Toothache

About toothache 

You may feel toothache in many ways, including:

• it can come and go or be constant
• eating or drinking can make the pain worse (particularly if the food or drink is hot or cold) the pain can also be mild or severe
• it may feel ’sharp’ and start suddenly
• it can be worse at night (particularly when you're lying down)
• a lost filling or broken tooth can sometimes start the pain
• it can also sometimes be difficult to decide whether the pain is in your upper or lower teeth
• when a lower molar tooth is affected, the pain can often feel like it's coming from the ear
• toothache in other upper teeth may feel like it's coming from the sinuses (the small, air-filled cavities behind your cheekbones and forehead)
• the area of your jaw close to the infected tooth may also be sore and tender to touch
• it's also possible for periodontal disease to give rise to a ’dull’ pain (periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth)

When to see your dentist 

If you have toothache for more than one or two days, visit your dentist as soon as possible to have it treated. The longer you leave it, the worse it will get. Your dentist, not your GP, is the best person to see for dental problems and treatment.

There are out of hours emergency dental services available if you are unable to wait to see your dentist.

If your toothache isn't treated, the pulp inside your tooth will eventually become infected. This can usually lead to a dental abscess, with severe and continuous throbbing pain.

Painkillers, such as paracetamol and ibuprofen, may reduce the pain and discomfort while you're waiting for an appointment. Children under 16 years of age shouldn't be given aspirin.

Causes of toothache 

Toothache occurs when the innermost layer of the tooth (dental pulp) becomes inflamed. The pulp is made up of sensitive nerves and blood vessels.

Dental pulp can become inflamed as a result of:

• tooth decay – this leads to holes (cavities) forming in the hard surface of the tooth
• a cracked tooth – the crack is often so small that it can't be seen with the naked eye
• loose or broken fillings
• receding gums – where the gums shrink (contract) to expose softer, more sensitive parts of the tooth root
• abscess – a collection of pus at the end of the tooth caused by a bacterial infection

There are a number of other conditions that can cause pain similar to toothache, even though the pulp isn't affected. These include:

• periodontal abscess – a collection of pus in the gums caused by a bacterial infection
• ulcers on your gums
• sore or swollen gums around a tooth that's breaking through – for example, when your wisdom teeth start to come through 
• sinusitis – which sometimes causes pain around the upper jaw
• pain associated with the joint that attaches the jaw to the skull (temporomandibular joint)

Babies can also experience discomfort when their teeth start to develop. This is known as teething.

Treating toothache 

Your dentist will examine your mouth and may take an X-ray to try to identify the problem.

Your dentist will discuss your treatment with you. Your treatment will depend on the cause of the pain (see causes of toothache above).

Preventing toothache 

The best way to avoid getting toothache and other dental problems is to keep your teeth and gums as healthy as possible. To do this, you should:

• limit your intake of sugary foods and drinks – you should have these as an occasional treat and only at mealtimes; read more about cutting down on sugar
• brush your teeth twice a day using a toothpaste that contains fluoride – gently brush your gums and tongue as well
• clean between your teeth using dental floss to keep your gums healthy and, if necessary, use a mouthwash (using a mouthwash is not a substitute for flossing) 
• don't smoke – it can make some dental problems worse

Make sure you have regular dental check-ups, preferably with the same dentist. 

The time between check-ups can vary. It will depend on how healthy your teeth and gums are and your risk of developing future problems.

Your dentist will suggest when you should have your next check-up based on your overall oral health.

Children should have a dental check-up every six months. This is so tooth decay can be spotted and treated early.

More useful links

• How to use your health services