Toothache
Toothache nearly always means the same thing: in the tooth or around it there is a process that will not stop on its own.
On this page
- When it is no longer toothache but spreading infection
- Decay and pulpitis: what is actually hurting
- “It went away by itself” usually means the nerve has died
- A cracked tooth, exposed roots and sensitivity
- The wisdom tooth and inflammation around it
- Pain after dental treatment
- How to help yourself until the appointment, and what not to do
- Online consultation
Medicines commonly prescribed for Toothache
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Teva B.V.Prescription not requiredDosage form: EFFERVESCENT TABLET, 1 g paracetamolActive substance: paracetamolManufacturer: Upsa S.A.S.Prescription requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription required
Toothache nearly always means the same thing: in the tooth or around it there is a process that will not stop on its own. A painkiller changes not the process but only your ability to put up with it, so the one real answer is to get to a dentist, and everything else merely helps you last until the appointment. The subject looks domestic, and that is exactly why it has a dangerous side: infection from a tooth can spread beyond the tooth into the face and neck, and that is no longer “I will wait for the dentist”, that is an ambulance. We start there, because those are the cases most often missed.
When it is no longer toothache but spreading infection
Infection from the root of a tooth can move into the soft tissues of the face, the floor of the mouth and the neck. It sometimes develops over hours, and what makes it dangerous is not the pain but swelling that presses on the airway.
Call an ambulance or get to hospital immediately if, along with toothache, any of the following appears:
- swelling of the face that is growing quickly;
- swelling that is closing the eye, or swelling creeping up towards the eye;
- swelling under the jaw, under the tongue or in the neck;
- difficulty opening the mouth, or a mouth that will not open at all;
- difficulty swallowing, saliva pooling, a changed voice;
- difficulty breathing;
- a high temperature with shivering;
- confusion, marked weakness, the sense of getting worse hour by hour.
A small amount of puffiness in the cheek beside the painful tooth is not in itself an ambulance sign, but it is not something to sit on for a week either: swelling like that is looked at the same day. It becomes worrying when it grows, when it climbs towards the eye or runs down towards the neck, and when a temperature joins it. And with swelling of that kind do not apply heat: warmth on the cheek speeds the spread.
Decay and pulpitis: what is actually hurting
Loss of enamel by itself does not hurt. Pain begins when the damage reaches the layer beneath the enamel and then the pulp, the bundle of nerves and vessels inside the tooth.
The character of the pain gives a rough idea of where you are:
- a short jolt from something cold, sweet or sour that goes at once — the irritation is still superficial;
- pain that lasts minutes after the trigger is taken away — the inflammation has reached the nerve;
- pain that arrives by itself, with no trigger, in waves, spreading to the temple, ear or jaw, worse lying down and at night, and often with no way of telling which tooth it is — that is the picture of pulpitis;
- the tooth has become painful to bite on, feels “higher” than the others, hurts even when the tongue touches it, and there is a bad taste — the inflammation has moved out beyond the root.
The practical conclusion is simple: the further down that list you are, the less sense there is in waiting. Pain at night that stops you sleeping, and pain on biting, are reasons to ask for a same-day appointment rather than one “whenever it suits”.
“It went away by itself” usually means the nerve has died
This is the most expensive mistake in the subject. A bad toothache settles after a few days, the person is relieved and does not go. But the tooth has not got better: what has usually happened is that the pulp has died and there is nothing left to hurt. The infection, meanwhile, has not gone anywhere — it is still inside the root canal, working its way slowly towards the tip of the root.
From there events take one of two courses. Either over weeks or months a chronic focus forms at the root that gives no sign of itself for years and is picked up by chance on an X-ray. Or at some point it flares, and then within a day come the swelling, the temperature and exactly the picture this page opened with. That is how people end up with a swollen face: not because they endured the pain, but because the pain let them go.
Hence the rule: if a tooth hurt and then stopped, you still need to be seen — and to say that there had been pain. Pain that has settled does not cancel the appointment, it only cancels the urgency.
A cracked tooth, exposed roots and sensitivity
Not every toothache begins with decay.
- A cracked tooth. The pain comes at the moment of biting and especially as the pressure is released, while at rest the tooth is quiet. Often it is a tooth already treated in the past or carrying a large filling. A crack can be invisible both to the eye and on an X-ray, and finding it is the dentist's job.
- A filling that has come out or split. The floor of the cavity is open and the tooth responds to everything — air, water, food. Here it is important not to drag it out: an open tooth breaks down fast.
- Exposed roots. When the gum recedes, the root is left bare, and the root has no enamel. Hence the short sharp pain from cold air, cold water and brushing. Usually it is not one tooth that suffers but a whole area.
- Worn enamel. Acidic drinks, the habit of brushing straight after something acidic, and grinding the teeth at night all make teeth sensitive without a single hole.
- Not the tooth at all. Pain in the upper back teeth can come from sinusitis, pain in front of the ear on chewing comes from the jaw joint, and a burning one-sided pain along the line of a nerve belongs to another specialty altogether. If a dentist finds no cause in the teeth, the search continues elsewhere rather than ending in a filling “just in case”.
The wisdom tooth and inflammation around it
A wisdom tooth often comes through only partly: some of the crown is clear of the gum while the rest is still covered by a flap of mucous membrane. Food debris collects under that flap and cannot be cleaned out with a brush, and pericoronitis begins.
It looks like this: the gum behind the last tooth is painful and swollen, biting hurts, the breath smells unpleasant, sometimes the mouth is hard to open wide, and the glands under the jaw may enlarge and become tender. It typically comes in bouts: a few bad days, then quiet, then again.
At home it can be eased — rinses with warm, not hot, salt water or an antiseptic solution, careful cleaning of that area with a soft brush, a painkiller. But the matter is settled at the dentist: the flap is irrigated, the tooth is assessed on an X-ray and a decision is made about keeping or removing it. And if the mouth is hard to open, a temperature has developed or the swelling is running down the neck, that is already the emergency from the first section, and rinsing is not what you spend time on.
Pain after dental treatment
Some soreness after treatment is normal, and it helps to know in advance where the line is.
To be expected: sensitivity to cold and to biting after a large filling, a dull ache for the first few days after root canal treatment, and a sore socket with some swelling for the first two or three days after an extraction. All of that should be steadily easing.
Not normal, and a reason to go back: pain that increases day by day instead of settling; sharp pain on biting that turns up a few days after a filling, which often simply means the filling is catching when the teeth meet and needs adjusting; severe throbbing pain on the third or fourth day after an extraction, together with a bad smell and an empty socket; and swelling with a temperature at any stage.
How to help yourself until the appointment, and what not to do
All of this is for a few days of waiting; none of it is treatment.
- A painkiller: paracetamol, or a non-steroidal anti-inflammatory if it is not unsuitable for you. For dental pain the second group usually works better. Check the dose and how it fits with your other medicines with a pharmacist or a doctor, and if you have stomach, kidney or heart problems do not choose the drug on your own.
- Rinses with warm salt water after meals: half a teaspoon of salt in a glass, spat out and not swallowed. Children are not given rinses because of the risk of swallowing the solution.
- Soft food at body temperature; do not chew with the painful tooth.
- A soft brush. Carry on brushing, that tooth included, just more gently.
- Sleep with your head raised a little: flat on your back the pain is usually worse.
- No smoking and no alcohol: both make healing worse.
And now what must not be done. Do not hold a tablet against the tooth or the gum — not aspirin, not anything else: a tablet does not work locally, but it does cause a chemical burn of the lining, which then has to be treated as well. Children and teenagers are not given aspirin at all. Do not warm the cheek and do not sleep on a hot water bottle. Do not try to open or squeeze an abscess. And do not prescribe yourself an antibiotic left over in the cupboard: an antibiotic is not a substitute for treating the tooth. It may damp down a flare for a while, but the source of the infection stays in the tooth, and without drainage, root canal treatment or extraction it all comes back. Nor should you count on a dental gel from the chemist to settle the matter: it dulls the pain for minutes and does nothing to the process.
Online consultation
A filling cannot be placed through a screen, but two questions genuinely can be settled online, and both matter. The first is how urgent this is: an Oladoctor doctor will work out, from your account and your photographs, whether this is pain you can wait for a dentist with, or swelling that means hospital today. The second is how to get through the wait without harm: which painkiller suits you given your conditions and your other medicines, what in your case you should not do, and what to watch for so that you do not miss things getting worse. The doctor will also explain what a report or an X-ray you have already had actually says, help you make sense of pain that has appeared after treatment, and tell you when it is worth going back to your own dentist and when to look for a different specialist.
This material is for information only and does not replace medical advice.
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