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77 Tamarack Circle, Montgomery, NJ 08558People often refer to IQ and EQ as measures of different types of intelligence. In dentistry, we use a similar term: Dental IQ, a concept that represents a person’s level of basic dental knowledge. High Dental IQ reflects stronger awareness of prevention, better ability to self-screen for common dental problems, and a clear sense of what to do when dental issues occur. More importantly, it encompasses the ability to form realistic expectations about possible treatment and take swift, effective action early on. This series is meant to help non-dental professionals raise their Dental IQ.
The day before New Year’s, I saw three patients who came in with tooth pain. There’s a saying: “A toothache isn’t a disease—but when it hurts, it can be agonizing and unbearable torment.” That line is half true and half false: “When it hurts, it can be agonizing and unbearable torment” is true; “a toothache isn’t a disease” is false.
The patients I saw that day were quite representative of common dental emergencies that can be easily prevented or handled well with a bit higher dental IQ, so I want to share their stories to help more people in need.
Patient #1: A Senior Female Physician Who Is Deeply Afraid of the Dentist
The first patient was an experienced female physician who was deeply fearful of dental visits despite being a health professional herself. She told me she would avoid dentists whenever possible because she felt miserable after every dental appointment. The last time she came was also because of pain… more than two years ago. When the pain became so bad she couldn’t eat, so she had no choice but to come in.
I examined her painful tooth: there was a huge cavity, already decayed all the way to the nerve. That was classic pulpitis, or infection of the dental nerve. That meant major treatment was necessary: removing the nerve, root canal therapy (therapy of cleaning and sealing the nerve chamber), and then a crown or a cap. Recovery would also take time. I took the opportunity to ask her:
“When you said you always feel awful after dental visits, was it because each time you needed rather big procedures? When was your last dental cleaning?”
She replied, “Yes. My teeth have always been terrible. I’m so busy at work, I can’t even finish all the recommended treatments, and I don’t have time for cleanings.”
I couldn’t help thinking: How can we help her break out of this cycle? How can we help more people understand that it’s such a pity to let dental disease progress this far; why not love yourself a bit more and come in earlier?
A common reason why some patients neglect their dental health is because they don’t understand the consequences of forgoing routine dental care. Many people believe dental disease is something that suddenly occurs, like the flu, and might treat it similarly, by just taking some over-the-counter medicines, but these are dangerous misconceptions. Dental disease is something that develops over time, and medication generally isn’t effective for curing dental disease. As such, I want to explain dental nerve infection in simpler language: how it develops, what early symptoms look like, and how to prevent it.
How Pulpitis Develops (in simple language)
Pulpitis is a bacterial infectious disease. It often starts as a small cavity on the tooth surface. Bacteria first attach to the tooth and, over time, form dental plaque and calculus: calcified “ bacteria city” on the teeth, akin to a fortress that sits outside your immune system’s direct reach and protects itself.
Bacteria in the mouth “feeds” on food you take in the mouth, and produces acid as a waste product, which in turn erodes the enamel (see reference image) on the tooth surface. The mouth eventually produces saliva to counteract the acid, but acid erosion can overrun the body self defense system and build up over time. Furthermore, drinking acidic drinks like sugary sodas will expedite this process, which is why dentists caution against them. Enamel erosion via acid progresses slowly because enamel contains a lot of minerals and is very hard; it is often asymptomatic (no symptoms), and many cavities at this stage are only noticed on a dental X-ray.
Bacteria multiply exponentially: one becomes two, two becomes four, snowballing rapidly. Once decay reaches dentin (see reference image), the process can accelerate dramatically because dentinal tubules (microscopic tube-like structures that run from the dentin to the pulp (see reference image), the innermost part of the tooth) provide physical pathways that make bacterial spread easier.
At this stage, depending on your pain threshold and sensitivity, you may start to notice symptoms such as sensitivity to cold and hot. But without trigger, the discomfort may seem minor. Some people think, “Fine, I just won’t eat or drink very hot or cold things.” The problem is: at this point, the nerve is sending an early red alert: it isn’t fully inflamed yet, but it’s warning you. Because the warning only shows up with certain stimuli (cold, heat, sweet foods), many people ignore it. Nonetheless, routine dental exams and X-rays can usually diagnose this stage easily, and treatment is relatively straightforward.
If you come in for regular cleanings every six months, cavities can be identified and treated at this stage without problems.But if you ignore these small alarms, whether due to busy life style, fear, or because you’re simply not very sensitive, the decay continues. Symptoms may then enter an intermittent phase: sometimes present, sometimes not.
Pain perception depends on nerve signals. When the brain receives pain signals, it integrates them and tell other parts of the body what to do. People with strong action force may schedule a dental visit right away upon receiving the first signal. But if it’s not their top priority at the time, it might get suppressed. If that signal suppression happens repeatedly, the brain can gradually “learn” to ignore it. This is called desensitization or habituation: getting used to the pain, ignoring it until a stronger pain signal forces you to pay attention.
Some people take painkillers and pray to hope it is taken care of. Others say, “It’s just life stress,” and try self healing remedies, aka: rest, wait and see; some even misuse antibiotics. Unfortunately, at this stage, none of these fix the root problem.
A key reason is the blood supply. Dentin has almost no blood supply. It relies mainly on the nerve-and-blood-vessel system inside the pulp chamber, and even that support is limited to a weak “siphon-like” supply. As a result, medications carried through the bloodstream often cannot effectively reach the places where bacteria are hiding and spreading within tooth structure.With the same reason, body self defense system like white blood cells, macrophages and antibodies cannot reach far enough to destroy the bacteria city inside of the dentin.
If no proper treatment is done, bacteria eventually travel down and reach the pulp chamber. Symptoms may escalate into spontaneous pain even when doing nothing, pain that lasts for hours after a sip of cold water, waking up at night with throbbing pain, and even chewing pain that seriously affect daily life.
People may ask: “Why can a throat infection most of the time resolve with antibiotics, but pulpitis usually can’t?” It comes back to blood supply. The throat has rich circulation; antibiotics can reach its “battlefield” easily, leaving bacteria with nowhere to hide. With adequate dose and duration, bacteria can be extinguished and the disease is cured. A tooth, however, has a much narrower route: the pulp is accessed mainly through the single neurovascular bundle entering at the root tip (essentially, there’s just one small connection). When that pathway is still relatively “open,” antibiotics may sometimes reduce symptoms temporarily, but remember where the bacteria came from: they started on the tooth surface and traveled inward through many areas with poor blood supply where they can “hide”. This is why antibiotics can relieve pulpitis but rarely eradicates it. And no one can take antibiotics long-term without causing additional more serious problems. Once you stop, bacteria will rebound. Each recurrence further damages the neurovascular bundle. Eventually, when that bundle “collapses,” infection can travel through the root canal to the root tip and into the surrounding bone, causing apical periodontitis: infection of the bone- a more advanced stage of the disease.
At this stage, the main symptom is often severe spontaneous pain and biting pain, sometimes with a throbbing pulsating sensation. It may make a person feel miserable because the top and bottom teeth can barely touch otherwise excruciating pain occurs. Because teeth are dense structures, inflammatory fluid, pus, and pressure build up inside and cannot expand or drain easily. The pressure then pushes infection toward the root tip, exits through the apical foramen, reaches the surrounding alveolar bone, and begins to erode it. On X-ray, the bone density around the root tip decreases and appears as a dark area, indicating bone “eaten away” by bacteria.
By this point, if you still hope to solve it with medication alone, the effect is usually even more limited because it’s even harder for drugs to get to the inside of the tooth with the neuro vascular bundle being collapsed. The only way to treat this is to remove the decayed tissue at the source and clean out the bacteria. That means root canal treatment, filling/sealing the canals, and then placing a strong protective crown.
The Point: Tooth Pain Usually Isn’t a Sudden “Disaster”
Most toothaches aren’t sudden catastrophes. They are your body trying, again and again, louder each time, to tell you that something’s wrong. This started long ago. You’ve just been toughing it out, delaying, hoping it will go away on its own.
But for many dental problems, the most “easy, affordable, tooth-saving” window is often at the very beginning, when there’s only a slight sensitivity, the faintest discomfort.
The better approach is not complicated: replace “wait until it hurts” with regular checkups and prevention. See a dentist routinely so a dental professional can monitor your oral health systematically. Take X-rays when needed, get cleanings when needed, and fill small cavities early. Using prevention as the best treatment often saves not only money, but also stress, and it protects your future self.
Author｜Joyce Guojun Ma, DDS, PhD
General Dentist | MAGD | DABOI/ID | DICOI | DABDSM
Practicing medicine in the three eastern states (NJ / NY / PA)
Peking University School of Stomatology | New York University School of Dentistry |
Johns Hopkins University Neuroscience PhD
Specializing in: Preventive dentistry, Occlusal function, Full mouth reconstruction, Periodontal laser treatment, Implants and bone grafts, Cosmetic orthodontics, Temporomandibular joint disorder (TMD), and Sleep-disordered breathing (OSA).