Elusive Source of Tooth Pain

People may be notoriously bad at pinpointing which tooth is aching because, to the brain, a painful upper tooth feels a lot like a painful lower tooth, according to a new study.

It's more difficult for the brain to distinguish between different areas of pain in the mouth than in any other part of the body, according to a study set to be published in the journal "Pain." Researchers led by Clemens Foster, Ph.D., of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy volunteers as they experienced tooth pain.

The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth. The bursts produced a painful sensation similar to if the subjects bit into an ice cube.

The level of the bursts were tuned so that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable. To see how the brain responded to pain emanating from different teeth, the researches used fMRI to monitor the changes in activity when the upper or lower tooth was zapped.

"At the beginning, we expected a good difference, but that was not the case," Dr. Forster said.

Many brain regions responded to top and bottom tooth pain — carried by signals from two distinct branches of a fiber called the trigeminal nerve — in the same way. Separate regions in the brain's cerebral cortex, known to play an important role in the pain projection system, behaved similarly for both toothaches.

"Dentists should be aware that patients aren't always to locate the pain," Forster said. "There are physiological and anatomical reasons for that."

Forster did state that the experiments might have missed subtle differences that could account for why some tooth pain can be localized.

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This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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As we get older, dental care for adults is crucial. Here are a few of the conditions to be aware of:

Gum disease – if your home care routine of brushing and flossing has slipped and you have skipped your regular dental cleanings, bacterial plaque and tartar can build up on your teeth. The plaque and tartar, if left untreated, may eventually cause irreparable damage to your jawbone and support structures, and could lead to tooth loss.

Oral cancer – according to the National Institute of Dental and Craniofacial Research, men over the age of 40 have the greatest risk for oral cancer. About approximately 43,000 people will be diagnosed with cancer of the mouth, tongue or throat area, and the ACS estimates that about 7,000 people will die from these cancers. The use of tobacco products and alcohol increases the risk of oral cancer. Most oral cancers are first diagnosed by the dentist during a routine checkup.

Dental fillings break down – fillings have a life expectancy of eight to 10 years. However, they can last 20 years or longer. When the fillings in your mouth start to break down, food and bacteria can get underneath them and can cause decay deep in the tooth.

Keep your teeth clean with an oral health routine.

Establishing an oral health routine is important for a healthy mouth. Try one of our oral health products to help you establish a schedule.