The most common cause of toothache is dental decay. Find out how to get rid of and prevent toothache.
Medically reviewed by Dr Roger Henderson
Toothache can affect anyone of any age, and is the commonest reason for requests for emergency dental treatment.
Dr Roger Henderson looks at the causes, symptoms and how to get rid of toothache:
What is toothache?
The most common cause of toothache, or pain in the region of the jaws and face, is dental decay. Once a cavity is formed, this can lead to inflammation of the dental pulp – the nerves and blood vessels in the centre of the teeth – and this is called pulpitis.
There are two types of pulpitis:
- Reversible pulpitis – the damage to the pulp is relatively mild and can heal again following dental treatment.
- Ireversible pulpitis – the damage is too severe for this to occur and the pulp dies even if dental treatment occurs.
Toothache can range in severity from mild to agonising and there may be short, sharp pains that occur in response to hot, cold or sweet foods or drinks.
If the toothache lasts for longer than three minutes, it’s likely that the tooth is dying and if tooth decay is left untreated, the pulp dies and becomes infected, causing a dental abscess.
If the pain wakes you up from sleep, then it is likely that irreversible pulpitis is present. The pain from a dental abscess is usually when there’s pressure on the tooth and is throbbing and continuous.
Symptoms of toothache may include:
- A sharp, dull, constant or throbbing pain around the tooth, which may become worse when pressure is applied to the tooth
- A headache
- A fever or high temperature
- Swelling of the gum around the tooth
- Dental decay
- Fracture of the tooth
- Cracked tooth – this may be invisible so can be difficult to diagnose
- Irritation of the nerve following dental treatment – regardless of how well it is done, dental treatment and the materials used to fill the tooth can sometimes cause pain later. Often this settles after a few days but if a dental filling is placed to close to the pulp of a tooth this can cause long term toothache
- A leaking filling, decay under an existing filling, or a filling that has fallen out
- Exposed dentine around the necks of the teeth following gum recession or over vigorous brushing may cause sensitivity with hot, cold and acidic foods and drinks
- Sensitive teeth – the pulp is intact but the outer layer of enamel which helps insulate the tooth has thinned (brushing too hard or eating or drinking too many acidic things can do this).
The following problems can also cause symptoms similar to toothache, even though the teeth themselves may be free of disease:
- a gum abscess due to gum (periodontal disease)
- ulcers on the gums (acute ulcerative gingivitis)
- ulcers on the soft tissues of the check, tongue and lips
- inflammation of the gum around a tooth which is in erupting into the mouth (pericoronitis), particularly wisdom teeth
- inflammation of the sinuses (sinusitis), often seen in colds can be mistaken for toothache in the upper jaw.
- trauma from biting on hard food. This can cause bruising and discomfort around the teeth. This usually settles in a few days.
Several other conditions may also cause pain in the mouth so always seek advice from your dentist if you have toothache.
Remember that the nerves supplying the teeth sometimes give the wrong message to the brain. This means that, although you feel pain in a particular tooth, the problem may actually be in a different tooth – even one located in the opposite jaw.
The best way to prevent toothache is to keep your teeth and gums healthy.
Try to avoid dental decay and cavities by cutting down on how often you have sugary foods and drinks – have them as an occasional treat, and at mealtimes only – and aim to have no more than three meals and two snacks a day.
Brush your teeth twice daily using a toothpaste containing at least 1350 parts per million fluoride. To get the most benefit from the fluoride, spit after brushing and do not rinse. Clean between your teeth using interdental brushes or dental floss, according to your dentist’s advice and visit your dentist regularly as often as they recommend. This way, problems can be caught early and your treatment will be simpler.
If you have toothache, seek immediate advice from your dentist before the problem becomes worse.
Pulpitis is often reversible (the more pain you have when biting down on a tooth, the more severe it is likely to be) and once your dentist has identified and treated the problem (often with a simple filling), the toothache will disappear.
If a dental abscess is present this will require root canal treatment if the tooth is to be saved, or even extraction of the tooth.
Home remedies for toothache
However, the following advice may be helpful until you are able to see your dentist:
- Avoid hot, cold or sweet foods and drinks – this will help prevent the pain from toothache worsening.
- If the pain is prolonged and severe, painkillers such as paracetamol or ibuprofenmay provide some relief. Remember even if the pain goes away, without treatment it will eventually come back again and become worse.
- If the pain is caused by exposed root surfaces, toothpaste for sensitive teeth, either used normally or rubbed onto the exposed root, may be helpful. The toothpaste may take some days to work. If this is not successful your dentist may be able to seal the area or apply stronger medicines to help.
- A hot saltwater mouthwash (a teaspoon of salt to a cup of water) used to thoroughly rinse the painful area may help if the problem is caused by a tooth erupting.
What to expect when you see your dentist for a toothache
After taking a careful history about your toothache, your dentist will examine your teeth carefully one by one. This will include checking to see how healthy your gums are, and for signs of any infection or abscesses. They may gently tap each tooth to see if this causes pain or discomfort, or place cold cotton wool next to the painful tooth. If the tooth is dead then this is not usually painful but if there is pulpitis it can feel uncomfortable. They may also take an X-ray to look for any fractures, infection, filling defects or abnormalities of the teeth.
Reversible pulpitis is treated by treating the cause, often by drilling out any decayed tooth and replacing it with a filling. If your dentist is not sure whether the tooth will recover or not they may place a temporary filling in it and then see you again in a few weeks to assess it. After treatment it will take several days for the toothache to settle down and you may need to take regular painkillers over this time.
Irreversible pulpitis has two main treatments – either removing the affected tooth entirely (particularly if putting a filling into it is difficult), or by doing root canal treatment. This option involves removing any dying pulp and putting a special filling into the space to prevent any further infection, and is typically carried out over two appointments 2-3 weeks apart.