Toothache and Tooth Pain

Tooth pain has several causes, and the kind of pain says more than its location. A short sharp twinge with cold is usually exposed dentin or a small cavity, a lingering ache is an inflamed nerve, pain on biting often means a crack, and a constant throbbing ache with swelling is an infection. Below is what each kind usually means, what to do until you can be seen, and how we find the tooth responsible. Call us at (305) 568-8899 as soon as you can; we try to see patients in pain the same day.

What the pain usually means

A sharp twinge with cold or sweet that fades in seconds. Often exposed dentin: a receding gum, a worn spot, a small cavity, a leaking filling. Usually a small problem, and a good time to catch it.

Pain with cold or heat that lingers, or an ache that starts on its own, especially at night. The nerve inside the tooth is inflamed, usually from deep decay, a deep filling or a crack. This is the pain that leads to a root canal, and the earlier it is treated, the easier that treatment is.

Pain when you bite, particularly on letting go. A classic sign of a cracked tooth. It can also be a filling or crown that sits a fraction high, or inflammation at the tip of the root.

A constant, throbbing ache, with the tooth feeling raised or tender to touch, sometimes with swelling. Infection at the root or in the gum. This one does not improve on its own and needs to be seen promptly.

Soreness in the gum around a tooth, bleeding, or pain behind a back molar. Usually gum inflammation, food packed between teeth, or the gum over an erupting wisdom tooth.

An ache across a whole side, or in several upper back teeth at once. Often not a tooth at all: clenched jaw muscles, or a sinus infection pressing on the roots of the upper molars.

What to do before you can be seen

• Take an over-the-counter pain reliever as the label directs, if your doctor allows it.
• Keep your head raised when lying down.
• Avoid very hot, cold or sweet food and drink on that side.
• A cold compress on the cheek helps with swelling.
• Do not put aspirin or anything else on the gum itself; it burns the tissue.
• If a piece of tooth or a filling has come out, keep it and avoid chewing on that side.

Call before it gets severe

A tooth that has been hurting badly for days develops a severely inflamed nerve that is harder to numb, which is where the reputation of the emergency root canal as a painful procedure comes from.

How we find the cause

We start with your account: when the pain started, what brings it on, how long it lasts, whether it wakes you. Then tests that single out the tooth: a cold test on each tooth in turn, gentle tapping, a bite test for cracks, and gum measurements. X-rays show decay, infection at the root and the state of old fillings; a 3D scan is added only when a flat image cannot answer the question.

If the source is obvious and you are in severe pain, we numb the tooth before the discussion. If it is not obvious, we test first, because numbing the area makes it harder to tell which tooth is responsible. Our diagnostics page describes this in detail.

What usually fixes it

Depending on the cause:

• A filling for decay or a leaking edge
• A crown to hold a cracked tooth together
• A root canal for an inflamed or dead nerve
• Gum treatment for a periodontal cause
• A small adjustment for a filling that sits high
• For a tooth that cannot be saved, an extraction with a plan for the space

The aim of the first visit is to get you comfortable, explain the cause and agree the next step.

If you were given antibiotics elsewhere and told to wait, the American Dental Association’s clinical guideline on antibiotics for dental pain reaches the same conclusion we do: for most toothaches the answer is treatment of the tooth, not antibiotics, which the guideline reserves for infection that is spreading or causing fever when treatment cannot be had promptly.

Frequently asked questions

Why does my tooth hurt only when I bite?

Pain on biting, especially on letting go, often points to a crack, a filling that sits slightly high, or inflammation at the root tip. Each is treated differently, which is why we test rather than guess.

Can a toothache go away on its own?

The pain sometimes does; the cause rarely does. A nerve that stops hurting may have died rather than healed, and an infection can go quiet and return worse. Tell us about pain that came and went; it still needs a look.

Will antibiotics fix it?

Usually not on their own. Most tooth pain comes from inside the tooth or around its root, where antibiotics do not reach the cause. They have a place when there is spreading infection or fever, prescribed alongside treatment of the tooth.

What can I take for the pain tonight?

An over-the-counter pain reliever as directed on the label, if your doctor allows it. Keep your head raised, avoid very hot, cold or sweet food on that side, and use a cold compress on the cheek for swelling. Never put aspirin on the gum. Then call us in the morning.

When is a toothache an emergency room matter?

When it comes with difficulty breathing or swallowing, swelling that spreads toward the eye or down the neck, or a high fever with facial swelling. Those are medical emergencies first. Everything else, call us.

Sources

Professional guidelines and peer-reviewed reviews this page draws on.

1. Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. Journal of the American Dental Association. 2019;150(11):906-921. DOI