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Recently, we did an email interview with Dr. Scott Biggs, an Endodontist(a dental specialist that treats the pulp or nerve of teeth). You can visit his website at http://www.lvendo.com/ 1.  Why are toothaches so painful? A toothache can many times be one of the most painful experiences one will experience in their lifetime.  The source of such pain can be very complex.  Inside the tooth (the pulp), where nerves and blood vessels reside, is a closed and non-expandable area.  When the pulp is inflamed due to cavities, bacteria, etc., the tissue becomes engorged yet has nowhere to go.  Thus, the nerves are in essence crushed causing constant stimulation of the nerve causing the pain of a toothache. 2.  What is the cause of the usual toothache pain? Toothache pain can be caused by a variety of factors.  The most common cause would be a cavity.  The bacteria from the cavity causes inflammation of the pulp inside the tooth causing the pain.  Cracks or fractures of a tooth can also introduce bacteria into the pulp causing the same problems.  Many times after routine fillings or other dental work, teeth can become sensitive to temperature changes for a period of time.  This is usually temporary.  Other causes of tooth pain or perceived tooth pain, are high fillings, exposed root surfaces, gum disease, temporomandibular joint disorders, cardiac problems (angina), sinus problems, earaches and other atypical facial pain. 3.  Why does a toothache wake you up at night? When the pulp of the tooth is inflamed and is not treated, a pulp can become irreversibly damaged and degenerate.  The most common symptoms associated with this degeneration, are sharp lingering pain to cold or hot and spontaneous pain.  Normally a nerve sends a signal to the brain when it has been stimulated telling the brain it feels pain.  When a nerve degenerates it will sometimes send signals to the brain without being stimulated.  This unstimulated signal causes the spontaneous pain that will wake you up at night.  4.  Why does the pain hurt like the dickens for days then just goes away? When a pulp has completely degenerated to a point where there is no longer vitality in the tooth, the tooth is called necrotic.  Many times at this point the severe pain that was experienced previously will go away.  Unfortunately this is usually short lived.  The pain will almost always return eventually, but this time as a dull aching, throbbing type of pain. Thank you to Dr. Biggs for this very informative article. http://www.sandquistdds.com/index.php/dental/smilebytes/4_questions_about_toothaches_and_tooth_pain/