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 to 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.

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 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.

Generally the abcess follows chronic episodes of toothaches that have gone untreated.

The associated tooth is painful to touch and may be elevated in the socket.

While it is not common to have systemic problems associated with this condition there may be fever and lymphnode involvement.

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.

There are a number of medications that may aid in providing temporary relief of dental pain caused by decay until a dentist can be consulted. The following can be found over the counter in most pharmacies. Caution: Products containing Eugenol should not be used by those persons who are allergic to Eugenol, or when there is throbbing or swelling in the affected area.

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.