Toothache can be caused by several reasons, such as tooth decay, a cracked or damaged tooth, an abscessed tooth, or an infection. Pain from a toothache can be constant or come and go. For example, eating or drinking can put pressure on the affected tooth, causing pain. Mild toothaches may be addressed with over-the-counter medications. However, if the pain persists for two days, you must visit your dentist right away to assess the problem to prevent it from getting any worse. Furthermore, sometimes toothaches can be referred pain when there is a problem in another part of your body; therefore, the pain should not go unnoticed and requires medical assessment.
This article provides insights on the causes of toothaches, their treatment, how to prevent them, and when to visit your dentist.
A toothache is pain felt in or around a tooth. However, the type of pain can vary and present itself in multiple ways 1. The following are symptoms of a toothache:
- Sharp, throbbing pain in or around your tooth or gum
- Swelling around your tooth
- Pain with chewing
- Tooth sensitivity to hot or cold beverages
- Bleeding around tooth or gum
- Foul tasting drainage from the infected tooth
- Bad odor from the mouth
Common Causes of Toothaches
Toothaches can be caused by several reasons, which include the following:
- Tooth Decay – Tooth decay, also known as dental caries, is one of the most common causes of toothache. Tooth decay is the destruction of the tooth structure caused by bacteria that live in dental plaque. Plaque is a sticky substance formed when bacteria mix with sugary or starchy food if you do not clean your teeth well. When you eat sugary foods or beverages, the bacteria in plaque produce acids that attack the tooth enamel and damage the tooth if allowed to build up over time. Tiny openings or holes eventually develop in the damaged tooth, commonly known as cavities. If the cavities are not treated, they grow larger and deeper, causing toothaches and eventually leading to tooth loss.2
- Dental Abscess – A dental abscess usually arises after tooth decay, dental trauma, or failed root canal. When bacteria break down your tooth enamel due to tooth decay, trauma, or failed root canal, they eventually enter the pulp cavity of your tooth if not treated early. After they enter the pulp cavity, they induce inflammation and cause pockets of pus to form in different parts of the tooth, known as an abscessed tooth. An abscessed tooth causes moderate to severe toothaches that need to be taken care of by dental professionals since they do not go away on their own. If dental abscesses are not treated at an early stage, the bacteria can spread to other parts of the body leading to serious complications. 3
- Impacted Tooth – Toothaches can also be due to an impacted tooth, most commonly from partial wisdom tooth eruption. Inflammation can occur surrounding an impacted tooth when bacteria or food debris accumulate beneath the flap of gum covering the tooth, causing toothaches, swelling, tenderness, or inflamed gums.4
- Periodontal Disease – Periodontal disease or gum disease is an oral disease involving the periodontium, the supporting structures surrounding the tooth, including the gums, alveolar bone, cementum, and periodontal ligament. Periodontal disease is mainly caused due to inadequate oral hygiene practices, which leads to bacterial plaque build-up that eventually leads to caries, dental abscesses, and periodontal disease. Periodontal disease can cause severe toothaches, tooth sensitivity, difficulty in chewing, swelling, bad breath, or tooth loss. 5
- Dental Trauma – Injury to the teeth or supporting structures, including tooth fractures, loosening, or displacing of the tooth, can cause toothaches. Dental trauma needs to be immediately assessed by dentists to provide the appropriate care required and prevent tooth infections from bacteria building up in the injured teeth.
Although toothaches are most often due to the above conditions, sometimes, toothaches can also be due to referred pain in which pain from one part of the body is felt in the other. The following are a few causes of referred toothaches:
- Sinusitis – If pain in the upper teeth on both sides of your face occurs without any signs of dental-related problems, it could be due to sinusitis. The roots of your upper teeth lie close to your sinuses; therefore, inflammation of your sinuses can sometimes be perceived as toothaches.
- Muscular Toothaches – Muscular toothaches occur due to pain in specific muscles which produces referred pain in different teeth. For example, pain in the temporal muscles located on each side of your head can produce pain in the maxillary molar region of your teeth. Dentists can promptly diagnose muscular toothaches by pressing trigger points and analyzing where the pain is perceived.
- Headaches – Referred pain in the teeth can also be due to headaches, including migraine headaches, cluster headaches, and other neurovascular headaches.6
- Cardiac toothaches – Although less common, toothaches can be referred pain of cardiac origin. Cardiac toothaches are usually perceived bilaterally, affecting the teeth in both parts of the mouth. In contrast, odontogenic pain (pain within the tooth or surrounding tissues) is always unilateral.7
How are Toothaches Treated?
Pain from temporary irritation around the tooth can be treated at home with pain medication, cold compress, or saltwater rinses. However, if the pain persists for two days, professional help is needed. Over-the-counter medicines such as paracetamol may alleviate pain from toothaches, but the results are only temporary since they do not address the underlying cause. Dentists help diagnose the underlying cause of toothaches through dental assessment and may also carry out X-rays to identify the problem. The following are the different treatments depending on the cause of the toothache:
- Tooth decay – Treatment for tooth decay depends on the severity.
- If your tooth decay is at its early stages, your dentist may prescribe fluoride toothpaste and mouthwash, and dental treatments at the dental office.
- If you have a cavity or hole in your tooth, your dentist will remove the decayed material with a drill and fill it with dental material.
- Severe tooth decay is treated by a partial or full crown or by tooth extraction. A dental implant can replace an extracted tooth.
- If the nerves of your tooth are also affected, a root canal may be performed.
- Dental Abscess – Dentists usually treat an abscessed tooth by draining the abscess and providing antibiotic support. If the damage is too severe, your dentist may remove the tooth before draining the abscess or perform a root canal procedure and drill the tooth to drain the abscess and remove the infected pulp.
- Impacted Tooth – An impacted tooth such as a partially erupted wisdom tooth requires an evaluation from dental professionals for appropriate treatment. Dentists may treat inflammation from the impacted tooth by saltwater rinses or prescribing antibiotics. Additionally, pain medications may be prescribed to treat the pain. Surgical treatment may be necessary to remove the gum flap from a partially erupted tooth or for complete removal of the underlying tooth.8
- Periodontal Disease – Treatment of periodontal diseases includes non-surgical intervention techniques such as using antibiotics to eliminate the bacteria or mechanical methods. Mechanical methods include scaling to remove the tartar from the tooth and gums and root planing to smooth the tooth’s surfaces to discourage further bacterial build-up. If the problem cannot get solved through non-surgical techniques, surgery or chemotherapeutics agents are required.
- Referred pain – If pain from toothache is due to referred pain, your dentist may refer you to a doctor for further diagnosis and treatment.
How can you prevent toothaches?
Toothaches usually occur due to poor oral hygiene habits and can easily be prevented by the following:
- Regular brushing at least twice a day and preferably after every meal
- Flossing your teeth at least once a day
- Limiting the consumption of sugary foods and beverages
- Having regular dental check-ups to detect any early signs of tooth decay
- Seeing your dentist for professional cleaning at least twice a year or as often as your dentist recommends
- Avoiding smoking
- Replacing your toothbrush every three months
When to visit your dentist for a toothache?
If you have a toothache, you can take painkillers such as paracetamol and ibuprofen to reduce the pain. However, you should visit your dentist as soon as possible if:
- The pain persists for more than two days
- Your toothache is severe, and the pain does not go away with painkillers
- You experience swelling in the mouth or face
- You have a fever along with the toothache
If you suffer from the above conditions, it is essential to visit your dentist because the problem will not go away on its own and will only get worse. Untreated bacteria from toothaches can spread to other parts of the face and even enter the bloodstream. Your dentist will give you a proper diagnosis and provide the best treatment for your toothache to relieve the pain and prevent the infection from progressing or spreading any further.
How to relieve a toothache while waiting for your dentist appointment?
The following may provide pain relief for your toothache while waiting for your appointment:
- Over-the-counter painkillers
- A pain-relieving gel for the mouth that can be bought from pharmacies
- Saltwater rinses
- Eating soft foods
- Avoiding chewing with the affected tooth
About the author
- Koh SWC, Li CF, Loh JSP, Wong ML, Loh VWK. Managing tooth pain in general practice. Singapore Med J. 2019;60(5):224-228. doi:10.11622/smedj.2019044
- Heng C. Tooth Decay Is the Most Prevalent Disease. Fed Pract. 2016;33(10):31-33.
- Shweta, Prakash SK. Dental abscess: A microbiological review. Dent Res J (Isfahan). 2013;10(5):585-591.
- Douglass AB, Douglass JM. Common dental emergencies. Am Fam Physician. 2003;67(3):511-516.
- Mann J, Bernstein Y, Findler M. Periodontal disease and its prevention, by traditional and new avenues. Exp Ther Med. 2020;19(2):1504-1506. doi:10.3892/etm.2019.8381
- Fukuda KI. Diagnosis and treatment of abnormal dental pain. J Dent Anesth Pain Med. 2016;16(1):1-8. doi:10.17245/jdapm.2016.16.1.1
- López-López J, Garcia-Vicente L, Jané-Salas E, Estrugo-Devesa A, Chimenos-Küstner E, Roca-Elias J. Orofacial pain of cardiac origin: review literature and clinical cases. Med Oral Patol Oral Cir Bucal. 2012;17(4):e538-e544. Published 2012 Jul 1. doi:10.4317/medoral.17636
- Douglass AB, Douglass JM. Common dental emergencies. Am Fam Physician. 2003;67(3):511-516.