Tooth Pain: Causes by Type of Pain

What the type of tooth pain tells you

Dental causes of tooth pain

Tooth decay

Tooth decay is the most common cause. Bacteria produce acid that dissolves enamel. Early decay is painless. Once it reaches the dentin underneath, sweet, hot or cold foods cause pain. A filling at this stage stops the pain.

Sensitive teeth

Worn enamel or receding gums expose dentin, which has tiny tubes leading to the nerve. Cold drinks, cold air, sweets and brushing cause a sharp, brief pain. Causes include brushing too hard, acidic foods and drinks, reflux, grinding and gum recession.

Pulpitis

Pulpitis is inflammation of the pulp, the nerve and blood vessels inside the tooth, usually from deep decay, a crack or repeated dental work. In reversible pulpitis, pain stops quickly once the trigger is removed. In irreversible pulpitis, pain lingers, throbs and can be spontaneous. This usually needs a root canal or extraction.

Dental abscess

A tooth abscess is a pocket of pus at the root tip or in the gum. Pain is constant and throbbing, worse on biting, with a swollen gum, a bad taste or a gum boil. The face may swell. Sometimes pain eases suddenly when the nerve dies or the abscess drains, but the infection remains.

Cracked tooth

Cracked tooth syndrome causes a sharp pain when biting, particularly on release, and sensitivity to cold. It is common in molars of people who grind their teeth or have large fillings. Cracks can be hard to see on X-rays.

Gum disease

Advanced periodontitis causes aching, loose teeth and gum abscesses.

Wisdom teeth

A partly erupted wisdom tooth can trap food and bacteria, causing pericoronitis: pain, swelling at the back of the mouth, bad breath and difficulty opening the mouth.

After dental work

Mild sensitivity after a filling is common for a few days to weeks. A filling that is too high causes pain on biting. Dry socket after an extraction causes severe pain 2 to 4 days later.

Non-dental causes of tooth pain

• Sinusitis: the roots of the upper back teeth sit next to the maxillary sinus. A sinus infection causes aching in several upper teeth, worse when bending forward or walking downstairs.
• Bruxism: clenching or grinding, often at night, causes aching teeth, jaw muscles and morning headaches.
• TMJ disorders: pain in the jaw joint and chewing muscles can spread to the teeth.
• Trigeminal neuralgia: brief electric-shock pains in the face and teeth.
• Heart pain: angina or a heart attack can occasionally be felt in the lower jaw and teeth, usually with exertion and other symptoms.

How a dentist finds the cause

The dentist will ask where and when it hurts and what triggers it, then examine the teeth and gums. Tests include tapping the teeth, cold tests to check the nerve, biting on a special tool to find cracks, gum pocket measurements, and dental X-rays to show decay, bone loss and abscesses.

Tooth pain relief at home

These help until you can see a dentist:

• Pain relievers: ibuprofen works well for dental pain. The American Dental Association notes that ibuprofen combined with acetaminophen (paracetamol) is often more effective than opioids. Follow the label doses and check that both are safe for you. Avoid NSAIDs with kidney disease, stomach ulcers or blood thinners.
• Cold compress on the cheek for 15 to 20 minutes.
• Rinse with warm salt water.
• Floss gently to remove trapped food.
• Desensitizing toothpaste for sensitive teeth, used twice daily for 2 to 4 weeks.
• Avoid triggers such as very hot, cold or sweet foods, and chew on the other side.
• Sleep with your head raised to reduce throbbing.

Do not put aspirin directly on the gum, which burns the tissue. Do not give benzocaine gels to children under 2.

Dental treatment

• Desensitizing treatments and fluoride varnish for sensitivity.
• Fillings for decay.
• Root canal treatment for irreversible pulpitis or abscess, which saves the tooth.
• Extraction when a tooth cannot be saved.
• Crowns for cracked teeth.
• Night guards for grinding.
• Antibiotics only for spreading infection, swelling or fever. They do not cure toothache from pulpitis on their own.

Preventing tooth pain

• Brush twice daily with fluoride toothpaste and clean between teeth daily.
• Limit sugary snacks and acidic drinks.
• Use a soft toothbrush and do not scrub.
• Wear a mouthguard for contact sports and a night guard if you grind.
• See a dentist regularly so problems are caught before they hurt.

For pain that is the main reason you are searching right now, see also toothache.

Frequently asked questions

What causes sudden tooth pain?

Sudden tooth pain is often caused by a cracked tooth, a lost filling, decay reaching the nerve, a developing abscess, or sinus pressure. Sensitivity to cold after brushing hard or eating acidic food is also common. Pain that persists, throbs or wakes you needs a dentist.

Why does my tooth hurt when I bite down?

Pain on biting usually points to an abscess, a cracked tooth, a filling that is too high, or inflammation of the ligament around the tooth from grinding. A sharp pain when releasing the bite is typical of a crack. See a dentist, as these rarely settle on their own.

What is the best painkiller for tooth pain?

For most adults, ibuprofen is very effective for dental pain, and ibuprofen combined with acetaminophen often works better than opioids. Follow label doses and check they are safe with your health conditions. Pain relief is temporary; the cause still needs dental treatment.

Can a sinus infection cause tooth pain?

Yes. The roots of the upper back teeth are close to the maxillary sinus. A sinus infection can cause aching in several upper teeth at once, worse when bending forward, with nasal congestion. Tooth pain from sinusitis usually improves as the sinus clears.

When is tooth pain an emergency?

Get emergency care if tooth pain comes with swelling of the face, jaw or neck, fever, difficulty swallowing, breathing or opening your mouth. These suggest a spreading infection. Jaw pain with chest pressure or breathlessness should be treated as a possible heart attack.