Dental caries (tooth decay) is by far the most common dental emergency seen in the dental office. Cavities are the result of metabolism of carbohydrates by bacteria in dental plaque and the action of subsequent acid produced on the teeth. This decalcification begins on the surface of teeth, and if not treated in its early stage, can result in exposure of the interlayer of hard innervated tissue known as dentin, and eventually the nerve in the pulp chamber. The pulp chamber is the innermost portion of the tooth where the principle nerve and blood vessels terminate (Refer Dental Diagram 1).

Dental caries may be seen as white areas on the surface of the tooth in the beginning stages. These areas of decalcification will often become darker as the decay progresses. Often, the caries will extend to the inner layer of the tooth structure resulting in pain, and further disintegration of both the external and internal portions of the tooth. There are two classifications that are based on the type of surface on which the decay is found:

1. Normal Tooth Cross Section Diagram 1
2. Smooth Surface Caries Diagram 2
3. Pit and Fissure Caries Diagram 3
   
   

   Symptoms of Dental Caries

The most obvious symptom of a toothache resulting from dental caries is pain. Often in the beginning of a toothache the pain is periodic, coming and going. However, in most cases these episodes become more frequent and of longer duration and eventually the pain becomes constant.

Tooth decay may be associated with an existing restoration (a filling, etc.) with decay under or around it, or with a virgin tooth with no restoration.

The pain from a toothache should be differentiated from other conditions that may cause pain and/or swelling in the dental arch. Most commonly these are cracked teeth, lose (mobile) teeth, and periodontal disease with an associated condition.
When the decay is large and the tooth is badly broken down, you can suspect that the source of pain is a tooth ache. However, pit and fissure cavities (Diagram 2) may appear small on the surface, but often pyramid into a large lesion as the decay goes deeper into the tooth structure.

Periapical abcesses are characterized by acute inflammation and swelling in the area of the bottom or apex of a tooth. Frequently the abcess manifests itself as a swollen area of tissue below a badly decayed tooth.

1. Generally the abcess follows chronic episodes of toothaches that have gone untreated.
2. The associated tooth is painful to touch and may be elevated in the socket.
3. While it is not common to have systemic problems associated with this condition there may be fever and lymphnode involvement.
4. If the periapical abcess is chronic there may be no clinical features due to localization. Note: If swelling is present do not iniate treatment with the following medications. Contact a local emergency facility or call us on the referral number so that antibiotic therapy can be iniated.

Tempanol (U.S. DenTec Corporation)
Tempanol is a temporary filling material that contains zinc oxide and eugenol (oil of clove). These medicaments have been used in dentistry for years in a number of applications.
Application as a toothache medication: Following the manufacturers directions, all food debris should be removed from the cavity by rinsing with slightly warm water. The area is then pat dry using a cotton swab. A cotton swab is then saturated with the liquid in the kit. The liquid is then carefully placed in the cavity. Caution should be used to avoid touching the surrounding tissue and tongue. After the application remove the cotton swab, a fresh swab should be used with each application. This product is not to be used more than four (4) times a day without consulting a dentist or physician.
This product should not be used if the affected area has swelling or throbbing.
It should be noted that placement of the temporary filling material over the cavity sight may enhance the effectiveness of the liquid component, however, excess liquid should be removed.



Dentemp (Majestic Drug Company Inc.)
Like Tempanol, Dentemp contains zinc oxide and eugenol. However, it does not contain the filler material used as a temporary filling in Tempanol. This medicament can be found in many pharmacies in the United States and may provide temporary relief from dental pain. Its formulation is the same as that used by most dentists as a sedative filling. As with the sedative filling material found in the dental office, it must be mixed by the user. Thus, The directions must be read completely and carefully before using.



Oil of Cloves
In some areas, the aforementioned products may not be readily available. One alternative may be to use ordinary Oil of Cloves. A small bottle can be purchased in almost any pharmacy. Place a small amount on a small cotton pellet, dry the pellet slightly so as to not over saturate, and place it directly into the cavity. The use of clove oil for temporary toothache relief is historic.



Orajel (Del Pharmaceutical, Inc.)
Orajel belongs to a family of toothache medications that have a topical anesthetic as the active ingredient. Most commonly that anesthetic is Benzocaine.
Application: Following the manufacturer's instructions open the tube, place a small amount both inside the cavity and on the gums. This medication as with other medications, should not be used by persons allergic to there ingredients, such as Anesthetics in the "caine" family including benzocaine, procaine, and butacaine, ect.
Do not use this product repeatedly, do not use more than four (4) times a day without consulting a dentist. It is intended for temporary treatment. Consult with a dentist as soon as possible.



Anbesol (Whitehall-Robins Heathcare)
Anbesol like oragel uses Benzocaine as an active ingredient.
Application: The application of anbesol is identical to that of Orajel. However, it should be noted that with both products children under the age of 12 years old should be closely supervised.



Other Treatments In some cases placing ice on the tooth may provide some temporary relief. Try this for 10 to 20 minutes at a time, many people find this to work for a short time. Ibuproben: dentists often prescribe 800mg every four (4) to six (6) hours as an alternative to narcotic pain relievers.


However, it should be noted that the package insert should be followed as closely as possible. Ibuproben may also be used in conjunction with the other aforementioned treatments for pain relief.