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.

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 untreated. 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 resulting in your typical toothache. There are two classifications that are based on the type of surface on which the decay is found:

1.Smooth Surface Caries 2. Pit and Fissure Caries

The most obvious symptom of a toothache resulting from dental caries is pain in the latter stages. 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, but is found most frequently in virgin teeth 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 manifestations of periodontal disease, cracked teeth, and loose (mobile) teeth,

When the decay is large and the tooth is badly broken down, you can suspect that the source of pain is a toothache. 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 root 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 there usually no systemic problems associated with this condition there may be fever and lymphnode involvement. Note: If swelling is present do not iniate treatment with the following medications. Contact your dentist or contact an emergency dentist so that antibiotic therapy can be iniated. It should be noted that if a periapical abcess is chronic there may be no clinical features due to localization and necrosis.