Toothache

  • Medical Author:
    Donna S. Bautista, DDS

    Dr. Donna S. Bautista, DDS, completed her undergraduate studies at the University of California, San Diego with a bachelor of arts in biochemistry and cell biology. During her time at UC San Diego, she was involved in basic research including studying processes related to DNA transcription in the field of molecular biology. Upon graduation, she went on to attend dental school at the University of California, San Francisco. In addition to her formal dental training, she provided dental care for underserved communities in the Bay Area through clinics and health fairs. She also worked toward mentoring high school students interested in the field of dentistry.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Shocking Diseases of the Mouth

What is a toothache?

A toothache is pain that occurs in or around a tooth. The pain originates from within a tooth or the surrounding gum and bone structures. Toothache pain is usually felt as a constant or intermittent ache that does not go away. A toothache can be stimulated by temperature changes such as exposure to cold drinks or pressure on the tooth while chewing. In other instances, a tooth can arise spontaneously without any stimulation.

It's hard to ignore an aching tooth while eating or going about one's day. Persistent pain urges us to find out how to get rid of a toothache. While bothersome, it is a way for the offending tooth or area to signal that some attention and care is needed before things get worse.

What causes a toothache?

Toothaches are usually caused by injury or trauma to the tooth or area. Injury is commonly a result of dental decay (or "cavity"). A cavity is usually felt when it gets larger and deeper into the layers of tooth structure. The hard outer layer of tooth is called enamel, and the softer layer beneath enamel is called dentin. Dentin is the tooth's sensitive layer with tiny microscopic tubes that run from the very center of the tooth. The center of the tooth is called the pulp chamber and contains the pulp. The pulp is comprised of blood vessels and nerves. If decay gets past enamel into the dentin, the cavity can sometimes cause discomfort. A deeper cavity that approaches the center of the tooth will likely cause pain since there is more damage to the tooth and there is less tooth structure to insulate and protect the pulp. Localized infection between the gum and tooth (periodontal abscess) can cause toothache. A traumatic physical blow to a tooth can induce a toothache as well.

Other causes of toothache include the following:

  1. Abscessed tooth: This is an infection that originates from within the tooth and spreads to the root and the surrounding bone.
  2. Damaged or fractured tooth: Fracture of a tooth can expose the sensitive dentin or even the pulp. Sometimes fractures are not obvious even though the fracture line can run deep into the tooth, causing pain every time one puts pressure on it with biting or chewing. This is called "cracked tooth syndrome."
  3. Dental work: After a filling or crown is done, the tooth can feel more sensitive. This is especially the case if the decay removal was large or deep. Dental work, although necessary, can sometimes irritate the nerve. Over time, the sensitivity can resolve if the tooth is healthy enough.
  4. Teeth clenching or grinding: This habit is called bruxism and is oftentimes done unconsciously and at night. Unfortunately, bruxism causes damage to teeth and sometimes irritates the nerves to the point where teeth become sensitive.
  5. Gum infection or gum disease: The gum, gum ligament, and bone that surround and anchor the teeth are collectively called the "periodontium." Pain is usually felt during the later stages of gum disease (or "periodontitis") where there is advanced loss of bone around the teeth. Because of bone loss, a gum abscess (infection) can form in the space that develops between the tooth and the gum, causing pain.
  6. Exposed root surfaces: When the roots of teeth are no longer covered with the protective bone and gum, these surfaces can be sensitive to stimuli such as brushing the teeth or temperature changes.
  7. Sinusitis: Because the roots of the upper molars are very close to the maxillary sinus cavities, inflammation from the sinus cavities can cause these molars to be sensitive and feel like a toothache.
  8. Third molars ("wisdom teeth"): Third molars are the very last permanent teeth to appear in the mouth. More often than not, there is not enough space for these molars in the mouth. As a result, third molars become fully or partially trapped (impacted) within the jawbone and below the gum. Because of poor accessibility, it is difficult to properly clean partially exposed third molars; therefore, these areas are susceptible to problems. Problems with third molars can cause dull to severe pain from pressure of eruption, gum infection, or dental decay.

Quick GuideTop Problems in Your Mouth

Top Problems in Your Mouth

Toothache Symptoms and Causes

The symptoms of toothache include sharp pain or dull pain in or around a tooth. The most common cause of a toothache is a dental cavity as a result of tooth decay.

  • Dental cavities and toothache can be prevented by proper oral hygiene.
  • Another common cause of toothache is gum disease.
  • Toothache can also be a result of an injury or an abscess of the tooth.
  • Toothache symptoms can be caused by a problem that does not originate from a tooth or the jaw.

Symptoms of toothache can be mimicked by sinus infection, shingles, and other diseases.

What are toothache symptoms and signs?

Signs and symptoms that can might indicate a tooth problem are

  • pain with biting or chewing,
  • teeth hypersensitivity to changes in temperature,
  • cheek or gums swelling near tooth,
  • discharge or bleeding of gums,
  • constant throbbing within a tooth.

A toothache can present as a dull or sharp pain that may arise spontaneously on its own or by stimulation.

Additional symptoms may include

How is a toothache diagnosed?

The dentist performs a series of diagnostic tests along with dental X-rays to determine the origin of a toothache. These tests try to mimic what may be causing the pain, such as cold stimuli, biting or chewing pressure, and finger pressure on the gums. The response to a cold stimuli test can help in determining whether a tooth is vital (nerve is intact within tooth) or suffering from pulpitis (inflammation of the pulp). Duration and acuity of pain from cold stimuli is helpful information in diagnosis.

Sometimes, the cause of a toothache may come from somewhere different than where pain is actually felt. This is called "referred pain." For these situations, diagnostic dental tests are particularly important in accurately detecting the problem.

What is the treatment for a toothache?

Treatment for a toothache depends on the cause of the pain and how much damage is present. In general, the best way to stop a toothache is to remove any present infection or decay and repair the damage to protect exposed, sensitive areas. For a shallow cavity on a tooth, the decay is removed and a filling is placed to seal the tooth. If the cavity is very deep and gets into the pulp, "root canal treatment" is performed because the pulp has been exposed and infected with bacteria. This procedure essentially removes all the vital contents of the tooth (nerves and blood vessels) and seals the inner aspects of the tooth (root canal system) with an inert filling material. Root canal treatment along with antibiotic therapy is usually needed for an abscessed tooth that has very localized infection. If the infection has become widespread, antibiotic therapy and additional steps may be needed to properly drain the infection. Sometimes extraction of the tooth may be the only option for treatment if the tooth or surrounding gum and bone are too damaged.

For a periodontal abscess, a simple drainage procedure is performed under local anesthesia. Additionally, the affected gum pocket is thoroughly cleaned to remove any tartar buildup and debris. Once the area has been cleaned up, the pocket is irrigated with an antimicrobial rinse. Sometimes, antibiotics are locally-administered into the pocket to further aid in healing. Depending on the extent of the abscess, oral antibiotics may also be prescribed. A follow-up visit is recommended to make sure the infection has completely resolved and develop a plan to properly maintain the area.

For tooth fractures or cracked tooth syndrome situations, dental crown placement is the usual treatment. A crown will replace missing tooth structure and/or it will help protect the weakened tooth from further breakdown and sensitivity.

Are home remedies effective for a toothache?

Generally, home remedies are only effective as a temporary measure to calm a severe toothache and are not intended to cure the problem. How does one try to stop a toothache fast without the aid of a dental professional? Oral pain medication will be a key step. Over-the-counter pain medicines such as ibuprofen (Advil) or naproxen (Aleve) are called nonsteroidal anti-inflammatory drugs and are best taken on a schedule to provide pain relief. Acetaminophen (Tylenol) is an alternative painkiller. In some cases, alternating doses of ibuprofen and acetaminophen is effective.

Additionally, clove oil is a natural remedy that is used in some sedative dental filling materials and can be found at the pharmacy. It can be applied to an exposed area of the tooth by biting into a small cotton ball that is soaked with clove oil. This may help stop a toothache temporarily. Other products which contain benzocaine (including Orajel or Anbesol) can temporarily numb the affected tooth or gums and provide pain relief as well.

To help a toothache until treatment can be found, one should avoid chewing on the affected tooth/area and minimize extreme temperatures of hot and cold. Keeping the area clean and free of food debris may help as well. If swelling of the surrounding gums or tissues is present, immediate treatment with a dentist or physician is advised to avoid the spread of infection. Home remedies are meant to temporarily alleviate pain, but not to treat infection.

Above all, proper diagnosis and timely treatment by a dental professional is strongly advised to effectively treat a toothache.

How is a toothache treated during pregnancy?

Dental treatment can be safely performed during pregnancy as long as a few guidelines are followed.

Generally, if dental work is required to treat a toothache, the recommended time for treatment is during the second trimester of pregnancy. However, if there is a risk of infection or severe pain, dental treatment may need to be performed at any point during a pregnancy. The obstetrician is consulted on what would be the safest option to avoid any possible complications during dental treatment.

If a dental X-ray is needed, a lead apron is always used for every patient. For a pregnant patient, this is particularly important in protecting the unborn child.

Careful consideration should be made to ensure that any medications that are used are safe during pregnancy. This applies to local anesthetics administered during dental treatment and antibiotics (such as amoxicillin [Amoxil, Trimox, Moxatag, Larotid]) taken before or after treatment. Over-the-counter drugs such as aspirin, ibuprofen, or naproxen are avoided as these are not considered safe during pregnancy. Acetaminophen is considered safe for pain management.

Quick GuideTop Problems in Your Mouth

Top Problems in Your Mouth

What is the prognosis for a toothache?

For the most part, the prognosis is good for a toothache. In this era of modern dental care, a dental problem can quickly be identified and effectively treated. The outcome is best when toothache is treated as early as possible to avoid further damage or risk of spreading infection.

Is it possible to prevent a toothache?

Conscientious efforts to practice good oral hygiene go a long way in preventing dental problems. Furthermore, regular maintenance visits with a dental professional can serve to keep things in check. Small cavities can be found before turning into larger cavities or an abscessed tooth. Gum problems, including periodontal abscess, can be addressed before advancing to a more diseased state.

To keep teeth strong, avoid the habit of chewing on ice or very hard foods that can cause tooth fractures. Using our teeth as a tool to open a bag of potato chips or cracking open a nutshell increase the chances of a tooth fracture as well. Minimize high sugar content foods or beverages to decrease the risk of dental decay. Be mindful of acidity in beverages as this can be a source of sensitivity and cavities for teeth.

REFERENCE:

Cohen, Stephen and Richard C. Burns. Pathways of the Pulp, 2nd ed. The C.V. Mosby Company, 1980.

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Reviewed on 3/7/2016
References
REFERENCE:

Cohen, Stephen and Richard C. Burns. Pathways of the Pulp, 2nd ed. The C.V. Mosby Company, 1980.

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