Pain on biting or chewing can actually be extremely difficult to cope up with as these two are activities carried out daily and are extremely important for the well-being of a person. There are numerous reasons for the development of such a type of pain. Some kind of dental disorder or condition like decayed teeth, fractured teeth, gum disease or even tooth roots that are devoid of gum layer can cause such a problem. The pain on biting ranges from mild to moderate. At times, it might also become severe depending on the related disorder. The aggravating and relieving factors for pain on chewing vary in every separate case. Thorough oro-dental examination is important supported by a detailed case history and other diagnostic aids like X-rays. There are certain systemic diseases that are associated or act as a causative factor for pain on chewing or biting. They are mainly cardiac problems like angina or myocardial infarction, ENT (ear nose throat) infections or infection of sinuses and TMJ related disorders.
The general causes of pain from chewing or biting are mentioned below with the treatment options that are used to manage such cases:
One of the most common causes of toothache while biting or chewing is dental decay or dental caries. Dental caries is an infectious microbiologic disease that causes the demineralisation of the inorganic part and then the disintegration of the organic part of the tooth structure. Dental caries can be at various levels. It starts from as small as a minor discoloration and can proceed to severe conditions like non-vitality of the tooth. The decay causes the breakdown of tooth structure resulting in the formation of cavities. Cavities can involve only enamel, enamel and dentin or even reach dental pulp (innermost layer of tooth which is richly supplied with blood and nerve fibres). Dental decay extending to the pulp cause extreme pain while chewing or biting as the chewing forces are directed on to the nerve fibres situated in the dental pulp. If the layer of insulation (dentin) is moderately thick in the cavity formed, the pain on chewing is less. If the dentin layer is very thin or is absent, there is excruciating pain when anything pokes the dental pulp within the cavity.
The treatment option recommended for this type of problem is the restoration of the tooth after the removal of the decayed layers of tooth. There are various types of restorative materials available like tooth coloured and non-tooth coloured. If the cavity extends beyond the level of dentin i.e. into the pulp, then root canal treatment is the ideal treatment option.
Inflammation of the gums or loss of attachment from tooth root can be a contributing factor for pain on biting and chewing. Gingival inflammation can occur as a result of poor oral hygiene. When the food debris is not removed properly during brushing or rinsing of mouth, it accumulates in the area between the teeth and gums. This irritates the soft gums, in turn, and they respond by undergoing the process of inflammation. The swollen gums become extremely sensitive and bleed easily during activities like brushing. If the oral care is neglected the gum inflammation moves on to the next level- loss of attachment. Once the gums get detached from the tooth surface, there is a chance for the formation of periodontal pocket. Pockets worsen the condition because they become the area for collection of debris that cannot be eliminated easily. Exposed root surfaces causes pain while chewing. The gingival inflammation can have other causes like hereditary periodontal disease, habits like smoking and lifestyle diseases like diabetes.
The treatment of gum problems is based on the measures like oral prophylaxis to eliminate plaque and calculus (hard deposits). In progressive conditions, curettage and root planning are suggested to ensure for detailed cleaning.
As age progresses, the dentin layer wears off. This is called attrition of teeth. Tooth gets worn down due to abrasion (physical wear) or erosion (chemical wear). Due to physical trauma like hard tooth-brushing, there is loss of gum tissue in that area which leads to exposed tooth root surfaces. In both the above mentioned cases, the patient experiences pain while biting or chewing. Hypersensitivity can be felt as a short, sharp, pain like sensation that lasts for few seconds while consuming items that are either hot or cold.
This condition is generally treated by the application of topical fluoride gels and sensitivity toothpastes. If the condition is severe and pain is unbearable, root canal treatment is opted.
This factor can also contribute to the pain while biting or chewing. The tooth is generally healthy without any trace of dental decay or gingival disease. The tooth gets fractured due to excessive biting forces that are usually generated while biting hard objects. The detection part is difficult because the external features like dental decay are not present. A light is used to detect the fracture line. Through that crack the dental pulp gets exposed leading to toothache while chewing.
The treatment for this problem comprises root canal procedure and the placement of a metal ceramic crown thereafter.
Impacted teeth can be a source of pain in some cases. Impacted teeth push the neighbouring teeth to create space for their eruption. This can generate tremendous pain in the lower jaw mainly.
Painkillers provide some amount of symptomatic relief. The final treatment is the surgical elimination of the impacted tooth.
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