What causes toothache
Toothache is pain in or around a tooth or the jaw. The most common cause is tooth decay, also called cavities, where bacteria in plaque turn sugar into acid that slowly dissolves the tooth. Once decay reaches the inner nerve (pulp), the pain becomes strong, throbbing and often worse at night.
Other causes include gum disease, a cracked tooth, a loose or broken filling, a pus-filled infection called a dental abscess, and wisdom teeth pushing through the gums. Sometimes sinus infections or jaw joint problems cause pain that feels like toothache.
Symptoms to notice
The type of pain gives useful clues to the cause. Short, sharp pain often means early decay or sensitivity, while constant throbbing pain suggests the nerve is involved. Mention these details to your dentist, along with when the pain started and what makes it better or worse.
- Sharp pain or sensitivity with cold, hot or sweet foods
- Throbbing pain that lasts or wakes you at night
- Pain on biting or chewing
- Swollen, bleeding or receding gums
- Swelling of the face or jaw, bad taste in the mouth or fever
- Bad breath that does not go away
How a dentist diagnoses it
A dentist will look at your teeth and gums, tap and test the painful tooth, and check for swelling. A dental X-ray, either a small one of a few teeth or a full-mouth X-ray (OPG), shows decay between teeth, infection at the root tip and impacted wisdom teeth.
People with diabetes should have their blood sugar checked, because uncontrolled diabetes worsens gum disease and slows healing after dental treatment. Pregnant women should tell the dentist they are pregnant so that treatment, medicines and X-rays can be planned safely. Mention any blood thinners or heart conditions too.
Treatment options for toothache and dental care
The treatment depends on the cause. Small cavities are cleaned and filled. When decay or infection reaches the nerve, a root canal treatment removes the infected pulp and saves the tooth, usually followed by a crown. Badly damaged teeth or troublesome wisdom teeth may need to be removed. Gum disease is treated with professional cleaning and better daily care.
Antibiotics are used only when there is spreading infection, such as facial swelling or fever, and only on a doctor's or dentist's prescription. They do not fix the tooth, so the dental treatment is still needed. Taking leftover antibiotics at home for toothache is unsafe and adds to antibiotic resistance.
Short-term relief until you see a dentist
Painkillers such as paracetamol or ibuprofen can ease toothache for a short time, following the label or your pharmacist's advice. People with stomach ulcers, kidney disease, asthma worsened by painkillers, or in pregnancy should not take ibuprofen without advice. Never place a painkiller tablet directly on the gum, as it can burn the tissue.
Rinsing with lukewarm salt water and a cold pack on the cheek may help reduce pain and swelling. Avoid very hot, cold or sweet foods and chew on the other side. Keep your head raised at night. Painkillers only mask the problem, so see a dentist within a few days.
Daily habits for healthy teeth
Most dental problems can be prevented with simple daily care that starts in childhood. Parents should brush children's teeth until they can do it well themselves, using a small smear of fluoride toothpaste for young children. Avoid putting babies to sleep with a milk bottle, which causes early decay.
- Brush twice a day for two minutes with fluoride toothpaste, especially before bed
- Clean between teeth with floss or interdental brushes
- Cut down on sweets, biscuits, sugary tea and soft drinks, especially between meals
- Rinse your mouth with water after eating
- Stop tobacco, gutka and smoking, which harm gums and cause oral cancer
- Visit a dentist for a check-up and cleaning every six to twelve months
When to see a doctor or dentist
See a dentist for any toothache lasting more than a day or two, sensitivity that keeps returning, or bleeding gums. Seek urgent care for facial swelling, fever, or difficulty opening the mouth, swallowing or breathing. Elderly people, pregnant women and people with heart, kidney or liver disease should tell their dentist about their health. A doctor or pharmacist can advise on safe pain relief meanwhile.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Paracetamol (pain reliever)Eases mild to moderate toothache for a short time.Follow the label or your pharmacist's advice; do not exceed the stated amount.
- NSAIDs such as ibuprofenReduce pain and swelling from dental inflammation.Follow the label or your pharmacist's advice; avoid in stomach ulcers, kidney disease and pregnancy unless a doctor advises.
- Antibiotics such as amoxicillin or metronidazoleTreat spreading dental infection such as an abscess with swelling or fever.Only on a doctor's or dentist's prescription; they do not replace dental treatment.
- Fluoride toothpaste and desensitising toothpasteStrengthen enamel and reduce sensitivity to hot and cold.Use as the label advises; use only a small smear for young children.
- Chlorhexidine mouthwashReduces plaque and gum inflammation for short periods.Use as your dentist advises; can temporarily stain teeth.
See a doctor urgently if
- Get emergency help if facial swelling spreads to the eye or neck or you have trouble breathing or swallowing.
- See a dentist or doctor urgently if you have tooth pain with fever and facial swelling.
- See a dentist urgently if a tooth is knocked out or broken after an injury.
- See a doctor or dentist soon if you have jaw pain with chest pain or breathlessness, which may be a heart problem.
- See a dentist soon if gums bleed often or teeth feel loose.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.