Understanding Tooth Pain: When Do I Need To Make An Appointment?

The correct answer is every 6 months – prevention is key to identifying disease and making sure gum disease, caries progression, and cancer are caught early. With this in mind, it’s important to understand tooth pain and why it is beneficial to catch it early, rather than later. In future topics, gum disease and oral cancer will be discussed.

What Causes Tooth Pain?

There is a complicated cascade that results in tooth pain, and can be from various factors. For this post, we will focus on the carious process (a term used to describe decay or cavities). Caries arise due to the breakdown of enamel and dentin from the production of acid by bacteria¹. The reason some individuals experience caries more than others is due to the factors that cause caries – the bacterial load, saliva flow, amount of fluoride, and diet of the host¹. As sugars are broken down by the bacteria, they release acid, which demineralizes teeth and further results in decay. A response to this decay is pain of varying levels depending on the extent of the decay.

When Will I Know I have Cavities?

You may not! This is why it’s important to see the dentist regularly – we can catch cavities early through our training, observing the teeth clinically as well as radiographically. There are signs, however, that you’re experiencing symptoms of a cavity.

Ignore the labels – focus on how there’s three layers from enamel, dentin, to pulp³

The tooth is divided into layers, like a cake. On the outside, enamel. Enamel is the hardest substance of the body and covers a softer material, dentin. The dentin provides support and protection from the oral cavity. Deeper still, exists the dental pulp – this is where nerves and vasculature lie, connecting to the sterile alveolar bone below it. As decay digs deeper into each layer, more complications arise, and with it, more symptoms. Not every symptom and possibility will be discussed in this post for simple terms.

Decay begins in the enamel, where it spreads to the dentin. When the decay is isolated to the enamel, a filling may not be necessary. You may not notice any symptoms, during this time. However, as the decay passes the DEJ (dentin-enamel-junction), symptoms of reversible or irreversible pulpitis become evident.

What Is ‘Pulpitis?’

Pulpitis is an inflammatory process within the pulp that is caused by stimuli such as mechanical damage, thermal injury, chemical irritation, and bacterial effects.

Oral and Maxillofacial Pathology, 4th Edition

Pulpitis is the inflammation of the pulp that acts as a ‘warning sign’ to potential serious problems. If the inflammatory process is not contained, spread of the infection to alveolar bone can cause life-threatening conditions such as cavernous sinus thrombosis, Ludwig’s angina, and even sepsis². Decay begins in the enamel, spreads to the dentin, and may result in the pulp becoming inflamed. Because there is nowhere for the inflammation to go (remember, the pulp is encased in a shell of enamel and dentin, and leads below to the bone), the inflammation causes pain. If caught early, the decay has not reached the pulp and only a filling is required. If caught late, the decay will have made its way into the pulp resulting in necrosis and requires a root canal treatment.

This is recurrent decay under an existing crown resulting in inflammation and resorption of the underlying bone – when ‘irreversible pulpitis’ stays for too long (necrotic)⁴

So How Do I know If It’s ‘Too Late?’

There’s different symptoms, like mentioned above, depending on the extent of the cavity process. Reversible pulpitis will exhibit sensitivity with cold and sweets (and sometimes heat) that lasts for a few seconds. This type of pain is reversible, and can generally be fixed with a simple filling. To contrast, irreversible pulpitis will show sharp pain from the same symptoms, but linger². Spontaneous pain that is not triggered by any stimuli will also be present on the tooth. Teeth that generate symptoms of irreversible pulpitis require a root canal. This is when we know it’s ‘too late.’ Avoiding this is key – you can save yourself a timely and costly procedure by catching cavities early, which is why it is so important to practice preventive dentistry (seeing you dentist every 6 months). Like mentioned earlier, there are more symptoms a tooth can present that are the result of a carious process that has reached into the pulp – such as tooth pain when biting or the development of an abscess. However, sometimes these symptoms present with other underlying conditions, such as gum disease, and will be talked about more in depth in a later article.

So When Do I Need To See The Dentist?

Every six months. If you wait until you see symptoms, you could be dealing with a root canal and a crown, or even worse – the extraction of a tooth. The warning signs of pulpitis are there to tell us something’s wrong, but it’s better to catch a cavity before the warning signs are present.

To Summarize:

  • Cavities are caused by a variety of factors including diet, saliva, fluoride intake, and bacteria
  • Tooth pain has different causes, but cavities can be one source
  • Pulpitis results from decay that has reached the inner layers of a tooth
  • Once the decay has reached far enough, different symptoms are presented
  • A root canal may need to be performed if prolonged, delayed sensitivity to stimuli such as cold occurs
  • Don’t wait until symptoms present to see your dentist
  • See your dentist every 6 months


¹Featherstone, J., & Chaffee, B. W. (2018). The Evidence for Caries Management by Risk Assessment (CAMBRA®). Advances in dental research29(1), 9–14. https://doi.org/10.1177/0022034517736500

²Chi, A., Neville, B., Damm, D., Allen, C. (052015). Oral and Maxillofacial Pathology, 4th Edition. [VitalSource Bookshelf 9.4.0]. Retrieved from vbk://9781455770526

³Nelson, Stanley. Wheeler’s Dental Anatomy, Physiology and Occlusion, 10th Edition. W.B. Saunders Company, 122014. VitalBook file.

⁴Torabinejad, Mahmoud, Ashraf Fouad, Richard Walton. Endodontics: Principles and Practice, 5th Edition. Saunders, 040114. VitalBook file.

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