What usually causes a toothache?
Decay is the most common cause. Once it gets through the enamel into the softer layer underneath, the tooth starts reacting to sweet, hot and cold things, and if it reaches the nerve the pain gets stronger and lasts longer.
Other common causes are a cracked tooth, a filling that has broken or started to leak, an infection at the tip of the root (an abscess), a problem in the gum around one tooth, and a wisdom tooth coming through at the back. Grinding your teeth at night can make healthy teeth ache as well.
Not every pain in a tooth starts in the tooth. A blocked or infected sinus can make the upper back teeth ache, often several at once and worse when you bend forward. Sore jaw muscles can feel like toothache too.
What does the type of pain tell you?
A short, sharp twinge with something cold or sweet that stops as soon as the cold has gone usually means sensitivity or early decay. Book a check, but it is rarely urgent.
Pain that lingers for minutes after something hot or cold, throbs on its own, or keeps you awake at night usually means the nerve is inflamed. That tends to need root canal treatment or, if the tooth cannot be saved, removal, so have it seen soon, ideally within a day or two.
A tooth that hurts when you bite or tap on it, especially with a bad taste or a small swelling on the gum, often points to an infection at the root. A sharp pain only when you bite on one spot, or when you let go, is typical of a cracked tooth.
These are patterns, not a diagnosis. An examination, and usually an X-ray, is what tells the cause.
What can you do until you are seen?
A painkiller taken exactly as the pack says can take the edge off the pain. Many pain tablets combine two medicines, often paracetamol with something else, so do not take two products that contain the same one. If you are pregnant, have a medical condition, take other medicines, or it is a child in pain, ask a pharmacist which one is safe.
Rinse with warm salt water, brush gently around the tooth and floss to free any food caught between the teeth. Chew on the other side, avoid very hot, cold or sweet food, and an extra pillow at night can ease a throbbing tooth. Clove oil, dabbed on the tooth with a little cotton and kept off the gum, which it can burn, may give some short-term relief. It does not treat the cause.
A few things to avoid. Do not hold a tablet against the gum, because it can burn it. Do not put a hot pack on your face. And do not take leftover antibiotics or ones bought without a prescription. They do not fix a toothache, and the wrong medicine can hide an infection that is getting worse.
When is toothache an emergency?
A swelling that spreads towards the eye or into the neck, swelling under the tongue or the tongue being pushed up, drooling or a muffled voice, difficulty swallowing, breathing or opening your mouth, a high fever, or feeling very unwell is an emergency. Go to a hospital emergency department, and call 108 if breathing is difficult.
If your gum or face has started to swell but none of those signs is there, how to tell when a dental swelling is urgent is covered in its own guide.
Pain in the lower jaw or teeth that comes with chest pain or tightness, pain down the arm, breathlessness, sweating or feeling sick, or jaw pain that comes on when you walk or climb stairs and eases when you rest, can be a heart problem rather than a dental one. Call 108 for an ambulance straight away rather than getting yourself to hospital.
A tooth knocked out or broken in a fall or an accident is urgent for a different reason, and the first hour after a dental injury is when what you do matters most.
What will the dentist do?
Find the cause first. That means questions about the pain, a look at the tooth and the gum, a few simple tests such as tapping the tooth or touching it with something cold, and usually an X-ray.
Treatment depends on what is found. Decay that has formed a cavity is filled, and very early decay can sometimes be stopped with fluoride and watched. A tooth whose nerve is badly inflamed or infected usually needs root canal treatment, and often a crown afterwards. An abscess is drained and its cause treated. A tooth that cannot be saved is taken out, and the ways to replace it are explained.
If the pain has eased by the time you are seen, still describe exactly what it was like. Pain that stops on its own can mean the nerve has died, and an infection can then carry on without hurting.
Who sees toothache at STHIRA?
Check-ups and fillings are done by the clinic's own dentist. Complex root canal cases are treated by Dr Manish Khazane, our visiting endodontist, and abscess drainage and difficult extractions by Dr Bhargav Kuchu, an oral and maxillofacial surgeon.
The clinic is open Monday to Saturday, 10:00 am to 8:30 pm, and Sunday, 10:00 am to 2:00 pm. If you are in pain, get in touch with the clinic and say so when you book. If any of the emergency signs above are there, go to a hospital instead.
Decay caught early can usually be dealt with by a filling, and sometimes needs no drilling at all. Our page on tooth-coloured fillings explains what that involves.
Common questions
How long can I leave a toothache?
A twinge with cold that passes quickly can usually wait for a booked appointment. Pain that throbs, lingers or wakes you at night should be seen within a day or two. A swelling that spreads towards the eye or into the neck, or makes it hard to swallow, breathe or open your mouth, or comes with a high fever, is an emergency. Go to a hospital emergency department, and call 108 if breathing is difficult.
Why does toothache feel worse at night?
When you lie flat, more blood reaches the head and an inflamed tooth can throb more, and there is less to take your mind off it. Pain that wakes you usually means the nerve is inflamed, so have it checked soon.
Can a toothache go away on its own?
The pain sometimes stops, but the cause usually has not gone. Pain that disappears after days of throbbing can mean the nerve has died, and an infection can then carry on quietly. Have the tooth checked even if it feels better.
Should I take antibiotics for a toothache?
Not on your own. Antibiotics do not cure most toothache, and they are usually only needed when an infection is spreading, for example with facial swelling or fever, or for some people with particular medical conditions. A dentist decides that after examining you.
Can a sinus problem cause toothache?
Yes. A blocked or infected sinus can make the upper back teeth ache, often several together, and the pain is often worse when you bend forward. A dentist can check whether the teeth themselves are the cause.