Toothache caused by carious processes.

Tooth decay is a chronic, destructive, infectious process affecting the tooth surface.

We are at risk of developing carious lesions every day, through the foods we eat, the degree of hygiene we observe or the peculiarities of our bodies.

Stages of carious development

  • Demineralization:

Enamel is made up of hydroxyapatite prisms, a substance that is susceptible to acid and bacterial attack.

The first manifestation of a caseous lesion is the appearance of white, chalky, matt stains on any of the dental surfaces.

This process represents demineralization, when Calcium ions detach from enamel prisms, allowing bacteria to exert their destructive effect.

  • The appearance of enamel lesions: these are small depressions in the enamel, detectable by palpation with a probe but also by visual inspection. They may be brown in color.

  • The appearance of lesions in the dentine: dentine is the layer of dental tissue under the enamel where the nerve endings of the dental pulp, responsible for tooth sensitivity, are located.

  • Once in the dentine, any carious process evolves more rapidly due to its weaker mineralization.

  • If the patient has an increased susceptibility to develop carious lesions, the factors favoring the development of caries in the oral cavity will lead to caries reaching the pulp chamber quite quickly.

  • Pulp chamber involvement: the pain becomes more acute and removal of the carious process reaches the pulp chamber.


Treatment at this stage is pulpectomy, i.e., removal of the nerve from the root canals and pulp chamber.

Pain due to carious processes can manifest itself in a variety of ways, from tenderness, triggered by the consumption of foods with extreme temperatures, to harsh manifestations that wake the patient from sleep.

Types of dental sensitivity

Dentin hyperesthesia

Occurs in deep carious processes that do not reach the pulp chamber. At this stage, the pain appears sweet, cold, never spontaneous and subsides on treatment with analgesics. By removing the carious dentin, the pain disappears.

Acute pulpitis

In this stage the pulp chamber is reached by the carious process. In the early stages, pain is provoked and succumbs to painkillers. When the provoking stimulus is removed, however, the pain persists for another 20-30 minutes. Over time, as the bacterial load in the pulp increases, with the creation of direct communication between the contaminated external environment and the internal environment (represented by the pulp chamber), the intensity of the pain increases. These may wake the patient at night, radiate to neighboring teeth or nearby structures.

If the pain is pulsatile (pain sensation that is not continuous, but rhythmic), it is most likely due to an accumulation of pus in the root chamber and root canals.

Chronic pulpitis

If the pain is ignored by the patient, if it is bearable, it may disappear. However, the infectious process does not go away, and it can become more acute at any time, with painful symptoms.

Treatment of carious lesions

In the first stage, that of demineralization, therapy is conservative, re-mineralizing with chlorhexidine solutions or varnishes and pastes applied by the dentist in the surgery. Good, systematic hygiene helps in the fight against caries.

In carious processes with a lack of substance, the therapy is to remove the altered dentine and reconstitute the dental tissues with composite materials, glass ionomers, amalgams or prosthetic techniques, depending on the case.

Through prevention, regular dental check-ups and thorough hygiene, the patient can minimize the risk of caries.

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