too high.  When you bite together, the filling and its opposing tooth may be the first teeth to touch.  It may create an uneven bite.  However, the worst side-effect of a high filling is pain!

Why Does a High Filling Hurt and Cause Pain?

A Tooth With Symptomatic Apical Periodontitis Due to a High  FillingThe tooth is supported in bone by a thin layer of tissue called the periodontal ligament.  When you have a filling that is too high, the tooth gets pressed down a lot harder and it makes this ligament very tender.

All of the tissues of our body can get tender when put under stress.  For example, if you work outside in the garden all day pulling weeds without any gloves on, your hands will get red and inflamed.  As a result, the body sends an extra amount of blood to your hands to help them heal.  They gets red, inflamed, and very tender as part of the healing process.  This is what happens with the periodontal ligament when it gets compressed much more than usual due to a high filling.

The technical term for this is symptomatic apical periodontitis or acute apical periodontitis.

In the image to the right, you can see a high filling on the left side of the molar tooth.  I made the filling yellow so it will stand out.

In the bottom left, you can see that the periodontal ligament has widened and become red and inflamed.  This is the source of your pain when you have a high filling.

How to Stop the Pain Caused by Symptomatic Apical Periodontitis

In order to stop the pain, the cause must be removed.  That means you need to call your dentist and tell them that the filling is too high.  The process of grinding it down and re-checking your bite should only take a few minutes and most dentists probably won’t charge for it — after all, the filling was high in the first place because they didn’t grind it down enough to begin with.

How Long Will It Be Until the Pain Stops?

After the dentist has ground down the filling, the peridontal ligament will still need some time to heal from the additional stress that was placed upon it.

This healing process can take anywhere from a one day to two weeks.  As a general rule, if you are still in pain after more than two weeks you should make an appointment with your dentist, as this could be a sign that something else is wrong with your teeth.

I have a friend who recently experienced symptomatic apical periodontitis as a result of a filling that was too high (he was the inspiration for this post.)  He went back and had it adjusted and it was still too high.  He went back again, and the dentist took it down a little bit more.  After that, he said it was feeling better.

Don’t be shy about calling your dentist – the quicker that a problem is resolved, the less likely it is to develop into something more serious.

Has this ever happened to you or your dearly-loved ones?  Please leave a comment below and share.