Toothache: Causes and Relief

What the type of pain tells you

Common causes of toothache

Tooth decay

Tooth decay (cavities) happens when bacteria in plaque turn sugars into acid that dissolves enamel. Early decay may cause no pain. Once it reaches the softer dentin, teeth become sensitive to sweet and cold. When it nears the nerve, it causes pulpitis.

Pulpitis

Pulpitis is inflammation of the pulp, the nerve and blood vessels inside the tooth. In reversible pulpitis, the pain is short and the tooth can be saved with a filling. In irreversible pulpitis, pain lingers or throbs spontaneously, and the nerve needs a root canal or the tooth needs removing.

Dental abscess

A dental abscess is a collection of pus from an infected nerve (at the root tip) or a deep gum pocket. It causes severe, constant throbbing pain, a tooth that hurts to touch, swelling of the gum or face, and sometimes fever. Antibiotics alone do not cure it: the source must be drained or removed.

Cracked tooth

Cracked tooth syndrome causes sharp pain when biting, often on release, and sensitivity to cold. Cracks are common in heavily filled teeth and in people who grind or chew ice.

Gum disease and receding gums

Periodontitis can cause aching teeth, loose teeth and gum abscesses. Receding gums expose root surfaces that are sensitive to cold and brushing.

Wisdom teeth

Partly erupted wisdom teeth can trap food and bacteria under a gum flap, causing pain, swelling, bad taste and difficulty opening the mouth.

Teeth grinding

Bruxism, often during sleep, overloads teeth and jaw muscles, causing aching teeth, jaw pain and headaches in the morning.

Pain that is not from the tooth

• Sinusitis: the roots of the upper back teeth sit close to the maxillary sinus, so a sinus infection can cause aching in several upper teeth.
• TMJ disorder: jaw joint and muscle pain felt in the teeth.
• Heart pain: angina or a heart attack can occasionally cause lower jaw or tooth pain, usually with chest symptoms or on exertion.
• Trigeminal neuralgia: brief, electric shock-like facial pain triggered by touch or chewing.

Toothache at night

Toothache often feels worse at night because lying down increases blood flow to the head, raising pressure inside an inflamed tooth, and there are fewer distractions. Pain that wakes you from sleep usually means irreversible pulpitis or an abscess, and you should see a dentist soon.

How to relieve a toothache now

• Pain relief: the American Dental Association guideline supports NSAIDs such as ibuprofen as first choice for dental pain, alone or combined with acetaminophen (paracetamol), at label doses. Do not exceed the daily maximum for either. Avoid NSAIDs with stomach ulcers, kidney disease or certain heart conditions, and do not give aspirin to children or teenagers.
• Do not put aspirin on the gum. It burns the tissue.
• Cold compress on the cheek for 15 minutes at a time.
• Warm salt-water rinses to clean the area and soothe gums.
• Floss gently around the tooth to remove trapped food.
• Over-the-counter numbing gel (benzocaine) for short-term relief in adults. Do not use benzocaine on children under 2.
• Sleep with your head raised on an extra pillow.
• Avoid very hot, cold or sweet foods, and chew on the other side.

Pain relief buys time but does not fix the cause. Most toothaches need a dentist.

How dentists diagnose toothache

The dentist will ask about the pain and examine your teeth and gums. They may tap on teeth, test sensitivity with cold, check your bite, and take X-rays to look for decay, abscesses and bone loss. A cracked tooth may need a special bite test or dye.

Treatment

• Filling: for decay with reversible pulpitis.
• Root canal treatment: removes the inflamed or infected nerve and saves the tooth.
• Extraction: if the tooth cannot be saved, or for problem wisdom teeth.
• Abscess drainage: with antibiotics only if infection is spreading or you have fever.
• Crown: to protect a cracked or heavily filled tooth.
• Gum treatment: deep cleaning for periodontitis.
• Desensitizing toothpaste or fluoride varnish: for sensitive exposed roots.
• Night guard: for grinding.

Prevention

• Brush twice a day with fluoride toothpaste and clean between teeth daily.
• Limit sugary snacks and drinks, especially between meals.
• See a dentist regularly for checkups.
• Wear a mouthguard for contact sports and a night guard if you grind.
• Do not chew ice or hard objects.

Frequently asked questions

What is the fastest way to stop a toothache?

Taking ibuprofen, or ibuprofen with acetaminophen (paracetamol), at label doses is the most effective quick relief. A cold compress, warm salt-water rinses and avoiding triggers help too. See a dentist to treat the cause, because the pain often returns.

Why does my toothache throb?

Throbbing pain usually means the nerve inside the tooth is inflamed or infected. Pressure builds inside the rigid tooth as blood flows in with each heartbeat. Throbbing pain that lingers or wakes you at night needs a dentist soon.

Can a toothache go away on its own?

Brief sensitivity may settle, but pain from decay, an inflamed nerve or an abscess usually does not resolve without treatment. Sometimes pain stops because the nerve has died, but the infection remains and can spread.

When is a toothache an emergency?

Go to the ER if you have facial or neck swelling that is spreading, difficulty breathing, swallowing or opening your mouth, or a high fever with swelling. These can signal a spreading dental infection.

Can a sinus infection cause a toothache?

Yes. Sinusitis can cause aching in several upper back teeth, often worse when bending forward, along with a blocked nose and facial pressure. If only one tooth hurts, or pain persists after the sinusitis clears, see a dentist.