A toothache is a symptom that comes from the inner tissue of a tooth or from the gum and bone around it. It can appear because of decay, pulp inflammation, a crack, gum disease or an abscess.
When a toothache keeps you awake, keeping your head raised, applying a cold compress to the outside of the cheek and avoiding trigger foods may bring temporary relief. However, pain that starts at night or wakes you from sleep is a sign that a dental assessment should not be postponed.
What Is a Toothache?
A toothache is not a disease on its own. It is the pain created by a problem developing in the tooth or the tissues around it. It may begin as a mild sting or turn into a throbbing pain that spreads to nearby areas.
The outer part of the tooth is made of enamel and dentin, while the inside holds the pulp with its nerves and blood vessels. When decay or a crack gets close to the pulp, heat, cold and pressure can trigger pain. As the inflammation advances, pain can begin without any trigger at all.
The place where pain is felt does not always point to its source. A problem in one tooth can radiate to the ear, temple or cheek on the same side of the jaw. Some pain felt in the upper back teeth may also be related to the sinuses.
What Are the Symptoms of a Toothache?
The character, duration and triggers of a toothache give clues about the underlying problem. Even so, a diagnosis cannot be made from the symptoms alone.
- Sensitivity triggered by hot, cold, sweet or sour foods
- Throbbing that starts on its own or a pulsing sensation
- Pain that increases at night or wakes you from sleep
- Sensitivity while biting and chewing
- Redness, swelling or bleeding of the gums
- A bad taste or bad odor in the mouth
- Swelling in the cheek or jaw
- Pain radiating to the ear, temple, neck or jaw
Long-lasting pain can make sleep, eating and concentrating on daily tasks difficult. A sudden drop in pain does not necessarily mean the problem has resolved.
What Causes a Toothache?
Tooth decay is one of the common causes of toothache. Acids produced by plaque bacteria weaken the enamel. As the decay deepens, the dentin and pulp tissue can be affected.
Inflammation can develop in the pulp because of deep decay, trauma or a crack. Pain that starts with a trigger at first may later begin spontaneously. Night pain and long-lasting sensitivity to hot and cold can be seen in this picture.
An infection around the tooth root can turn into an abscess. An abscess can cause throbbing, pain on biting, a bump on the gum, a bad taste, fever or facial swelling. Even if the pain eases when the abscess drains, dental treatment is still needed.
Other possible causes are:
- A broken or cracked tooth
- A loose, worn or fractured filling
- Gum disease and exposure of the root surface
- Food packing between the teeth
- Gum inflammation around a wisdom tooth
- Teeth clenching or grinding
- Dental trauma
- Temporary sensitivity caused by orthodontic appliances
- Pain related to the sinuses, jaw joint or facial nerves
| Character of the Pain | Possible Causes | Assessment |
|---|---|---|
| Short sting that starts with cold | Tooth sensitivity, early decay or gum recession | The cause is identified with a dental examination. |
| Throbbing that starts at night and lasts | Deep decay or pulp inflammation | You should see a dentist without delay. |
| Pain while biting | A crack, inflammation around the root or a high filling | A clinical examination and, if needed, imaging are done. |
| Pain with swelling and a bad taste | An abscess or gum infection | Same-day assessment may be needed. |
| Pain with morning jaw fatigue | Teeth clenching or grinding | The teeth and jaw joint are examined together. |
Why Does a Toothache Keep You Awake and How Does It Ease?
A toothache that keeps you awake is most often linked to deep decay, pulp inflammation, a crack or an infection around the root. Throbbing can feel stronger when you lie down. Fewer distractions at night can also make the pain feel more intense.
In people who clench their teeth, the load on the jaw muscles and teeth can increase through the night. This can lead to morning jaw fatigue, headache or pressure sensitivity in several teeth.
When a toothache starts at night, the following steps can be used as temporary measures:
- Clean the teeth gently with a soft brush.
- If food is stuck between the teeth, clear the area without forcing it.
- Lie down with your head slightly raised.
- Apply a cold compress wrapped in a cloth to the outside of the cheek.
- Avoid very hot, cold, sugary or hard foods.
- Do not chew on the painful side and choose soft foods.
A hot compress should not be used, especially when swelling or infection is suspected. Heat can increase discomfort and swelling in the area. No medicine, alcohol or herbal product should be placed on the painful tooth.
One situation we see often in our clinic is people assuming the problem is over when the pain eases in the morning. Pain that wakes you from sleep can come back, and the underlying problem can progress.
What Helps a Toothache?
Home measures can help you manage the pain until you reach a dentist. They do not treat decay, pulp inflammation or an abscess.
Warm Salt Water Rinse
Rinsing with warm salt water can help remove food debris and soothe irritated tissue. The rinse should not be swallowed. This method should not be used in young children who cannot spit safely.
Cold Compress
If there is facial swelling or pain after trauma, a cold compress can be applied to the outside of the cheek. The cold item should not touch the skin or the gum directly.
Keeping Up Oral Hygiene
Stopping brushing altogether because of pain can increase plaque build-up. The area should be cleaned gently with a soft-bristled brush. Avoid harsh movements and pressing on the gum.
What to Watch For With Medication
Painkillers can give some people temporary pain control. However, the right medicine depends on age, medical conditions, pregnancy and other medications being used.
Painkillers should be used after an assessment and on prescription. The dose or duration should not be increased on your own decision. Placing a painkiller on the tooth can cause chemical irritation of the gum.
Antibiotics are not needed for every toothache and do not remove the source of the pain. The dentist decides whether antibiotics are needed after assessing the examination findings and how far the infection has spread.
Does Garlic Help a Toothache?
There is not enough clinical evidence that home methods such as garlic, thyme and clove oil treat toothache. Applying crushed raw garlic to the gum can cause a chemical burn of the oral lining.
Clove oil can also irritate the tissues when used undiluted or directly. Herbal products should not replace a dental examination and treatment aimed at the cause.
When Should You See a Dentist?
If a toothache lasts more than two days or keeps getting worse, you should see a dentist. Pain that wakes you from sleep, recurs or prevents biting needs earlier assessment.
With the following signs, it is important to get a dentist's opinion the same day:
- Swelling in the cheek, jaw or gum
- Fever, fatigue or a bad taste
- Marked difficulty opening the mouth
- Pain that becomes severe when biting
- A broken tooth, facial trauma or a tooth knocked out of position
- Toothache together with a condition that affects the immune system
Swelling that spreads around the eye or to the neck, and difficulty breathing, speaking or swallowing require emergency assessment. With these signs you should seek emergency care.
How Are the Examination and Treatment Planned?
The dentist asks when the pain started, which triggers make it worse and how long it lasts. The teeth, fillings, gums and jaw tissues are examined. A dental X-ray may be used when needed.
Treatment is planned according to the cause of the pain. For early or moderate decay, removing the decayed tissue and placing a filling can be considered. If the pulp is involved, vital pulp treatments or root canal treatment may come up.
When there is an abscess, draining the source of infection, root canal treatment or tooth extraction may be considered. Whether the tooth can be saved depends on the position of the crack, the bone support and the remaining healthy tissue.
For gum disease, professional teeth cleaning and personalized oral care can be planned. For pain linked to teeth clenching, the bite, jaw muscles and jaw joint are examined together.
How Is a Toothache Relieved in Children?
Common causes of toothache in children include decay, teething, food packing and trauma. Keep in mind that a child may not be able to describe the location of the pain correctly.
The painful area can be cleaned with a soft brush. If there is facial swelling, a cold compress can be applied to the outside of the cheek. No medicine, garlic or clove oil should be rubbed on a child's tooth.
Children should not be given medicines prepared for adults. The need for a painkiller should be decided on prescription, taking the child's age, weight and health into account.
If there is fever, facial swelling, trauma, pain that wakes the child at night or an inability to eat, a pediatric dental assessment should not be delayed. Seek emergency care if breathing or swallowing becomes difficult.
How Can a Toothache Be Prevented?
- Brush the teeth twice a day with fluoride toothpaste.
- Clean between the teeth regularly with suitable interdental products.
- Reduce how often you have sugary foods and drinks.
- Have broken or loose fillings checked without delay.
- Use a mouthguard approved by your dentist during sports.
- Keep up dental check-ups based on your personal decay and gum risk.
Regular care cannot prevent every toothache. It does, however, help detect decay and gum problems early. Check-ups arranged before pain appears can allow more limited treatment options to be considered.
Frequently Asked Questions
Can a toothache radiate to the ear?
Yes. Pain from the back teeth in particular can be felt in the ear, temple or jaw on the same side. An examination is needed to identify the source of the ear pain.
Why do teeth hurt more at night?
In conditions such as pulp inflammation, spontaneous throbbing can become more noticeable at night. Lying down and having fewer distractions can also make the pain feel more intense.
How can you sleep with a toothache?
You can keep your head slightly raised, apply a cold compress to the outside of the cheek and avoid hot and cold foods. These are temporary steps; pain that wakes you needs a dental examination.
Which painkiller helps a toothache?
The right painkiller depends on your age, medical conditions and the medicines you take. Medication should be used after assessment and on prescription, and never placed on the tooth.
Does garlic help a toothache?
There is not enough clinical evidence that garlic treats toothache. Applied directly, raw garlic can cause a chemical burn on the gum and the lining of the mouth.
Should you rinse your mouth during a toothache?
Rinsing with warm salt water can bring temporary relief and help clear food debris. A rinse does not replace treatment and should not be used in children who cannot spit.
Can a toothache be fatal?
A toothache itself is not fatal. However, an untreated dental infection can rarely spread to surrounding tissues; difficulty breathing or swallowing requires emergency assessment.
After how many days of toothache should you see a dentist?
If the pain lasts more than two days, you should see a dentist. With swelling, fever, trauma or pain that wakes you at night, do not wait that long.