Toothache.

Reading the kind of pain you have

Not all toothaches are the same, and the way a tooth hurts often hints at what’s going on. These patterns are a guide only. Teeth can be misleading, and pain sometimes seems to come from a different tooth, or even the opposite jaw, so an examination and x‑ray are needed to know for sure.

• A quick, sharp twinge with cold or sweet things that fades within seconds: often exposed root surfaces, worn enamel, a small cavity or a leaking filling. The nerve is usually still healthy.
• Pain that lingers for a minute or more after hot or cold: this can mean the nerve inside the tooth is inflamed and may not recover on its own.
• A throbbing ache that starts by itself, keeps you awake or gets worse lying down: often a sign the nerve is badly inflamed or the tooth has become infected.
• Pain only when you bite, or when you release your bite: can point to a cracked tooth, a filling that sits slightly high, or inflammation around the root tip.
• A dull ache across several upper back teeth, worse when you bend over: sometimes linked to a blocked sinus rather than the teeth themselves.
• Soreness and swollen gum around a partly erupted wisdom tooth: often an infection of the gum flap over the tooth, called pericoronitis. Our wisdom teeth page explains the options.

Common causes of tooth pain

Decay is the most familiar cause. Once a cavity reaches the softer dentine layer beneath the enamel, the tooth tends to react to temperature and sugar, and if it reaches the nerve the pain usually becomes constant. Old fillings can also break down at the edges and let decay creep in underneath.

Other common culprits include cracks from clenching or biting something hard, receding gums that expose the root, grinding at night, food packing between two teeth, and gum infections. A tooth that has recently had a large filling or crown can be tender for a few weeks while it settles, though pain that builds rather than fades should be checked.

Pain relief: what helps and what to avoid

Over‑the‑counter pain relief can take the edge off while you wait to be seen. Follow the directions on the packet and don’t exceed the stated dose. Ask your pharmacist which option suits you, particularly if you are pregnant, take blood thinners or other regular medicines, or have asthma, stomach ulcers or kidney problems, as some anti-inflammatories aren’t suitable for everyone.

• Do rinse with warm salty water to clean the area and soothe the gum
• Do floss gently around the tooth, as trapped food sometimes causes the pain
• Do use a cold pack wrapped in a cloth on the outside of your cheek
• Do prop your head up on an extra pillow if the ache is worse at night
• Don’t place an aspirin tablet on the gum or tooth, as it can burn the gum
• Don’t hold a heat pack against your face, which can make an infection worse
• Don’t take two products that contain the same medicine, such as a cold and flu tablet with paracetamol

Calling us or going to hospital

Call us during opening hours if a toothache lasts more than a day or two, keeps you awake, needs regular pain relief, or comes with a bad taste or a swollen gum, which can be signs of an abscess. Toothaches that come and go are still worth having checked, because the underlying problem often keeps progressing even when the pain eases.

Go to your nearest hospital emergency department, or call 000, if swelling from a tooth starts to affect your breathing, your swallowing or the area around your eye, if you have bleeding you can’t control, or if the pain follows a facial injury along with other injuries. A high temperature with facial swelling also needs urgent medical care.

What we usually do when you come in

We start by asking about the pain: when it began, what sets it off, how long it lasts and whether anything relieves it. Your dentist then examines the area, may tap or apply cold to individual teeth to find the one responsible, and usually takes a digital x‑ray to see decay, cracks or infection below the surface.

Our first aim is to get you comfortable. Depending on the cause, that may mean placing a soothing dressing or temporary filling, adjusting a high spot on a filling, cleaning out an infected gum pocket, or starting root canal treatment to relieve pressure inside the tooth. Local anaesthetic is used whenever treatment might otherwise be uncomfortable.

Treatment options once the cause is clear

Many toothaches can be fixed with a filling if the nerve is still healthy. If the nerve is irreversibly inflamed or infected, the choice is usually between root canal treatment, which saves the tooth, and removing it. A cracked tooth may need a crown or onlay to hold it together, while sensitivity from exposed roots can often be managed with desensitising treatments and a change in brushing habits.

Your dentist will explain the options for your tooth, the likely number of visits, and how each choice might affect the teeth around it. Emergency visits and fillings usually fall under general dental cover, while root canal treatment and crowns are often claimed under major dental, depending on your policy.

Toothache in children and during pregnancy

Children often find it hard to describe dental pain and may simply go off their food, chew on one side or wake at night. A baby tooth with a deep cavity can still become infected, so it’s worth calling rather than waiting for it to fall out. Check children’s pain relief doses with your pharmacist.

If you’re pregnant, hormonal changes can make gums more tender and prone to bleeding. Dental care, including local anaesthetic and treatment of an infected tooth, is generally considered appropriate during pregnancy, so let us know you’re expecting when you call and we’ll plan around it.