Rinse with warm water, floss gently on both sides of the sore tooth, and take an over-the-counter pain reliever exactly as its label directs. Put a cold compress on the outside of your cheek. Do not hold an aspirin against the gum, and do not put heat on a swollen face. Then call a dentist. A toothache this bad is a symptom, not a condition, and it does not resolve itself.
Do this in the next ten minutes
- Rinse with warm water. The ADA lists this first for a toothache. It clears the area, and it is easier on a painful tooth than cold water.
- Floss gently on both sides of the tooth. A popcorn hull wedged under the gum causes more urgent calls than most people expect, and it takes ten seconds to fix. The ADA is specific that you should not go after something trapped with a sharp or pointed instrument. Floss is the tool.
- Take pain relief exactly as the label directs. Do not double up on products with the same active ingredient or exceed the daily maximum. If you take daily medication, have stomach, kidney or liver problems, or are pregnant, ask a pharmacist which one fits you first.
- Cold on the outside of the cheek. The ADA's instruction for a swollen face is a cold compress. Twenty minutes on, twenty off, with something between the ice and your skin.
- Keep your head raised. Lying flat increases the pressure inside an inflamed tooth, which is why a toothache is so often worse at bedtime than it was at lunch.
- Call a dental office and describe it. Not a web form. Say where the pain is, when it started, what sets it off, and whether anything is swollen.
What the pain quality suggests
The American Association of Endodontists sorts tooth pain by how it behaves rather than how much it hurts, and the pattern narrows the cause faster than the intensity does. None of what follows is a diagnosis. It tells you how fast to move and what to say on the phone.
Sensitivity that stops the moment the cold goes
A jolt from ice water or cold air that fades within a second or two. The AAE describes momentary sensitivity to hot or cold as generally not signalling a serious problem, though it can point to minor decay, a loose filling, or root surface exposed by receding gum. An ordinary appointment, not an urgent one.
Sensitivity that lingers 30 seconds or more
If cold or heat sets off pain that keeps going after the source is gone, the AAE says the pulp has likely been irreversibly damaged by deep decay or physical trauma, and the treatment is usually root canal therapy. Lingering is the word doing the work. A tooth that hurts for a second and a tooth that hurts for a minute are two different teeth.
Sharp pain when you bite down
The AAE lists decay, a loose filling, a crack in the tooth and damage to the pulp among the causes. One ordinary explanation is worth ruling out early: a filling or crown sitting a fraction too high takes the whole force of the bite, and adjusting it takes minutes. Say which tooth, and whether it happens on every bite or only on certain foods.
A jolt when you release the bite, not when you press
Most people report this backwards, so it is worth knowing. You bite down and nothing happens. You let go, and a bright, brief pain runs through the tooth. The AAE lists erratic pain on chewing, possibly with the release of biting pressure, among the signs of a cracked tooth. Biting flexes the crack open and releasing snaps it shut against the tissue inside. The first 24 hours after a tooth cracks covers what to do before you are seen.
Constant throbbing, worse lying down, with swelling
The AAE describes severe, constant pain with pressure, swelling of the gum and tenderness to touch as a sign that a tooth may be abscessed, causing infection in the surrounding tissue and bone. The NIH's dental institute describes the same picture from the decay side: an abscess forms as a pocket of pus and causes pain, facial swelling and fever. This one moves. Where the line between a dental office and the emergency room falls is the page to read next if your face is swollen.
A dull ache and pressure across the upper back teeth
The AAE gives this one two ordinary explanations: grinding, and a sinus headache. If several upper teeth on one side ache at once, if bending forward changes it, and if you have a cold running, sinuses are the likelier answer. A single tooth you can put a finger on is a different problem.
What not to do
- Do not hold an aspirin against the gum. The ADA says plainly not to put aspirin on the aching tooth or gum tissue. Aspirin works after you swallow it. Held against the gum it does nothing for the tooth and burns the tissue it touches, leaving a white chemical burn on top of the toothache.
- Do not put heat on a swollen face. The ADA's instruction for facial swelling is cold. Heat encourages an infection to move through the tissue rather than stay where the body walled it off.
- Do not dig at the tooth with a pin, a knife tip or a toothpick. The ADA warns specifically against removing something caught between teeth with a sharp or pointed instrument. You will damage the gum and push the object deeper.
- Do not squeeze or pop a bump on the gum. It may drain on its own and feel better for a day. That is pressure released, not infection cleared.
- Do not take antibiotics left over from an old prescription. A partial course of the wrong drug will not clear a dental infection, and it makes the next one harder to treat.
- Do not keep testing it by chewing on that side. Repeatedly provoking a cracked tooth extends the crack.
Red flags: the emergency room comes before the dentist
Some things that arrive with a toothache outrank the toothache. Go to an emergency room, or call 911, for any of these:
- Any difficulty breathing. Call 911.
- Trouble swallowing, drooling because swallowing hurts, or a voice that sounds muffled or changed.
- Swelling spreading upward toward the eye, or an eye beginning to close.
- Swelling under the jaw, in the floor of the mouth, or moving down the neck.
- Fever or chills alongside facial swelling.
- Being unable to open your mouth more than about a finger's width.
- Feeling confused, faint, or very unwell.
- Bleeding that steady pressure will not stop, or a blow to the face with a possible broken jaw.
A hospital can image how far an infection has travelled, give intravenous antibiotics, drain it, and protect the airway. It generally will not fix the tooth, so the dental appointment still happens once you are stable. Nothing on that list improves by sleeping on it.
A toothache that stops is not a toothache that is over
Severe pain that vanishes overnight often means the tissue inside the tooth has died. The infection that killed it is still in the bone and can still spread, now with the warning signal switched off. Book the exam anyway and say the pain stopped, because that detail changes what the dentist looks for. Why the relief is misleading goes further.
What the dentist actually does about it
An exam and usually an X-ray, to find which tooth and why. What follows depends on the answer: clearing decay and placing a filling, root canal therapy when the tissue inside the tooth is beyond saving, draining an abscess, adjusting a bite that is too high, treating a deep gum pocket as gum disease, or removing the tooth if it cannot be restored. Antibiotics are added when an infection is spreading; they calm it and do not remove the cause.
Getting through tonight
Warm salt-water rinses, soft food chewed on the other side, nothing very hot or very cold or sweet, an extra pillow, and pain relief kept on the label's schedule rather than chased after it peaks. None of that treats the cause. It buys you the hours until an office opens, which is all it is for.
When to call, and what to say
Call rather than message for anything that hurts, bleeds or swells. Which office to call and what to say on the phone has the list the front desk needs. If you are unsure this rises to an emergency at all, dental emergency or can it wait sorts it, and emergency dental care explains what an urgent visit covers. If the pain has eased by the time you read this, request an appointment anyway. A tooth that hurt this much once will hurt again, usually at a worse moment.