Generally, the ER is unable to treat dental pain beyond prescribing antibiotics.  Only your neighborhood dentist has the necessary tools to diagnose and treat tooth pain.

Tooth pain has a variety of causes and treatments.  Let’s review some of the major causes and treatments:

Tooth infection – Each tooth has a blood and nerve supply that runs through the root called the “pulp.”  When dental decay gets close enough to the pulp, bacteria can cause pulpal infection. Your body responds by sending infection-fighting cells to the tooth, which causes inflammation.  Unlike the rest of the body, there is no compliance in the tooth for swelling, so pressure builds up to cause pain and sensitivity. Treatment: Any time you start to experience tooth pain, you should pay a visit to your dentist.  Only your neighborhood dentist can determine the best long-term treatment, which depending on the level of decay, may involve a filling, root canal, or extraction.

Recent dental treatment – The mouth is constantly working to keep things in balance.  Recent extractions, fillings, or even cleanings can leave the mouth sensitive or sore.  As your teeth get accustomed to recent treatment, the symptoms almost always go away in a matter of days or weeks.  Sometimes, intervention is necessary to correct problems with recently performed dentistry. In the meantime, most people can take an over-the-counter pain reliever (like Tylenol or Ibuprofen) to help relieve some of the discomfort.

Tooth fracture –  Most commonly seen in patients with habitual grinding, malocclusion, or large dental restorations, teeth may become fractured over time due to a one time high-stress event or repeated low-stress trauma.  The fracture can occur in such a way that the tooth isn’t loose. These teeth can be more difficult to diagnose if the fracture is below the gum line, because they often appear intact on x-rays and exams. Visit your neighborhood dentist for help in diagnosis of fractured teeth.

Periodontal disease – The roots of your teeth are more sensitive to temperature and other stimuli than the hard enamel.  If your gums erode due to periodontal disease to the point that the root is exposed (looks yellow closest to the gums), you may experience increased sensitivity and pain/discomfort.  Try switching to an anti-sensitivity tooth paste for two weeks and see if sensitivity improves. Your neighborhood dentist will have more treatment options to fight periodontal disease.

A crown is fabricated unit that fits over a prepared natural tooth to restore lost function and/or esthetics.

So what does it cost?  To the dentist, this question can be as complicated as “How much does a vehicle cost?”  There are fast sports cars, big semi-trucks, camper vans, SUVs, old beaters, etc. and vehicles can cost anywhere between a few hundred dollars to a few hundred thousand!  Each one has a specific purpose and related cost. So let’s break down why this question is so complicated:

The ideal crown looks like a natural tooth.  It has layered elements of opacity and translucency and perfectly matches the neighboring teeth in shape and color.  The ideal crown must also be strong enough to endure the rigors of chewing but not so strong that it damages the other teeth that it bites up against on the other side.  The ideal crown must be smooth, non-toxic, and water-proof. It must be extremely durable, but it also needs to be easy to work with to get a perfect fit. No single material can do it all!  Right now we have a handful of materials that have varying degrees of each quality.

Cheapest: Stainless steel crowns – Stainless steel crowns are pre-fabricated to allow for easy placement, but they do not form a good seal with the natural tooth, and are therefore typically limited to placement on primary (baby) teeth that will be exfoliated before the seal becomes problematic. 

Best function: Gold!  Gold crowns hold up really well over time! Gold does a good job mimicking natural enamel, and it is malleable so it won’t fracture very easily.  Gold is easy to work with and will not corrode spending its lifetime in saliva. Repairing gold crowns is possible, which can lower the lifetime cost of a crown if something were to happen to it.  The biggest drawback to gold crowns is that gold crowns look like gold crowns, and patients don’t always want it to be obvious that dental work has been done. The price of a full gold crown can fluctuate based on the price of gold.

Good compromise: Porcelain-fused-to-metal.  These crowns attempt to combine the great properties of gold with more natural-looking white of porcelain.  Porcelain-fused-to-metal crowns are more opaque (less transparent) than a natural tooth, and over time the porcelain can fracture off of the metal framework.  The fabrication of porcelain-fused-to-metal crowns is more involved than full-gold, and the extra lab time causes increased cost.

Best esthetics:  Many different ceramic materials are available for crown fabrication.  There is a general trade-off between how natural a tooth looks and how strong it is.  Dentists tend to put the stronger ceramic materials in the back teeth that do a lot of grinding and put the better-looking materials in the front where strength is not as important as natural looks.

In addition to the part of the tooth that you can see in your mouth, each tooth has at least one long root that extends up to three times the length of the visible part into your jaw bone.  There are nerves and a blood supply called the “pulp” that go up through the root which help with sensation and nourishment to the inner tooth structure.

When the pulp is compromised through a cavity or trauma, bacteria can cause an infection that the body attempts to fight off.  By the time the patient starts feeling symptoms of this infection (pain/swelling), the tooth has already lost the fight and it’s time for a root canal.

A root canal is a deep filling that removes all the pulp/infection tissue down to the tip of the tooth and plugs it up with filling material.  The tooth is no longer susceptible to infection. The downside to a root canal can be a weakening of the tooth and discoloration. To combat the esthetic and structural challenges of a root canal, your neighborhood dentist will often place a crown on the treated tooth to ensure long-term durability.

Root canals are typically done under a local anesthetic which numbs the tooth and surrounding tissues for the procedure.  Most patients undergoing root canal treatment don’t feel a thing! Root canals got a bad reputation long ago when anesthetics were not as effective as they now are.  Modern techniques and chemical formulations enable dentists to provide great comfort to patients undergoing root canal therapy.