Image of a man holding his cheek in pain from toothache

Toothache

When to go to A+E

  • If you have a swelling in or around your mouth/neck and it is making it difficult for you to breathe, speak or swallow.
  • If you notice a swelling around your eye.

When to see an emergency dentist

  • Toothache that is keeping you awake at night.
  • Toothache that requires painkillers to try and relieve the pain.
  • Pain when biting.
  • Pain when eating or drinking hot food and drinks.
  • Lingering pain when eating or drinking cold food and drinks.
  • Toothache with a high temperature.
  • Toothache with swollen gums or a swelling on the gum next to your tooth that goes up and down.

What to do if you have toothache

  • Sleep with your head elevated in bed
  • Take over the counter painkillers (Ibuprofen/Paracetamol). Make sure you aren't allergic and that they don't interact with any other medication you are taking. Stick to the recommended dosages and do not give Aspirin to children under the age of 16.
  • Brush and floss your teeth in case food has been trapped between your teeth.
  • Swirl with a warm salty mouth rinse. Place a teaspoon of salt in a glass of hot water and wait for it to be cool enough to swirl.
  • Sometimes swirling with a cold drink can reduce toothache.
  • If you can feel a cavity in your tooth, try placing a cotton ball soaked in clove oil into the cavity.
  • Use a cold/ice compress to help reduce swelling.
  • Don't eat or drink anything that is likely to trigger the pain.
  • Don't smoke.

Finally, book an appointment with an emergency dentist near you.

Causes

Tooth decay – This is the most common cause of toothache. Bacteria located in a cavity in your tooth, can cause inflammation of the pulp (blood/nerve supply). This can be separated into two types:

Reversible inflammation – Toothache symptoms are often less severe, and normally triggered by cold or sweet food and drinks that typically last a few seconds. This is easier to treat.

Irreversible inflammation – Toothache symptoms are often more severe, but can range from pain with hot or cold that tends to linger for more than a few seconds, up to minutes and hours all the way to a severe constant ache. This is more difficult to treat.

Abscess – This is caused by a bacterial infection in and around your tooth. There are two common types of abscess that can affect your tooth.

Dental Abscess – This is caused by an accumulation of bacteria inside and around the end of your tooth.

Gum Abscess – This is caused by an accumulation of bacteria between the gum and the tooth, and is often found in patient's with pre-existing gum disease.

There are of course other types of oral abscesses and variations of those described above.

Cracked tooth – Cracked teeth are often difficult to diagnose and treat. Symptoms often begin with a sharp pain on biting. Cracked teeth are typically found in heavily filled posterior teeth, but not exclusively.

Broken tooth/Lost filling – Tooth pain can often be caused by a broken tooth or a loose/lost filling. Depending on the health of the pulp, this can often be treated by repairing the tooth.

Sinusitis – Sinusitis can often feel like toothache. Typically, the pain is localised to the top back teeth and feels like a heavy/dull pain that gets worse when you tilt your head forwards. Sinusitis normally has other symptoms as well as perceived dental pain and we would recommend a trip to your GP in this instance.

Partially erupted teeth – Teeth that are coming through the gum occasionally become infected and can feel like toothache. Typically, it affects wisdom teeth, but it can affect any tooth that is coming through.

Emergency Treatment

Treatment depends on achieving the correct diagnosis:

Abscess – If there is an obvious swelling, it is important to drain the infection as soon as possible. This may be achieved by incising/draining the swelling directly or by drilling into the tooth and placing a dressing inside the tooth to reduce the infection. If the patient has a high temperature or it isn't possible to drain the infection directly, then antibiotics may be prescribed. These are often only temporary measures and further treatment is normally required.

Irreversible Pulpitis (inflammation) – The dentist will initially assess the long-term restorability of the tooth. If it is restorable, the tooth will require root canal treatment to save it. At the emergency appointment, the dentist should either remove the nerve tissue inside the tooth and dress it with an antibiotic/anti-inflammatory paste or extract the tooth. If the tooth cannot be saved, the dentist will recommend extraction.

Reversible Pulpitis (Inflammation) – The dentist may try and place a permanent filling in your tooth at the first appointment if they have time and feel it is appropriate. Alternatively, they may try and place a temporary dressing to help reduce any inflammation inside your tooth, prior to placing a permanent filling.

Partially erupted teeth – Depending on the severity of the infection or inflammation, the dentist may either clean around the tooth or prescribe antibiotics under certain conditions.

Prevention

The best ways to prevent oral health problems include:

  • Visit your dentist regularly at a time period specified by your dentist. Children should visit the dentist every 6 months from when their first teeth appear.
  • Brush your teeth twice daily for two minutes with an appropriate fluoride toothpaste for your age.
  • Clean between your teeth with interdental brushes daily, and use a daily non-alcohol based fluoride mouthwash.
  • Reduce the amount and the frequency of sugar in your diet.
  • Don't smoke and limit your alcohol consumption to the recommended amounts.