Toothache: Common Causes, Home Relief and When to Get Help

Tooth pain is most often caused by tooth decay, a cracked tooth, an infection in or around the tooth, or irritated gums. Short, mild sensitivity may settle on its own, but tooth pain that lasts more than a day or two, keeps you up at night, or comes with swelling or fever needs a dentist soon.

Key Takeaways

• A toothache is a symptom, not a diagnosis: the same pain can come from a cavity, a crack, an abscess, gum disease or even a sinus.
• Throbbing tooth pain that lingers after hot or cold, or wakes you at night, often means the nerve inside the tooth is inflamed.
• Home toothache relief can make you more comfortable, but it does not fix the cause, and painkillers only mask it.
• According to the ADA, most toothaches are treated with dental care rather than antibiotics.
• Facial swelling that spreads, difficulty breathing or swallowing, or a high fever with tooth pain are reasons to call 911 or go to the emergency department.

What causes tooth pain?

Tooth pain is pain felt in or around a tooth, and it usually comes from the pulp (the nerve and blood supply inside the tooth), the ligament and bone around the root, or the gums. The NHS and Cleveland Clinic both list the same core toothache causes.

• Tooth decay: a cavity that reaches the dentin causes sensitivity; one that reaches the pulp causes stronger, lasting pain.
• Dental abscess: a pocket of infection at the root tip or in the gum, often from deep decay or an old injury.
• Cracked tooth: a crack flexes when you bite and irritates the nerve.
• Loose or broken filling or crown: exposed tooth underneath becomes sensitive and can decay further.
• Gum disease: inflamed gums and exposed roots can ache and feel tender.
• Grinding and clenching: overloaded teeth and jaw muscles ache, often in the morning.
• Erupting or impacted wisdom teeth: pain at the back of the jaw, sometimes with swollen gum.

Tooth pain can also come from outside the tooth. Sinus congestion can make upper back teeth ache, jaw joint problems can feel like tooth pain, and rarely, pain in the jaw can be a sign of a heart problem. If jaw pain comes with chest pressure, shortness of breath or sweating, call 911.

What your tooth pain may be telling you

The type of pain gives your dentist useful clues. The table below shows common patterns. It is a guide for the conversation with your dentist, not a way to diagnose yourself.

What you feel	Common causes	How soon to call
Quick twinge with cold or sweet that fades in seconds	Sensitive exposed root, early decay, worn enamel	Book a regular visit
Sharp pain when you bite, especially on release	Cracked tooth, loose filling, high filling	Call within a few days, sooner if it worsens
Pain with hot or cold that lingers for a minute or more	Inflamed pulp from deep decay or a crack	Call the dental office today or tomorrow
Constant, throbbing tooth pain that can wake you	Inflamed or dying pulp, abscess	Call the dental office today
Tooth feels tall, tender to touch, gum swollen or a pimple on the gum	Dental abscess	Call the dental office today
Dull ache in several upper back teeth, worse bending over	Sinus congestion	See your doctor or dentist if it persists
Ache in the jaw and teeth on waking	Grinding or clenching	Book a regular visit
Pain and swelling behind the last molar	Wisdom tooth or pericoronitis	Call the dental office today

A note on pain that suddenly stops: when a badly inflamed tooth stops hurting, it can mean the nerve has died rather than healed. Infection can still develop at the root, so a tooth that hurt badly and then went quiet should still be checked. Our guide to dental abscess signs explains what to watch for.

Throbbing tooth pain

Throbbing tooth pain is a pulsing ache that often matches your heartbeat. It usually means pressure is building inside the tooth or around the root because of inflammation or infection. The pulp sits in a rigid chamber, so swelling has nowhere to go and presses on the nerve. Throbbing pain rarely goes away permanently without treatment.

Why tooth pain is often worse at night

Tooth pain at night is a common complaint, and there are a few reasons for it. Lying flat increases blood flow to the head, which can raise pressure in an inflamed tooth. At night there are also fewer distractions, so you notice the pain more. Some people grind or clench in their sleep, and pain relievers taken earlier in the day may wear off overnight.

To make a night more bearable while you wait for an appointment:

• sleep with your head raised on an extra pillow;
• avoid eating or drinking sugary, very hot or very cold things close to bedtime;
• brush and floss gently so no food is trapped around the sore tooth;
• use a cold compress on the outside of the cheek for short periods if the area is swollen.

Tooth pain that wakes you from sleep is a sign the problem is more than mild sensitivity. Call the dental office in the morning.

Safe toothache relief at home

These steps can ease a toothache for a short time. They are not a substitute for treatment.

1. Rinse and floss. The ADA's MouthHealthy site suggests rinsing with warm water and gently flossing to remove food caught between teeth, which sometimes is the whole cause.
2. Try a warm salt-water rinse. The NHS suggests rinsing with warm salt water and spitting it out.
3. Use a cold compress. Cold on the outside of the cheek, wrapped in a cloth, can reduce swelling and dull the ache.
4. Eat soft, lukewarm food. Chew on the other side and avoid very hot, very cold and sugary foods.
5. Consider an over-the-counter pain reliever. Ibuprofen and acetaminophen are commonly used for dental pain. Follow the package directions, and ask a pharmacist which product and amount is right for you, especially if you are pregnant, breastfeeding, take other medications, or have stomach, kidney, liver or heart conditions. Children need products and amounts made for their age and weight.
6. Ask a pharmacist about oral pain gels. Numbing gels can help briefly; ask whether they are suitable for you or your child.

What to avoid:

• Do not place aspirin or crushed tablets on the tooth or gum; the ADA advises against it.
• Do not put heat on a swollen face.
• Do not try to pop or drain a swelling.
• Do not use leftover antibiotics or someone else's prescription.
• Do not take more pain medication than the package allows because the pain is strong. If the recommended amount is not controlling your pain, that is a reason to be seen, not to take more.

What about antibiotics?

Many people expect antibiotics for a toothache. The American Dental Association's guideline on antibiotics for dental pain and swelling recommends against them for most toothache conditions, and recommends dental treatment plus over-the-counter pain relief instead. Antibiotics are reserved for infections that are spreading or causing signs such as fever and feeling unwell. Antibiotics alone do not remove the source of infection, so the tooth still needs treatment.

When to call the dentist, and when to call 911

Most toothaches are a dental office problem. A small number are medical emergencies because infection from a tooth can spread into the face, neck and airway.

Situation	Where to get help
Mild sensitivity or occasional twinges	Book a visit at the dental office
Tooth pain lasting more than a day or two, or not settling with over-the-counter relief	Call the dental office today
Swollen gum, a bad taste, a pimple on the gum, or pain when biting	Call the dental office today
Swelling of the cheek or jaw, fever, trouble opening your mouth	Call the dental office today and mention the swelling
Swelling spreading to the eye or neck; difficulty breathing, swallowing or speaking	Call 911 or go to the Emergency Department at the Colchester East Hants Health Centre
Tooth pain after a serious facial injury or with uncontrolled bleeding	Call 911 or go to the Emergency Department
Not sure how urgent it is, or it is after hours	Call 811 to talk to a registered nurse, 24 hours a day

The NHS advises going to emergency care if swelling affects the area around the eye or neck, or is making it hard to breathe, swallow or speak. Cleveland Clinic similarly lists severe tooth pain with fever, severe swelling or uncontrolled bleeding as reasons for emergency care.

How a dentist finds the cause of a toothache

Finding the source of tooth pain can take some detective work, because pain can feel as though it is coming from a different tooth, or even the other jaw. A toothache visit usually includes:

• Questions: when it started, what triggers it, how long it lasts after cold or hot, whether it wakes you, and any recent dental work or injury.
• An exam: looking at the teeth and gums, checking fillings and crowns, and looking for swelling.
• Tests: tapping on teeth, a bite test, and applying cold to see how each tooth's nerve responds.
• X-rays: a digital X-ray shows decay between teeth, deep fillings near the nerve, and bone changes around a root tip that point to infection.

Once the cause is clear, your dentist will explain the options. Depending on the cause, treatment may be a filling, replacing a broken filling or crown, root canal treatment, draining an abscess, gum treatment, a night guard for grinding, or removing a tooth that cannot be saved. If a crack is the problem, our guide to chipped and cracked teeth covers the repair options. Some procedures may be done the same day to relieve pain, with the rest planned for a later visit.

Cost factors

What a toothache costs to treat depends on the cause, not the pain level. A small filling is a very different visit from root canal treatment and a crown. Early care is usually simpler and less expensive than waiting until the tooth needs a larger repair or removal. Your dentist can give you an estimate before treatment. For coverage through the federal program, see our Canadian Dental Care Plan page and call to confirm current participation and billing.

Tooth pain in children, pregnancy and older adults

Children

Children often describe tooth pain vaguely, or show it by refusing to chew on one side, rubbing the cheek or waking at night. Call the dental office if your child has a toothache. Use only pain relievers made for children, following the package directions for their age and weight, and ask a pharmacist if you are unsure. Swelling of a child's face is a reason to call the same day. Nova Scotia's Children's Oral Health Program may help with the cost of some dental care for eligible children; check novascotia.ca for current details.

Pregnancy

Hormonal changes in pregnancy can make gums more tender and prone to bleeding. A toothache during pregnancy should not be ignored, because untreated infection is a bigger concern than most dental treatment. Tell the dental team you are pregnant, and ask a pharmacist or your prenatal care provider which pain relievers are appropriate.

Older adults

Older adults are more likely to have tooth pain from decay along the root surface, cracks in heavily filled teeth, and dry mouth caused by medications. Dentures that rub can also cause pain that feels like a toothache. Bring a list of your medications to the visit.

Dental anxiety

Tooth pain is one of the most common reasons people who avoid the dentist finally call. If anxiety has kept you away, tell the team when you book. A first emergency visit can focus on finding the cause and relieving the pain, with time to talk through the next steps.

Getting toothache help in Truro

Landmark Dental Care is a family general practice at 125 Queen St in downtown Truro, open Monday to Friday, 8:30am to 5:00pm, serving Truro, Bible Hill, Colchester County and Central Nova Scotia. When you call with tooth pain, tell us how long it has hurt, what triggers it, and whether you have swelling or fever. That helps us decide how quickly you need to be seen.

Our general dentistry visits handle the fillings, crowns and checkups that prevent many toothaches, and our emergency dentistry team is there for pain that cannot wait. If the problem is at the back of the jaw, our article on wisdom tooth pain may help.

For red-flag symptoms, do not wait for a dental appointment: call 911 or go to the Emergency Department at the Colchester East Hants Health Centre, 600 Abenaki Rd, Truro, which is open 24 hours a day. For advice at any hour, Nova Scotians can call 811.

FAQ

How do I stop tooth pain fast?

Rinse with warm water, floss gently to remove trapped food, use a cold compress on the cheek, and consider an over-the-counter pain reliever following the package directions. These steps can take the edge off, but they do not treat the cause, so call a dentist if the pain lasts more than a day or two.

Can a toothache go away on its own?

Sensitivity from trapped food or a mildly irritated gum may settle. Pain from decay, a crack or infection usually returns or worsens, and pain that stops suddenly can mean the nerve has died, so it is still worth having the tooth checked.

Why does my tooth hurt when I drink something cold?

Brief sensitivity to cold often comes from exposed root surfaces or worn enamel. Cold pain that lingers for a minute or more after the drink is gone is more likely to mean the nerve is inflamed, and your dentist should check it.

Should I go to the emergency room for a toothache?

Go to the emergency department or call 911 if you have facial swelling that is spreading, trouble breathing or swallowing, a high fever, or a serious injury. For tooth pain without those signs, a dental office is the right place, because hospitals usually cannot treat the tooth itself.

Is it tooth pain or a sinus infection?

Sinus pressure can make several upper back teeth ache at once, often worse when you bend over, and usually comes with congestion. Pain in one specific tooth, or pain with hot and cold, is more likely to be dental. A dentist can check the teeth and tell you if a doctor is the better next stop.

Next step

If you have tooth pain that is not settling, get help for a toothache today by calling Landmark Dental Care at 902-893-2919, or reach us through the contact page. We are at 125 Queen St, Truro, and will help you figure out how soon you need to be seen.

References

• NHS: Toothache
• Cleveland Clinic: Toothache
• American Dental Association: Antibiotics for Dental Pain and Swelling Guideline
• ADA MouthHealthy: Dental Emergencies
• Nova Scotia Health: Colchester East Hants Health Centre
• Government of Nova Scotia: 811

This article provides general educational information and is not a diagnosis or a substitute for care from a dentist or other qualified health professional.