Toothache

Toothache can be caused by many factors, and patterns are generally classified according to repletion and vacuity. Repletion patterns usually involve the hand and foot Yangming (ST&LI) channels which pass through the lower and upper gums respectively

Causes of Toothache
-Dental caries: the most common cause of toothache -Periodontal disease: the second most common cause of toothache -Fractured tooth -TMD -Tooth impaction -Tooth eruption -Pain from other causes/locations can refer to the teeth resulting in toothache: -Earache -Sinusitis -Heart attack/myocardial infarction (can include jaw pain, neck pain, or toothache)
 * Dental Causes:**
 * Non-Dental Causes:**

Symptoms
may include: -Tooth pain that may be sharp, throbbing, or constant. In some cases, pain results only when pressure is applied to the tooth, or upon exposure of the tooth to cold, hot, or acidic foods or drinks. -Swelling around the tooth -Fever -Headache -Foul-tasting drainage from the infected tooth

TCM Disease Categorization
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TCM Etiology and Pathogenesis
-Wind-Heat invasion of the Yang Ming channels: Wind-Heat transforms into Fire which flares up along the Yang Ming channels of the face causing toothache -Diet: excessive intake of spicy, greasy, or sweet foods leads to Heat accumulation in the Stomach and Large Intestine. This Heat transforms into Fire which then flares up along the Yang Ming channels of the face causing toothache. -Aging, excessive sexual activity, chronic disease: these can weaken the Kidney Yin/Essence resulting in failure to strengthen the teeth (which are the “surplus of the bones”) and upward flaring of vacuity Fire causing toothache.
 * Repletion:**
 * Vacuity:**

Wind-Fire Toothache
LI-4, ST-7, ST-6, TW-5, GB-20 Auxillary Points: toothache because of dental caries + LI-2, SI-5 Swelling of the gums + TW-20, SI-8 Headache + Taiyang
 * Clinical manifestations:**Periodic toothache w/ redness and swelling of the gums, accompanied by aversion to cold, fever, dry mouth, thirst
 * Tongue:** Thin Yellow coat, possibly red tongue or red tip
 * Pulse:** Rapid, Floating
 * Treatment Method:** Course Wind, clear heat, disperse swelling, relieve pain
 * Acupuncture Treatment:** Needle w/ draining technique
 * Herbal Treatment:** Bo He Lian Qiao Fang or Yin Qiao San

Stomach Fire Toothache
LI-4, ST-7, ST-6, ST-44, PC-8 Auxillary Points: toothache because of dental caries + LI-2, SI-5 Swelling of the gums + TW-20, SI-8 Headache + Taiyang Modifications: Constipation: + Da Huang (9g.) Swelling & pain of gums w/ severe bleeding: + Shi Gao (30g.), Zhu Ye (9g.), Xuan Shen (9g.), Ban Lan Gen (9g.), Bai Mao Gen (15g.)
 * Clinical manifestations:**Excruciating toothache, severe swelling of the gums, exudation of pus w/ bleeding in some cases, pain generally radiating to the cheeks, headache, fever, thirst, halitosis, constipation
 * Tongue:** Red w/ Thick Yellow coat
 * Pulse:** Surging, rapid
 * Treatment Method:** Drain Stomach Heat, cool the blood, disperse swelling, relieve pain
 * Acupuncture Treatment:** Needle w/ draining technique
 * Herbal Treatment:** Qing Wei San

Vacuity (KI) Fire Toothache
Accompanying signs include weakness & aching of lower back & knees, dizziness and vertigo, blurred vision dryness of the mouth w/out desire to drink. LI-4, ST-7, ST-6, KI-3, LR-2 Auxillary Points: toothache because of dental caries + LI-2, SI-5 Swelling of the gums + TW-20, SI-8 Headache + Taiyang Modifications: To strengthen the Kidney & relieve toothache: + Gu Sui Bu (12g.)
 * Clinical manifestations:** Dull intermittent toothache, slight redness & swelling of the gums, atrophy of the gums, loosening of the teeth, loss of force in biting, increase in pain during the afternoon, no apparent foulness of breath.
 * Tongue:** Red, tender w/ little coat
 * Pulse:** Rapid, thready
 * Treatment Method:** Supplement Kidney Yin, drain fire, relieve pain
 * Acupuncture Treatment:** Needle w/ even supplementation, even draining technique
 * Herbal Treatment:** Zhi Bai Di-Huang Tang

Acupuncture for Toothache
Wind-Fire: LI-11, TB-5, GB-20 ST Fire: ST-44, LI-11, L-I2 ST Fire causing KI Yin vacuity with vacuity Fire: ST-44, KI-2, KI-6 KI Yin vacuity with vacuity Fire: KI-2, KI-3, KI-6, LV-2 For toothache because of dental caries: LI-2, SI-5 For swelling of the gums: TB-20, SI-5 For headache: Taiyang
 * Basic points:** LI-4, ST-6, ST-7
 * Modification based on the pattern:**
 * Additional points based on symptoms:**

Acute - LI-4, ST-44, TW-2
 * Sanzhen protocol:**

Alternate Therapeutic Methods
Method: needle to elicit strong sensation & retain needles for 20-30 minutes. Alternatively embed needles for 2-3 days.
 * Auricular Acupuncture:** Maxilla, Mandibula, Tragic Apex, Adrenal, Shen Men