Toothache: Causes and Treatment

Toothache: Causes and Treatment

Toothache is one of the few pains that reliably gets worse rather than better, and it is almost never something to wait out. The character of the pain tells you a great deal about the cause - and the cause determines whether this is a today problem or a this-week problem.

What the Pain Is Telling You

• Sharp pain on cold that stops as soon as the stimulus is removed. Usually sensitivity from exposed dentine, a receding gum or a small area of decay. Not urgent, but worth examining.
• Pain that lingers for minutes after hot or cold. The pulp is inflamed and probably irreversibly so. This is the classic sign that root canal treatment is likely to be needed.
• Throbbing that starts on its own and wakes you at night. Lying flat raises the pressure inside the tooth. This is an inflamed or infected pulp and needs treating, not managing.
• Sharp pain on releasing a bite rather than on biting. Typical of a cracked tooth.
• Constant pain and tenderness to touch, with the tooth feeling raised. Infection has reached the tissue around the root tip.
• Swelling of the gum, or of the face. An abscess. Facial swelling is urgent.
• Dull ache in several upper back teeth at once, worse when bending forward. Often sinus rather than teeth - which is why the upper back teeth are examined with that in mind.
• Ache in the jaw on waking, easing through the morning. Usually muscular, from grinding, rather than a tooth at all.

Common Causes

Deep decay is the most frequent. A cracked tooth is the most often missed, because it can be invisible on a radiograph. A failing filling or crown lets bacteria underneath. Gum disease produces a dull, diffuse ache with bleeding. An erupting or impacted wisdom tooth causes pain around a flap of gum that traps debris. A recently placed filling that is fractionally high causes pain on biting - and thirty seconds of adjustment fixes what painkillers will not.

And pain that is not from a tooth at all: sinusitis, jaw joint and muscle problems, and occasionally referred pain from elsewhere. This is why an examination and a radiograph come before treatment - treating the wrong tooth is a mistake that cannot be undone.

What Helps Until You Are Seen

• Painkillers as directed on the packet, taken regularly rather than waiting for the pain to peak
• Cold from the outside in twenty-minute intervals - never heat, which spreads infection
• Sleep with your head raised on extra pillows, which is why toothache is worse lying down
• Warm salt-water rinses for a gum problem
• Keep the area clean, even if it is tender

What not to do: do not place a painkiller tablet against the gum - it burns the tissue and does nothing for the tooth. Do not apply heat. Do not try to lance a swelling. And do not take leftover antibiotics from a previous illness: a partial course delays proper treatment and helps nothing. Antibiotics do not resolve pain from an inflamed pulp, because they cannot reach inside a tooth that has lost its blood supply.

Treatment

The treatment follows the diagnosis, not the pain:

• Decay that has not reached the nerve - a filling
• Irreversibly inflamed or infected pulp - root canal treatment, which relieves the pain immediately and dramatically
• Abscess - drainage first, then treatment of the tooth
• Cracked tooth - depends on where the crack runs; a crown may save it, a vertical root fracture cannot be repaired
• Gum origin - periodontal treatment
• Wisdom tooth - infection controlled first, then a decision about removal
• Unrestorable tooth - extraction, with a plan for the space

When It Cannot Wait

Seek care the same day - a hospital emergency department if no clinic is open - for swelling that spreads to the face or under the jaw, difficulty swallowing or opening your mouth, fever with dental pain, or pain that painkillers no longer control. Dental infections are ordinary until they are not, and the interval between the two is short.

If It Happens While You Are Travelling

Do not ration painkillers until the flight home. Toothache does not resolve on its own, and an untreated abscess does not stay local. Most clinics in a tourist area will see an emergency the same or next day, and in many cases the pain can be dealt with definitively in one appointment.

Send a photograph and a short description ahead if you can - it is often enough to tell you whether this needs attention today or can wait until you are home.

The information in this article is general and does not replace a clinical examination. The cause of toothache can only be determined after examination and radiographic assessment.

Written by Tuğçe Arslan Founder – Dentist · Beyaz Oral and Dental Health Clinic

She sees patients at our clinic in Kuşadası and writes and regularly reviews the medical content on this site. The information here is for general guidance only and does not replace an examination.