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An Overview of Toothaches

A toothache or tooth pain is caused when the nerve in the root of a tooth or surrounding a tooth is irritated. Dental (tooth) infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction. Pain can sometimes originate from other areas and radiate to the jaw, thus appearing to be tooth pain. The most common areas include the jaw joint (temporomandibular joint or TMJ), ear pain, sinuses, and even occasional heart problems.Bacteria growing inside your mouth can contribute to gum disease and dental decay, both of which can cause pain. Often, gum disease will not result in any pain.

You can prevent the majority of dental problems by flossing, brushing with fluoride toothpaste, and having your teeth professionally cleaned twice a year. The dentist may apply sealants and fluoride, which are especially important for children’s teeth.

Toothache Causes

Toothaches occur from inflammation of the central portion of the tooth called the pulp. The pulp contains nerve endings that are very sensitive to pain. Inflammation to the pulp or pulpitis may be caused by dental cavities, trauma, and infection. Referred pain from the jaw may cause you to have symptoms of a toothache.

Toothache Symptoms

Toothache and jaw pain are common complaints. There may be severe pain to pressure or too hot or cold stimuli. The pain may persist for longer than 15 seconds after the stimulus is removed. As the area of inflammation increases, the pain becomes more severe. It may radiate to the cheek, the ear, or the jaw. Other signs and symptoms that may lead you to seek care include the following:

  • Pain with chewing
  • Hot or cold sensitivity
  • Bleeding or discharge from around a tooth or gums
  • Swelling around a tooth or swelling of your jaw
  • Injury or trauma to the area

These signs and symptoms may sometimes be associated with dental decay, tooth fracture, or gum disease (periodontal disease). Dental decay or an area of redness around the tooth’s gum line may point to the source of pain. If you tap an infected tooth, it may make the pain more intense. This sign may point to the problem tooth even if the tooth appears normal.

A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear or throat pain or an injury to the temporomandibular joint (TMJ) that attaches the jaw to the skull may be confused with toothache. Pain from a deeper structure (called referred pain) may be passed along the nerve and be felt in the jaw or tooth. In order to pinpoint the source of the pain and get relief, call your dentist or doctor.

When to Seek Medical Care for a Toothache

You should call your dentist about a toothache when:

  • Pain is not relieved by over-the-counter drugs
  • You experience severe pain after a tooth is pulled; this may occur on the second or third day after tooth extraction. This is a result of the clot falling out and bone exposed until a new clot covers the exposed bone. The condition is known as alveolar osteitis or “dry socket syndrome.” If you develop this condition, you should see a dentist within 24 hours.
  • Pain is associated with swelling of the gums or face, or you have discharge around a tooth; fever is an important sign of infection in dental disease. Simple dental decay (caries) does not cause fever. These signs may signify an infection surrounding the tooth, the gum, or the jaw bone (mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended, “root canal” therapy is performed.
  • Broken or knocked-out teeth occurred from an injury; unless associated with more severe injuries, your dentist should be contacted as soon as possible. Swallowed teeth and permanent tooth loss are considered dental emergencies.
  • Pain is present at the angle of your jaw; if every time you open your mouth widely you have pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big.
  • Wisdom teeth are causing pain; as wisdom teeth (third molars) are coming into the mouth — or erupting — they cause inflammation of the gum around the visible portion of the crown. The gum overlying the crown may become infected. The pain from this may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot be closed properly.
These symptoms with toothache or jaw pain indicate that you should visit your doctor or a hospital’s emergency department.

  • High fever or chills: This may indicate a more widespread infection that might require more than antibiotics by mouth.
  • Recent head or face injury: If you experience headache, lightheadedness, nausea, vomiting, or other symptoms that concern you after an injury to your face or mouth, you may have a more serious injury in addition to your dental trauma.
  • Any jaw pain occurring with chest pain: Although jaw pain is most commonly caused by dental disease, it is sometimes referred pain from other areas. People with heart disease, especially those who have had stents placed, people with diabetes, or those who have had heart surgery may have jaw pain as a symptom of heart attack or angina. If your jaw or tooth pain is associated with lightheadedness, sweating, or shortness of breath, you should see a doctor.
  • Trouble swallowing or excessive pain or bleeding from gums: If you have a history of a weakened immune system, diabetes, or steroid use, you may be more susceptible to infections. Dental and gum infections in people with these conditions may require more aggressive treatment. An abscess may need draining or IV antibiotics.

Exams and Tests for Toothaches

A thorough oral exam usually leads to an appropriate diagnosis.

Sometimes, X-rays called periapical and Panorex views (panoramic X-rays of the teeth and jaw) are taken. If the cause is something other than a dental or jaw problem, the doctor may prescribe drugs directed at the problem. If the condition is more severe, the doctor may admit you to the hospital, or refer you to a specialist for further care and treatment.

Treating a Toothache at Home

For toothaches:

  • Over-the-counter pain medications such as acetaminophen or ibuprofen may be used. Take these as directed on the package while you arrange a dental appointment.
  • Avoid very cold or hot foods, because they may make the pain worse.
  • You may get relief from biting on a cotton ball soaked in clove oil.

For jaw pain:

  •  Aspirin may be helpful for problems in the jaw joints.
  •  Acetaminophen (not aspirin) should be used for children and teenagers.
  • If pain happens every time you open your mouth widely, the temporomandibular joint (TMJ) may be the source of the pain. Yawning or taking a large bite of food may worsen the pain.

Medical Treatment for Toothaches

In most cases, toothaches or jaw pain signifies a problem that must be cared for by a dentist.

A referral to a dentist for follow-up will usually be arranged. In some cases, the doctor may try an injection around the tooth for pain control. If there is swelling in the gums or face, or you have a fever, antibiotics may be prescribed.

  • At the dentist’s office, fillings, pulling teeth, or other procedures may be performed as required. A tooth extraction will be the most likely procedure with a primary (baby) tooth. On permanent teeth, if the problem is severe, root canal therapy and crown procedures are generally performed.
  • An antibiotic will usually be prescribed if a fever or swelling of the jaw is present. Such procedures are generally done in stages, with pain and infection being cared for immediately, and reconstructive procedures being performed at a later time (weeks to months).
  • If causes other than the teeth or jaw are responsible for the pain, management will depend on the condition.

Toothache Treatment Follow-Up

After toothache treatment at your dentist’s office, continue to practice good dental care. Routine and prompt follow-up appointments with the dentist should relieve your dental pain faster.

When you leave the dental office, take the medications as prescribed, and keep your follow-up appointment. If you have any concerning signs or symptoms, call your doctor.

Stopping smoking may help improve some dental conditions. If you are having trouble quitting, talk to your doctor about assistance.

Toothache Prevention

Most people can avoid toothaches and severe dental problems with regular dental care. Have your dentist’s telephone number easily available in case of an emergency.

  • Maintain a healthy diet. Bacteria thrive on refined sugar and starch and need this in order to burrow through the enamel on your teeth. Watch what you eat and be careful about the food that sticks to and between your teeth. Brush your teeth after eating.
  • Establish a good program of cleaning your teeth to remove the food particles. Brush your teeth after eating and brush your gums to encourage healthy gum. Use a soft toothbrush with fluoride toothpaste as recommended by the Canadian Dental Association. Floss between teeth daily. Water flossers are effective at removing trapped particles, but flossing your teeth does a more thorough job when done carefully. Rinse daily with an antiseptic mouthwash to help get rid of bacteria that cause plaque and early gum disease.
  • Prevent tooth decay with fluoride. Fluoride is effective in preventing tooth decay in children. Fluoride is a natural element and is found in many water supplies and vegetables. Check and see if your tap water is fluoridated as this is a great way to get it.
  • Arrange to have your teeth cleaned by a dental hygienist at least twice a year. It may help in preventing both decay and gum disease.
  • Keep your bridge or dentures clean. Your dentist can offer suggestions. Even if you do not have all of your original adult teeth, you can prevent new dental problems if you try these preventive tips.
  • Wear a protective sports guard or headgear while playing sports to help prevent injury.
  • Do not smoke. Smoking or vaping may make some dental conditions worse.

Outlook for Toothaches

For most common causes of toothaches, the prognosis is good with appropriate dental care. Following good dental hygiene, such as brushing with fluoride toothpaste, flossing, rinsing with an antiseptic mouthwash, and routine check-ups by the dentist help to prevent dental problems.

For conditions other than dental and jaw problems, prompt diagnosis and treatment usually improve long-term outcomes.