Toothache (odontalgia) is an acute symptom indicating damage to the hard or soft tissues of the dentomaxillofacial system. In Barcelona, with its specific climate (high humidity, Mediterranean air), the body's reaction to inflammatory processes can be more pronounced. Warm, humid air promotes tissue swelling, and temperature fluctuations (air-conditioned spaces and outdoor heat) can exacerbate dentin hypersensitivity. This condition can affect all age groups and both sexes, however, the peak of emergency dental visits occurs in adults aged 20 to 50. Ignoring the symptom leads to the progression of caries, pulpitis, apical periodontitis, and the risk of developing odontogenic abscesses.
Types and Localization of Tooth Pain: Clinical Picture
Pain classification is based on its character, intensity, and triggers, which is key for preliminary diagnosis. Acute paroxysmal pain, worsening at night, is characteristic of pulpitis — inflammation of the neurovascular bundle (pulp). Dull constant pain, localized to a specific tooth or diffuse, may indicate chronic pulpitis or incipient apical periodontitis. Throbbing, intense pain with clear localization, worsening when lying down, often accompanies acute suppurative apical periodontitis or a periapical abscess. Pain when biting (dentin sensitivity) is typical for apical periodontitis or dental trauma. Brief pain from thermal and chemical stimuli is a sign of dentin caries or dentin hypersensitivity.
Etiology: Main Causes and Pathogenesis of Diseases
The primary cause in 95% of cases is the microbial biofilm (dental plaque), whose metabolism leads to enamel demineralization and the development of caries. Without treatment, the carious process penetrates the dentin and then into the pulp chamber, causing infectious pulpitis. The spread of infection through the apical foramen of the root leads to damage to the periodontal ligament and alveolar bone — apical periodontitis. Additional risk factors in Barcelona include: frequent consumption of acidic products (wine, citrus fruits), which promotes enamel erosion, and the habit of consuming cold drinks after hot meals, which causes microcracks.
Modern Diagnosis: From Anamnesis to High Technology
The diagnostic process in Spanish clinics follows a strict protocol and includes several stages. It begins with anamnesis and visual clinical examination using a probe and dental mirror. A mandatory step is digital periapical radiography (visiography), which allows assessment of caries depth, the condition of periapical tissues, and the quality of previous endodontic treatments. In complex cases, e.g., when a cyst or impacted tooth is suspected, cone-beam computed tomography (CBCT) is requested, providing a three-dimensional image. For the differential diagnosis of pulp vitality, cold tests (ethyl chloride) and electric pulp testing (EPT) are used.
Severity and Emergency Situations
Dental pain is classified by severity to determine the urgency of intervention. Mild degree: brief sensitivity that does not affect quality of life. Moderate degree: moderate constant or intermittent pain, relieved by analgesics. Severe (acute) degree: intractable, intense pain, often accompanied by facial swelling (cellulitis), fever, and general intoxication. The latter condition is an odontogenic emergency and requires immediate specialist attention for incision and drainage of the abscess and initiation of systemic antibiotic therapy (usually based on amoxicillin with clavulanic acid according to protocols of the Spanish Agency of Medicines and Medical Devices, AEMPS).
Treatment Protocols: From Conservative Therapy to Surgery
The choice of tactics depends on the final diagnosis. For caries, cavity preparation and restoration with light-curing composite are performed. Treatment of pulpitis requires endodontic treatment: under anesthesia, pulpectomy (removal of coronal and radicular pulp) is performed, followed by mechanical and chemical preparation of the root canals with nickel-titanium files and irrigation with sodium hypochlorite and EDTA, and subsequent obturation with gutta-percha using the lateral condensation technique. Apical periodontitis may require either endodontic retreatment or an apicoectomy — resection of the root apex. All procedures are performed using a rubber dam for isolation of the operative field.
Prevention Strategies in the Mediterranean Context
Effective prevention is based on eliminating etiological factors. Proper oral hygiene is key: brushing with fluoride toothpaste (1450 ppm F) twice a day, using interdental brushes or dental floss, and water flossers. Given the climate, maintaining good hydration by drinking water instead of sugary soft drinks is important. It is recommended to include foods rich in calcium and phosphates (cheese, almonds, fish) in the diet, and limit the frequency of carbohydrate intake. Mandatory measures include professional hygiene with removal of supra- and subgingival dental deposits (scaling and root planing) and preventive dental check-ups every 6-12 months, which fully aligns with the recommendations of the Spanish Society of Periodontology and Osseointegration (SEPA).
