As the saying goes, “a toothache is not a disease, but a pain that really kills you”. Toothache is a common problem that many people are troubled by, and because people are unable to accurately determine the severity of the disease that causes toothache, it often causes irreversible lesions by the time they seek medical attention, and treatment is time-consuming and laborious. Due to the prevalence of this situation, it is important to grasp some basic principles of judgment and to seek timely medical attention when symptoms are detected. Different stages of toothache Most of the toothaches are closely related to tooth decay (also known as “tooth decay”) and pulpitis caused by tooth decay, and the degree of inflammation progress also determines the severity of toothache. Generally speaking, this toothache can be divided into 5 progressive levels: 1. When a cold or sweet stimulus can trigger a short (lasting a few seconds) and sharp pain in the affected tooth, it means the emergence of reversible pulpitis. If proper dental treatment is obtained at this point, the pulpitis does not have permanent consequences and the living pulp tissue can be preserved. 2. If the pain changes from (1) to a dull, throbbing pain that occurs spontaneously or is caused by a change in temperature and is not accompanied by swelling, then the stage of irreducible pulpitis has been reached. The pain is less severe than before, but can last for several hours and often interferes with sleep. Irreducible pulpitis also requires effective dental treatment to maximize tooth function, and taking antibiotics or painkillers will not be effective at this time. 3. If pulpitis is not effectively treated, it will progress to pulp necrosis and the pain will be temporarily relieved. However, due to pulp necrosis, bacteria and harmful products from bacterial decomposition of the pulp will enter the root tip, which will cause periapical inflammation with pain when the affected tooth is bitten or pressed. At this point, dental treatment is still necessary, and although antibiotics are effective, they are not always necessary. 4. If periapical infection remains untreated effectively, it may progress to an acute apical abscess. At this point, the affected tooth will become loose and the periodontium will become swollen, accompanied by biting pain. Dental drainage treatment to exclude the abscess is necessary for the patient, and antibiotics may also provide some relief. 5. Acute apical abscesses can also spread to the surrounding soft tissues and cause pharyngitis, which can then manifest as abscesses in the neck and other areas, sometimes affecting the respiratory tract. This condition is often more serious and requires emergency hospital admission. Tips for recognizing a dangerous toothache The above description of the different stages of toothache has provided an overview of the different causes of toothache, but it may not be sufficient to recognize a toothache that is rapidly progressing and has a tendency to cause systemic infection. The following are tips for identifying dangerous toothaches: Examine the swollen area: If the pulp infection has spread to the adjacent tissues, swelling of the affected area will be the first sign. Toothache with swelling around the jaw or around the eyes indicates that the infection has spread, and if it is accompanied by difficulty opening the eyes, it is more dangerous and requires urgent medical attention. Assess the degree of opening: In a normal person, the distance between the middle two incisors with a large opening (also known as the degree of opening) is sufficient to accommodate two to three fingers. If the opening suddenly fails to accommodate two fingers during a toothache, it is evidence that the infection has spread to the vicinity of the masticatory muscles, again requiring urgent medical attention. Other indications of infection spread: In rare cases, the infection causing the toothache may spread systemically and can even be life-threatening. Toothache accompanied by difficulty swallowing, breathing or speaking, and sudden onset of fever are all signs of systemic spread of the infection.