This is where the damage which leads to the hole or cavity breaks through the tough enamel and dentine in the tooth all the way to the nerves and I think that leads to swelling and pain.
All of your teeth cover nerves in your gums. So when you get a hole in your teeth, the nerve is exposed and this is why you get increased sensitivity. If this area gets infected and inflamed then this is when really bad toothache can begin.
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