A toothache can be a dull background ache that comes and goes, a sharp jolt when you bite, or a throbbing pain that keeps you awake. Because so many different problems can cause tooth pain, the sensation alone rarely tells you what is going on. This guide walks through the most common causes, the warning signs that mean you should get care quickly, what you can safely do at home in the meantime, and what to expect when you see a dentist.
What counts as a toothache?
MedlinePlus defines a toothache simply as pain in or around a tooth (MedlinePlus: Toothaches). That broad definition matters, because the source is not always the tooth itself. Pain can start in the nerve inside a tooth, in the gum and bone around it, in the jaw joint, or even somewhere else in the head and neck.
The most common causes
Tooth decay (cavities)
Decay is one of the most frequent reasons for tooth pain. Bacteria in plaque turn sugars and starches into acid that gradually weakens enamel. Early decay usually does not hurt at all. As it reaches deeper layers, it can cause sensitivity to sweets, heat or cold, and eventually a constant ache. The National Institute of Dental and Craniofacial Research notes that untreated decay can lead to pain, infection and tooth loss (NIDCR: Tooth Decay). Our guide to cavities, their stages and treatment goes into more detail.
Infection and abscess
When bacteria reach the pulp, the soft tissue in the center of the tooth, an infection can develop and pus can collect near the root. A tooth abscess typically causes a severe, continuous, throbbing pain and may come with swelling, a bad taste or fever. This is one of the situations where waiting is a bad idea. See our article on tooth abscess signs and why prompt care matters.
Cracks, chips and other trauma
MedlinePlus lists tooth trauma such as wear, injury or fracture among the causes of toothache. A crack may hurt only when you bite down or release, or when you drink something cold, and it can be hard to see. Grinding or clenching can also make teeth sore. Our guide to a cracked or chipped tooth covers what to do next.
Gum problems
Gum disease can make the area around a tooth tender, swollen or prone to bleeding, and advanced gum disease can loosen teeth. Food wedged between teeth and the gum can also cause a surprisingly sharp, localized pain. Read more in our article on signs of gum disease.
Pain that comes from somewhere else
Sometimes the tooth is not the problem. MedlinePlus explains that pain felt in a tooth can be referred from another part of the body. Its list of possible causes includes an earache, a sinus infection, an injury to the jaw or mouth, and even a heart attack, which can show up as jaw pain, neck pain or toothache. Upper back teeth sit close to the sinuses, so a sinus infection or congestion can make several upper teeth ache at once.
When a toothache is urgent
MedlinePlus advises seeking care if you have a severe toothache, a toothache that lasts longer than a day or two, or fever, earache or pain when opening your mouth wide. Use these as a practical triage guide:
- Call 911 or go to an emergency room if you have trouble breathing or swallowing, swelling that is spreading to your eye, neck or under your jaw, or jaw pain along with chest pain, shortness of breath or sweating. These can signal a spreading infection or a heart problem, not just a dental one.
- Call a dentist the same day for severe or throbbing pain, facial or gum swelling, a pimple-like bump on the gum, fever, a tooth that has been knocked loose or broken, or pain that keeps you from sleeping.
- Book a prompt appointment for a mild ache or sensitivity that has lasted more than a day or two, even if it seems to be getting better. Pain that fades does not always mean the problem has gone; an infected tooth can stop hurting while the infection continues.
If you are not sure which group you fall into, our dental emergency checker walks through common symptoms, and our article on what counts as a dental emergency explains the difference between urgent and routine problems.
What you can do at home in the meantime
Home care is a bridge to treatment, not a replacement for it. Sensible steps drawn from MedlinePlus and the ADA include:
- Rinse and clean gently. The ADA suggests rinsing with warm water and gently using floss to remove any food caught between teeth (ADA MouthHealthy: Dental Emergencies).
- Use over-the-counter pain relief as directed if you cannot see a dentist right away; MedlinePlus notes that over-the-counter pain relievers may help with the pain of a tooth abscess. Follow the label and check with a pharmacist or doctor if you have health conditions or take other medicines.
- Do not put aspirin directly on the tooth or gum. Both the ADA and MedlinePlus warn against this, because it can irritate and burn the tissue.
- Use a cold compress on the outside of the cheek if there is swelling or the pain followed an injury.
- Avoid chewing on that side and skip very hot, very cold or sugary foods and drinks that set off the pain.
What happens at the dental visit
MedlinePlus describes a typical toothache visit: the dentist examines your mouth, teeth, gums, tongue and throat, and may also check your ears, nose and neck. X-rays are common. Expect questions such as:
- When did the pain start, and where exactly is it?
- How severe is it, and does it wake you up at night?
- What makes it better or worse: biting, heat, cold, sweets, lying down?
- Have you had a fever, swelling or an injury?
- What medicines do you take, and when was your last checkup?
Thinking about these answers before you go helps the dentist narrow the cause faster. Treatment depends on what is found. MedlinePlus lists options such as removing decay and placing a filling, root canal therapy, or extracting the tooth. If grinding is to blame, a protective appliance may be suggested. If the pain is referred from elsewhere, you may be sent to your primary care provider.
For a sense of what drives the price of common treatments, see our guides to root canal costs and dental cost factors.
Preventing the next toothache
Not every toothache can be prevented, but many causes are slow-building problems that a routine exam can catch early. MedlinePlus recommends a low-sugar diet, brushing with fluoride toothpaste, regular flossing and professional cleanings, and mentions that sealants and fluoride applications help prevent decay. Tell your dentist if you think you grind your teeth. Wearing a mouthguard for sports and not chewing ice or hard candy, as the ADA advises, lowers the risk of a cracked tooth. Our article on how often to see the dentist explains how checkup schedules are set.
Finding care
If you do not have a regular dentist, our dentist directory lets you search by location and specialty. For pain that appears to be coming from the nerve of a tooth, you may be referred to an endodontist, a specialist in root canal treatment.
Frequently asked questions
Can a toothache go away on its own?
Mild sensitivity sometimes settles, for example after food is cleared from between teeth. But pain from decay or infection does not heal by itself, and an infected tooth can stop hurting while the infection continues. If pain lasts more than a day or two, see a dentist.
Why does my tooth hurt more at night?
Many people notice tooth pain more when lying down and when there are fewer distractions. Pain that wakes you up is worth mentioning to your dentist, because it helps them judge how inflamed the nerve may be.
Should I go to the emergency room for a toothache?
Go to an emergency room or call 911 if you have trouble breathing or swallowing, rapidly spreading swelling, or jaw pain along with chest pain or shortness of breath. For most other toothaches, a dentist is the right place to start.
Can a sinus infection cause tooth pain?
Yes. MedlinePlus lists sinus infection among the causes of toothache. A dentist can help tell whether the tooth or the sinus is the source.
Sources
- MedlinePlus – Tooth abscess
- MedlinePlus – Toothaches
- NIDCR – Tooth Decay
- ADA MouthHealthy – Dental Emergencies
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Toothbrush (Background focused)” by Deavmi, via Wikimedia Commons, licensed CC BY-SA 3.0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.