Toothache: Causes, Symptoms & When to Seek Care
📊 Quick facts about toothache
💡 The most important things you need to know
- Dental cavities are the leading cause: Most toothaches result from tooth decay that has reached the tooth's nerve (pulp)
- Seek emergency care for warning signs: Facial swelling with fever, difficulty breathing or swallowing requires immediate attention
- Pain relievers provide temporary relief: Over-the-counter medications help manage pain but don't treat the underlying cause
- Root canal treatment saves teeth: This procedure has an 85-97% success rate and can preserve teeth that would otherwise need extraction
- Prevention is highly effective: Brushing twice daily with fluoride toothpaste and regular dental check-ups significantly reduce toothache risk
- Pain location can be misleading: Tooth pain often radiates to the jaw, ear, or opposite side of the mouth
What Are the Symptoms of Toothache?
Toothache symptoms include sharp or throbbing pain in or around a tooth, sensitivity to hot and cold temperatures, pain when biting or chewing, swelling around the affected tooth, and radiating pain to the jaw or ear. The pain may be constant or intermittent, and its character often indicates the underlying cause.
Toothache can manifest in several different ways depending on the underlying cause. Understanding these symptoms helps determine the severity of the problem and whether you need immediate dental care. The nature of the pain – whether it's sharp, dull, throbbing, or intermittent – provides important clues about what's happening inside the tooth.
Many people find it difficult to pinpoint exactly which tooth is causing the pain. This occurs because dental nerves are connected to the trigeminal nerve, which supplies sensation to the entire face and jaw. As a result, pain from an infected lower tooth might feel like it's coming from the upper jaw, or tooth pain might radiate to the ear, temple, or even the neck.
The timing and triggers of toothache are also significant. Pain that occurs only when eating something hot or cold suggests different problems than constant, unprovoked throbbing. Similarly, pain that wakes you from sleep often indicates a more serious condition requiring prompt treatment.
Common Toothache Symptoms
The following symptoms are typically associated with toothache and dental problems. You may experience one or several of these simultaneously:
- Sharp, stabbing pain: Often triggered by biting down or temperature changes
- Constant throbbing: May indicate infection or advanced inflammation
- Sensitivity to hot and cold: Lingering sensitivity (more than a few seconds) suggests pulp damage
- Pain when chewing: Can indicate a cracked tooth or advanced decay
- Swelling around the tooth: May indicate abscess formation
- Bad taste in mouth: Often accompanies infection
- Fever with dental pain: Warning sign of spreading infection
Effects on Daily Life
Toothache doesn't just cause localized pain – it can significantly impact your overall quality of life and daily functioning. Many people with severe toothache find that their sleep is disrupted, as lying down can increase blood flow to the head and intensify throbbing pain. This sleep deprivation then affects concentration, mood, and ability to perform daily tasks.
Eating becomes challenging when you have toothache, as both the act of chewing and temperature changes from food can trigger pain. This often leads people to avoid eating on the affected side or to choose only soft, room-temperature foods. In severe cases, people may significantly reduce their food intake, which can affect nutrition and energy levels.
The psychological impact of toothache should not be underestimated. Chronic dental pain is associated with increased irritability, anxiety, and difficulty concentrating. Many people also feel embarrassed about dental problems, which can delay seeking treatment and allow conditions to worsen.
| Symptom | Possible Cause | Urgency |
|---|---|---|
| Brief sensitivity to cold | Early cavity, receding gums | Routine dental visit |
| Prolonged sensitivity to hot | Pulp inflammation (pulpitis) | See dentist soon |
| Severe throbbing with swelling | Dental abscess | Urgent dental care |
| Pain on biting, localized | Cracked tooth, damaged filling | See dentist promptly |
When Should You See a Dentist for Toothache?
See a dentist if toothache lasts more than 1-2 days, is severe, or is accompanied by fever, swelling, or difficulty swallowing. Seek emergency dental care immediately for facial swelling with fever, difficulty breathing, or a knocked-out tooth. Mild, intermittent tooth sensitivity can often wait for a routine appointment.
Knowing when to seek dental care for toothache can be challenging. While some tooth pain resolves on its own or requires only routine treatment, other situations require urgent intervention to prevent serious complications. The key is recognizing the warning signs that indicate a potentially dangerous infection or condition that needs immediate attention.
Dental infections can spread beyond the tooth and jawbone to other parts of the body. In rare but serious cases, bacteria from a tooth infection can enter the bloodstream (causing sepsis) or spread to the floor of the mouth and throat (Ludwig's angina), potentially blocking the airway. This is why certain combinations of symptoms require emergency care rather than waiting for a regular dental appointment.
The good news is that most toothaches, while painful, don't require emergency treatment. Understanding the difference between urgent and non-urgent dental problems helps you make appropriate decisions about when and where to seek care, ensuring you get timely treatment when needed without overwhelming emergency services unnecessarily.
- Facial swelling that is spreading, especially with fever
- Difficulty breathing or swallowing
- Severe bleeding that won't stop
- A tooth that has been knocked out (bring the tooth with you)
- Severe pain that doesn't respond to pain medication
- Swelling around the eye or difficulty opening your eye
In these situations, go to an emergency dental clinic or hospital emergency department. Find your local emergency number.
Non-Emergency Situations
Many types of toothache, while uncomfortable, don't require emergency treatment. If your symptoms fall into the following categories, you can typically wait to see your regular dentist during normal office hours:
- Mild sensitivity to cold or sweet foods that goes away quickly
- Intermittent, mild pain without swelling or fever
- A lost filling without severe pain (cover with sugar-free gum temporarily)
- Minor tooth chip with no sharp edges cutting your mouth
- Dull ache that improves with over-the-counter pain relievers
Situations Requiring Prompt (But Not Emergency) Care
Some dental problems need attention within a few days but don't require immediate emergency care. Contact your dentist's office to arrange an appointment as soon as possible if you experience:
- Persistent toothache lasting more than 1-2 days
- Localized swelling around a tooth without fever
- A broken or cracked tooth causing moderate pain
- Severe sensitivity that lingers after eating hot or cold foods
- Pain when biting that affects your ability to eat
What Causes Toothache?
Toothache is most commonly caused by dental cavities (tooth decay) that have reached the tooth's nerve. Other causes include tooth infections, cracked or fractured teeth, gum disease (periodontitis), teeth grinding (bruxism), impacted wisdom teeth, damaged fillings, and tooth sensitivity from exposed root surfaces.
Understanding the anatomy of a tooth helps explain why different conditions cause different types of pain. A tooth consists of several layers: the outer protective enamel (the hardest substance in the body), a layer of dentin beneath it, and at the center, the pulp chamber containing blood vessels and nerves. The root of the tooth extends into the jawbone and is covered by cementum rather than enamel.
When any of these structures becomes damaged or diseased, toothache can result. The pain we experience is primarily caused by inflammation or infection of the dental pulp, or by exposure of the sensitive dentin layer when enamel is worn away or damaged. Different causes produce different pain patterns, which helps dentists diagnose the underlying problem.
Tooth decay remains the most common cause of toothache worldwide, affecting billions of people. The process begins when bacteria in the mouth convert sugars into acids that gradually dissolve tooth enamel. Once decay penetrates through the enamel and reaches the dentin, sensitivity begins. If untreated, the decay eventually reaches the pulp, causing severe pain and potentially leading to infection.
Dental Cavities (Tooth Decay)
Dental cavities are the leading cause of toothache globally. When bacteria in dental plaque metabolize sugars from food, they produce acids that demineralize tooth enamel. Over time, this creates holes (cavities) that progressively deepen into the tooth structure. The pain from cavities typically progresses as follows:
In the early stages, when decay is limited to the enamel, there may be no symptoms at all. As the cavity extends into the dentin, you may notice sensitivity to sweet, hot, or cold foods that goes away quickly. When decay reaches close to or into the pulp chamber, the pain becomes more intense and persistent – often described as a throbbing ache that may keep you awake at night.
If the bacterial infection spreads beyond the root tip into the surrounding bone, an abscess can form. This causes severe, constant pain, and the area around the tooth may swell. At this stage, the tooth typically requires either root canal treatment or extraction to eliminate the infection.
Infection Under a Root-Filled Tooth
Sometimes a tooth that has previously had root canal treatment develops a new infection. This can happen if the original root canal filling develops a leak, allowing bacteria to re-enter the tooth, or if bacteria remained in the canal system after the initial treatment. The infection can spread through the root tip into the surrounding bone, causing pain and swelling.
Symptoms of infection under a root-filled tooth may include dull, aching pain, tenderness when pressing on the tooth or surrounding gum, and swelling. Treatment typically involves either retreatment of the root canal or, in some cases, a surgical procedure called an apicoectomy to remove the infected root tip.
Gum Infection During Tooth Eruption
When teeth are in the process of coming through the gum, the overlying gum tissue can become inflamed and infected – a condition called pericoronitis. This is most common with wisdom teeth, which often have difficulty fully erupting due to limited space in the jaw. Food debris and bacteria can accumulate under the gum flap covering the partially erupted tooth, leading to infection.
Pericoronitis causes pain, swelling, and difficulty opening the mouth or swallowing. The gum around the tooth is typically red, swollen, and tender. Treatment involves cleaning the area, sometimes with antibiotics, and in cases of recurrent infection, removal of the problematic tooth may be recommended.
Tooth Sensitivity
While not technically a toothache, tooth sensitivity causes significant discomfort that many people describe as tooth pain. Sensitivity occurs when the protective enamel is worn away or when gums recede to expose the root surface (which is covered by cementum, not enamel). The exposed dentin contains microscopic tubules that lead directly to the nerve, causing sharp pain when stimulated by temperature changes, sweet foods, or even air.
Common causes of tooth sensitivity include aggressive brushing that wears away enamel and causes gum recession, acidic foods and drinks that erode enamel, teeth grinding, and gum disease. Treatment focuses on reducing sensitivity through desensitizing toothpastes, fluoride treatments, and addressing the underlying cause.
Teeth Grinding (Bruxism)
Grinding or clenching your teeth, especially during sleep, places enormous pressure on teeth and jaw muscles. This can cause toothache-like pain, headaches (particularly upon waking), and jaw pain. Over time, bruxism can wear down teeth to the point where the dentin or even pulp becomes exposed, causing genuine tooth damage and sensitivity.
Many people are unaware they grind their teeth until a sleep partner mentions the noise or a dentist notices the characteristic wear patterns. Treatment typically involves a custom-fitted nightguard to protect teeth during sleep, along with stress management and addressing any underlying causes.
Dental Prosthesis Issues
Dental prostheses such as dentures, bridges, and crowns can cause pain when they don't fit properly. Ill-fitting dentures may rub against the gums, causing sores and pain. Crowns or bridges that are too high can create excessive pressure when biting, leading to pain in the affected tooth or the opposing teeth.
Tooth Injuries
Trauma to teeth from accidents, falls, or sports injuries can cause immediate pain and may have long-term consequences. Even if a tooth appears intact after an injury, the pulp inside may be damaged and can slowly die over time, eventually leading to infection. Cracked teeth are particularly problematic because cracks can propagate over time, potentially leading to tooth fracture.
Periodontitis (Gum Disease)
Periodontitis is a serious gum infection that damages the soft tissue and can destroy the bone supporting your teeth. While gum disease often progresses painlessly, advanced cases can cause significant pain, especially when abscesses form in the gum pockets around teeth. Symptoms include red, swollen gums, bleeding when brushing, loose teeth, and persistent bad breath.
Conditions That Mimic Toothache
Several non-dental conditions can cause pain that feels like a toothache. This is important to recognize because treating the wrong cause won't resolve the pain. Conditions that can mimic toothache include:
- Sinusitis: Infection or inflammation of the sinuses can cause upper teeth to ache because the roots of upper back teeth are close to the sinus floor
- TMJ disorders: Problems with the temporomandibular joint can cause pain that radiates to the teeth
- Trigeminal neuralgia: A nerve condition causing intense facial pain that may feel like tooth pain
- Angina: In rare cases, heart-related pain can be referred to the jaw and teeth, particularly on the left side
- Ear infections: Can cause referred pain to the jaw and teeth area
What Can You Do at Home for Toothache?
For temporary toothache relief, take over-the-counter pain relievers like ibuprofen or acetaminophen, rinse with warm salt water, apply a cold compress to the outside of your cheek, and avoid very hot, cold, or sweet foods. These measures provide temporary relief but don't treat the underlying cause – you still need to see a dentist.
While home remedies cannot cure toothache, they can provide significant temporary relief while you wait for a dental appointment. The key is to reduce pain and inflammation while protecting the affected tooth from further irritation. Understanding which approaches are evidence-based and safe helps you manage discomfort effectively without risking harm.
Pain management is the primary goal of home treatment. Over-the-counter medications like ibuprofen (an anti-inflammatory) and acetaminophen (paracetamol) are generally effective for dental pain. Ibuprofen is often preferred for toothache because it reduces inflammation as well as pain, but acetaminophen is a good alternative if you cannot take anti-inflammatory medications. Always follow package directions and don't exceed recommended doses.
The best long-term approach to preventing toothache is maintaining excellent oral hygiene. Brushing twice daily with fluoride toothpaste, flossing daily, limiting sugary foods and drinks, and attending regular dental check-ups are the foundation of oral health. These habits can prevent most causes of toothache and save you from significant pain and expense.
Effective Home Remedies
The following home treatments are generally safe and may help reduce toothache symptoms:
- Over-the-counter pain relievers: Ibuprofen or acetaminophen taken as directed. Don't apply aspirin directly to the gum – this can cause chemical burns
- Salt water rinse: Mix half a teaspoon of salt in 8 ounces of warm water. Swish gently for 30 seconds and spit. This helps reduce inflammation and may draw out some infection
- Cold compress: Apply an ice pack wrapped in a cloth to the outside of your cheek for 15-20 minutes at a time. This reduces swelling and numbs the area
- Elevation: When resting, keep your head elevated with pillows to reduce blood flow to the area and decrease throbbing
- Avoid triggers: Stay away from very hot, cold, sweet, or acidic foods and drinks that provoke pain
Preventing Toothache Through Good Oral Hygiene
Prevention is far better than treatment when it comes to dental problems. The majority of toothaches are caused by preventable conditions like tooth decay and gum disease. Following these evidence-based recommendations significantly reduces your risk:
- Brush twice daily: Use a soft-bristled brush and fluoride toothpaste for at least two minutes each time
- Floss daily: Clean between teeth where brushing cannot reach
- Limit sugar: Reduce frequency of sugary snacks and drinks, especially between meals
- Regular dental visits: Professional cleanings and examinations every 6-12 months help catch problems early
- Use fluoride: In addition to fluoride toothpaste, your dentist may recommend fluoride mouthwash or treatments if you're prone to cavities
- Wear a mouthguard: If you grind your teeth or play contact sports, protect your teeth with appropriate guards
How Is Toothache Diagnosed?
Dentists diagnose toothache through clinical examination of the mouth and teeth, dental X-rays to visualize decay and infections, and specialized tests such as cold tests or bite tests. The location, character, and triggers of your pain help the dentist identify which tooth is affected and what's causing the problem.
Accurate diagnosis is essential for effective toothache treatment. The dentist begins with a thorough medical and dental history, including questions about when the pain started, what makes it better or worse, and whether you have any other symptoms. This information provides important clues about the underlying cause before any physical examination begins.
The clinical examination involves visual inspection of all teeth and soft tissues, looking for obvious signs of decay, cracks, swelling, or infection. The dentist will tap on teeth to check for tenderness and may use a dental explorer to feel for soft spots or rough edges that indicate decay. They'll also examine your gums for signs of infection or disease.
Dental X-rays are crucial for diagnosing toothache because they reveal problems invisible to the naked eye. X-rays show decay between teeth, infections at the root tips, bone loss from gum disease, and the position of impacted teeth. Modern digital X-rays use very low radiation doses and provide immediate images for analysis.
Diagnostic Tests
Specialized tests help determine the health of the dental pulp and identify exactly which tooth is causing problems:
- Cold test: A cold stimulus is applied to teeth to assess nerve response. Normal teeth feel brief cold sensation; inflamed pulp causes prolonged pain
- Bite test: Biting on a special stick helps identify cracked teeth, which cause characteristic pain on release of biting pressure
- Percussion test: Tapping on teeth identifies tenderness that indicates inflammation at the root tip
- Electric pulp test: A small electrical current tests whether the nerve inside the tooth is alive
- Transillumination: Shining a bright light through the tooth can reveal cracks not visible on X-rays
Sometimes the source of toothache isn't immediately clear, and the dentist may need to see you for multiple visits or perform several tests before making a definitive diagnosis. This is especially true for referred pain, where problems in one tooth cause pain that feels like it's coming from another tooth, or for subtle crack lines that are difficult to detect.
How Is Toothache Treated?
Toothache treatment depends on the underlying cause. Common treatments include dental fillings for cavities, root canal treatment for infected pulp, tooth extraction for severely damaged teeth, antibiotics for spreading infections, and specialized treatments for gum disease or cracked teeth. The goal is always to preserve the natural tooth when possible.
The treatment approach for toothache depends entirely on what's causing the pain. Modern dentistry offers many options for saving damaged teeth that would have required extraction in the past. Your dentist will discuss the best treatment options for your specific situation, taking into account factors like the extent of damage, your overall oral health, and your preferences.
Pain relief is an immediate priority, and this may be addressed with local anesthesia before treatment begins. Most dental procedures can be performed comfortably with appropriate numbing. If you experience dental anxiety, discuss this with your dentist – various sedation options are available for more comfortable treatment.
Dental Fillings
When toothache is caused by a cavity that hasn't yet reached the pulp, a dental filling is usually sufficient treatment. The dentist removes all decayed tooth material, cleans the cavity, and fills it with a restorative material. Modern filling materials include tooth-colored composite resin (most common for visible teeth) and silver amalgam (still used for some back teeth).
The procedure typically takes 20-60 minutes depending on the cavity size. Local anesthesia ensures you don't feel pain during treatment. After the anesthesia wears off, you may experience some sensitivity for a few days, but this usually resolves quickly. With proper care, fillings can last many years.
Root Canal Treatment
When infection or inflammation affects the dental pulp (the nerve and blood vessels inside the tooth), root canal treatment is needed to save the tooth. Despite its reputation, modern root canal treatment is typically no more uncomfortable than getting a filling – the procedure actually relieves pain rather than causing it.
During root canal treatment, the dentist removes the infected or inflamed pulp tissue, cleans and shapes the root canals, and fills them with a biocompatible material. The tooth is then sealed and usually requires a crown for protection, as root-treated teeth can become brittle over time. Root canal treatment has an excellent success rate of 85-97%, and treated teeth can function normally for many years or even a lifetime.
Antibiotics
Dental infections generally don't require antibiotics because the source of infection (the diseased pulp or periodontal pocket) must be physically treated. However, antibiotics are sometimes necessary to control spreading infection, particularly if there's significant swelling, fever, or systemic symptoms. Antibiotics may also be prescribed for certain high-risk patients to prevent complications.
If your dentist prescribes antibiotics, take the full course as directed even if you start feeling better. While taking antibiotics, you should also receive treatment for the underlying dental problem – antibiotics alone won't cure a tooth infection.
Wisdom Tooth Treatment
Pain from wisdom teeth often relates to pericoronitis (infection of the gum around a partially erupted tooth) or impaction. Initial treatment involves cleaning the area and managing pain and infection. For recurrent problems, wisdom tooth extraction is often recommended.
Wisdom tooth extraction is a common procedure. The complexity depends on the tooth's position – fully erupted teeth are simpler to remove than impacted teeth requiring surgical extraction. Recovery typically takes a few days to a week, with some swelling and discomfort expected during healing.
Treatment for Sensitivity
Tooth sensitivity can often be managed without invasive treatment. Options include desensitizing toothpastes containing potassium nitrate or stannous fluoride, which block the transmission of sensation from the tooth surface to the nerve. Professional fluoride treatments can strengthen enamel and reduce sensitivity.
For severe sensitivity, dentists can apply bonding agents or desensitizing varnishes to the tooth surface. In cases where gum recession has exposed root surfaces, gum grafting surgery may be an option to cover the exposed roots and reduce sensitivity.
Bite Guards for Bruxism
If teeth grinding is causing your tooth pain, a custom-fitted bite guard (nightguard) protects your teeth from the forces of clenching and grinding during sleep. These are typically made from hard acrylic and precisely fitted to your teeth for comfort. Over-the-counter bite guards are available but generally less comfortable and effective than custom-made options.
Adjusting Dental Prostheses
Pain from dentures, crowns, or bridges often resolves with simple adjustments. Your dentist can identify areas where the prosthesis is rubbing or where the bite is uneven and make appropriate modifications. Don't try to adjust prostheses yourself – this can damage them and potentially make problems worse.
Treatment for Tooth Injuries
Treatment for injured teeth depends on the type and extent of damage. Minor chips may need only smoothing or cosmetic repair. More significant fractures may require crowns, root canal treatment, or in severe cases, extraction. Teeth that have been knocked out (avulsed) can sometimes be replanted if treated within an hour – keep the tooth moist (in milk or saliva) and seek emergency dental care immediately.
Periodontitis Treatment
Treatment for gum disease focuses on removing bacterial deposits from teeth and root surfaces. This typically involves professional cleaning and scaling, sometimes with local anesthesia for comfort. Advanced cases may require surgical treatment to access and clean deep pockets around teeth. Ongoing maintenance with regular professional cleanings is essential to prevent recurrence.
Frequently Asked Questions
Medical References & Sources
All information in this article is based on peer-reviewed research and international clinical guidelines. Our medical editorial team reviews all content according to the GRADE evidence framework to ensure accuracy and reliability.
This article is based on Level 1A evidence – the highest quality of medical evidence, including systematic reviews and meta-analyses of randomized controlled trials. All recommendations align with current guidelines from the WHO, ADA, and FDI World Dental Federation.
Primary Sources
- World Health Organization (WHO). Global Oral Health Status Report 2022. WHO, 2022. www.who.int
- American Dental Association (ADA). Clinical Practice Guidelines for Caries Management. ADA Clinical Guidance, 2024. www.ada.org
- FDI World Dental Federation. FDI Policy Statement on Dental Caries. FDI, 2023. www.fdiworlddental.org
- Kassebaum NJ, et al. Global Burden of Untreated Caries: A Systematic Review and Metaregression. Journal of Dental Research. 2015;94(5):650-658.
- European Society of Endodontology. Quality Guidelines for Endodontic Treatment. International Endodontic Journal. 2023;56(S3):1-20.
Additional References
- Cochrane Oral Health Group. Systemic Antibiotics for Symptomatic Apical Periodontitis. Cochrane Database of Systematic Reviews. 2024.
- American Association of Endodontists. Root Canal Treatment: Patient Guide. AAE, 2024. www.aae.org
- International Association for the Study of Pain. Orofacial Pain Guidelines. IASP, 2023.
Editorial Team & Medical Review
This article was created by iMedic's medical editorial team and reviewed by licensed dental and medical specialists. All content follows our strict editorial guidelines for accuracy, objectivity, and evidence-based information.
iMedic Medical Editorial Team
Specialists in Dental Medicine and Oral Health
iMedic Medical Review Board
Independent panel following WHO, ADA, and FDI guidelines
Medical Editorial Board: iMedic has an independent medical editorial board consisting of specialist physicians and dentists in oral medicine, endodontics, periodontics, and oral surgery.