About Toothaches
Common causes of toothache include tooth decay, pulp inflammation or infection, a dental abscess, gum disease, a cracked or damaged tooth, a loose or broken filling, an erupting or impacted wisdom tooth, and teeth grinding. Sinus disease or jaw-joint and muscle disorders can sometimes cause pain that feels as though it comes from a tooth.
Factors that can increase the risk of tooth decay, gum disease, or other conditions that cause toothache include:
- Poor oral hygiene or inadequate fluoride exposure
- Frequent sugary foods or drinks
- Tobacco use
- Dry mouth, including dry mouth caused by medicines or medical conditions
- Previous tooth decay, gum disease, cracked teeth, or dental restorations
- Teeth grinding or clenching
- Infrequent dental care or barriers to accessing dental care
Risk varies by age and health history, but age or sex alone does not reliably predict whether someone will develop a toothache. Brushing twice daily with fluoride toothpaste, cleaning between the teeth, limiting frequent sugar intake, avoiding tobacco, and receiving dental care based on individual need can reduce the risk of many causes.
Symptoms vary with the cause. A toothache may involve:
- Pain triggered by hot, cold, sweet foods, brushing, or chewing
- Sharp, aching, throbbing, spontaneous, or persistent pain
- Pain that lingers after a hot or cold stimulus is removed
- Tenderness when biting or when the tooth is tapped
- Red, swollen, tender, or bleeding gums
- A visible cavity, crack, broken filling, tooth discoloration, or a loose tooth
- A bad taste, drainage, bad breath, or a pimple-like bump on the gum
- Swelling of the gum, face, cheek, or jaw, sometimes with fever or feeling unwell
Symptoms do not follow a dependable “early” and “late” sequence. Clicking of the jaw is more commonly associated with a temporomandibular joint disorder than with toothache itself.
Arrange prompt dental care for severe pain, pain lasting more than 1 to 2 days, fever, pain when biting, a bad taste or drainage, or swelling of the cheek or jaw. Seek emergency care immediately if swelling around the mouth or neck makes it difficult to breathe, swallow, or speak, or if swelling extends toward the eye or neck.
A dentist diagnoses the cause of a toothache by reviewing the symptoms, medical and dental history, and recent injuries or dental treatment. The examination may include:
- Inspecting the teeth, fillings, gums, mouth, face, and jaw for decay, cracks, swelling, drainage, or other abnormalities
- Checking the painful tooth and nearby teeth by tapping them, assessing tenderness, and testing the bite
- Testing the tooth’s response to cold, heat, or an electric pulp test when pulp inflammation or damage is suspected
- Using dental X-rays when needed to look for decay between teeth, infection around a root, bone loss, an impacted tooth, or another problem not visible during the examination
Additional evaluation may be needed if the pain could be coming from the sinuses, jaw joint, muscles, nerves, or another medical condition. Routine lung examination and recording the type of erupting tooth are not standard methods for determining the severity of a toothache.
Treatment depends on the cause and aims to relieve pain while correcting the dental problem.
Dental treatment may include:
- Removing decay and placing a filling or crown
- Root canal treatment for an infected or irreversibly inflamed pulp
- Draining an abscess or treating gum disease
- Repairing a cracked tooth or damaged restoration
- Removing a tooth that cannot be restored
Pain relief and short-term self-care:
- Over-the-counter pain relievers such as ibuprofen or acetaminophen may help when taken as directed and when safe for you. Ask a pharmacist or healthcare professional if you have medical conditions, take other medicines, are pregnant, or are unsure which product to use. Do not place aspirin directly on a tooth or gum because it can injure tissue.
- Rinsing gently with warm salt water, eating soft foods, avoiding very hot, cold, or sugary foods, and using a cold compress on the outside of the cheek may provide temporary relief. Children should not use a salt-water rinse if they may swallow it.
- Continue gentle brushing. Avoid smoking, which can worsen some dental problems.
Antibiotics:
Antibiotics are not needed for most toothaches and do not correct problems such as decay or an inflamed pulp. Dental treatment is the priority. A dentist may prescribe antibiotics when infection is spreading or there are systemic signs such as fever or malaise, or in certain higher-risk situations.
Home measures can ease symptoms temporarily, but they do not replace dental care. See a dentist if pain is severe, is not controlled with pain medicine, or lasts more than 1 to 2 days.
The course of a toothache depends on its cause. Pain from early decay or reversible pulp irritation may occur only with triggers. As inflammation progresses, pain may linger or occur spontaneously. If the pulp dies, pain can briefly improve before returning as inflammation or an abscess develops around the root.
Untreated dental disease can lead to:
- Worsening decay, pulp death, or loss of the tooth
- A dental or periodontal abscess
- Spread of infection into the face, jaw, or neck (cellulitis)
- Rare but serious spread to deeper tissues, the bloodstream, or other nearby structures
- Difficulty eating, sleeping, or carrying out daily activities
Dry socket, prolonged bleeding, and delayed healing are possible complications of a tooth extraction; they are not typical complications of toothache itself. Seek urgent dental care for facial swelling, fever, worsening pain, or difficulty opening the mouth. Seek emergency care for trouble breathing, swallowing, or speaking, or for swelling that extends toward the eye or neck.