2017 HCHB_digital

Toothache
Toothache is the term used for pain that occurs in and around the teeth and
jaws. The pain usually starts suddenly and it can vary from mild discomfort to a
severe throbbing, which is often worse at night and may be exacerbated by hot
or cold food or drinks.
A tooth has two main anatomical parts. The crown of the tooth is covered
with enamel and is visible in our mouths. The root is the part embedded in the
jaw that anchors the tooth into its bony socket. It is normally not visible. Beneath
the enamel lies a layer of dentine. Dentine is much softer than enamel, forms the
bulk of the tooth, and becomes sensitive if the protection of the enamel is lost.
The pulp is the innermost part of the tooth. It is made up of soft, sensitive tissue
that contains the blood and nerve supply to the tooth. The pulp extends from the
crown to the tip of the root.
Toothache happens when the innermost layer of the tooth – the pulp –
becomes inflamed. The most common reason for dental pulp inflammation is
tooth decay (dental caries). Tooth decay is caused by the action of acids on the
enamel surface. The acid is produced when sugars (ie, fructose, glucose, sucrose)
in foods or drinks react with bacteria present in the plaque on the tooth surface.
The acid produced leads to a loss of calcium and phosphate from the enamel by
a process called demineralisation. Saliva acts to dilute and neutralise the acid
that causes demineralisation and is an important natural defence against caries.
Saliva also has the ability to remineralise areas of destroyed enamel once the
acids have been neutralised. However, if the process of demineralisation exceeds
remineralisation, the caries progresses and a breakdown in the enamel surface
occurs leading to a cavity. Other causes of tooth pain include:
• a cracked tooth, loose or broken fillings, or a recently restored tooth
• a periapical abscess – pus which collects in the root as a result of an untreated
cavity, injury or prior dental work
• alveolar osteitis (dry socket) – pain that occurs in the tooth socket three to
four days following dental extraction. OTC analgesics will help relieve the pain
• pericoronitis – an infection of the soft tissue covering impacted wisdom teeth,
common in adolescents, which requires immediate referral to a dentist
• receding gums – contraction of the gums exposes dentine in the tooth root.
• Many people also suffer from “sensitive teeth”, when the teeth are exposed to
temperature extremes. The reason for the pain is unknown.
People at higher risk of dental decay
People considered at high risk of tooth decay (dental caries) include those:
• currently undergoing orthodontic treatment
• with a history of dental decay or precavitated lesion in the past three years
• with decreased salivary flow causing a dry mouth
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
[GENERAL SALE] eg, paracetamol (Panadol,
Paracare, Pamol suspension)
Effective at relieving pain but are not anti-inflammatory so will not relieve swelling or
inflammation in the area. Suitable for people with contraindications to NSAIDs.
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Oral hygiene products
Natural / herbal products /
supplements
[GENERAL SALE] eg, aspirin (Disprin range),
ibuprofen 25s (Nurofen range), ibuprofen
suspension (Fenpaed, Nurofen for Children)
eg, ibuprofen + paracetamol (Maxigesic,
Nuromol)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Rapid 25)
eg, ibuprofen + codeine (Ibucode Plus, Nurofen
Plus), paracetamol + codeine (Panadeine,
Panadeine Extra)
eg, interdental brushes, dental floss,
mouthwashes, personal water jets, toothbrushes,
toothpastes, xylitol or fluoride-containing
products, sugar-free gum
Clove oil, S. salivarius K12 and M18
Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical
conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customer to
stop taking if stomach upsets, increased bruising or prolonged bleeding occur.
Aspirin is not recommended for adolescents or children under 12 years old (see Childhood
Pain and Baby Teething: Treatment options). Avoid aspirin following dental surgery
(may prolong bleeding time). See Reference Section, OTC Medicines – Precautions.
Combination NSAIDs are effective for moderate pain. Warn customers that codeine is an
addictive substance and should not be used for more than three days at a time. Constipation
or drowsiness may also occur. Monitor sales and be alert for any customers who may be
misusing codeine-containing preparations.
Interdental brushes help remove plaque from between teeth and are an alternative to dental
floss. Both can help reduce tooth decay by removing food and plaque from the spaces
between teeth. Products containg xylitol or fluoride can decrease the risk of dental caries.
Mouthwashes (antiseptics) temporarily lower the number of bacteria in the saliva but are not
a substitute for regular teeth brushing.
Chewing sugar-free gum stimulates saliva production which is important for buffering food
acids, supplying minerals for remineralisation, and diluting and increasing clearance of food
debris from around the teeth. See Oral Health: Treatment options, for product details.
Clove oil applied directly to tooth with a cotton bud may act as a local anaesthetic until the
person can see a dentist. Can be fatal if swallowed. Keep out of reach of children.
S. salivarius K12 and M18 are oral cavity probiotics which are have activity against bacteria
implicated in bad breath, gingivitis, and tooth decay.
MANAGING PAIN
FREE
PROFESSIONAL DEVELOPMENT FOR
Pharmacy assistants, technicians and students
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Page 150 HEALTHCARE HANDBOOK 2017-2018 Common Disorders