Toothache: Causes, Symptoms and Treatment Options.
Toothache refers to pain in or around a tooth, and it can range from mild sensitivity to severe, persistent throbbing. It may affect your ability to eat, speak, and sleep comfortably. Toothache is usually a sign of underlying dental inflammation or damage, and a professional assessment can help identify the cause and determine the most appropriate treatment approach.
Professional Assessment
A thorough dental examination — including clinical assessment and imaging where appropriate — can identify the source of your tooth pain and guide the most suitable treatment.
“Thorough examination and clear explanation of the cause. My toothache was resolved with excellent care.”
What Is a Toothache?
A toothache is a symptom, not a diagnosis. It describes pain that may originate from the tooth itself or from the surrounding tissues. The nature and severity of the pain can provide useful clues about its cause, but only a professional examination can confirm the underlying issue.
Enamel & Dentine Pain
Pain arising from the outer layers of the tooth — the enamel and dentine — typically presents as sensitivity to hot, cold, sweet, or acidic stimuli. It may be sharp but brief, often subsiding once the stimulus is removed.
Pulp Inflammation
When inflammation reaches the dental pulp — the nerve and blood supply inside the tooth — pain may become more intense, prolonged, and spontaneous. It may throb, linger after temperature changes, or wake you at night.
Surrounding Tissue Pain
Pain may also originate from the gums, periodontal ligament, or surrounding bone. This type of discomfort is often felt as a dull ache, pressure, or tenderness when biting, and may be associated with gum disease or abscess.
The character of the pain — whether sharp or dull, constant or intermittent, localised or diffuse — helps guide the clinical assessment. A typically includes clinical testing and, where appropriate, radiographs to identify the source accurately.
Common Causes of Toothache
Toothache can arise from a range of dental conditions. Understanding the possible causes can help explain why professional assessment is important — only a clinical examination can determine the specific reason for the pain.
1Tooth Decay
Decay begins in the enamel and, if untreated, progresses into the softer dentine and eventually the pulp. As the cavity deepens, sensitivity increases and may develop into persistent pain. Early-stage decay may cause no symptoms at all, which is why regular examinations are important.
2Dental Infection or Abscess
When bacteria reach the pulp, infection can develop and spread to the bone at the tip of the root. A dental abscess — a collection of pus — may form, causing throbbing pain, swelling, and tenderness. This typically requires professional treatment to address the source of infection.
3Cracked or Fractured Tooth
A crack in a tooth may cause sharp pain when biting or releasing pressure, or sensitivity to temperature. Cracks can be difficult to detect clinically and may require specialised testing. The severity of symptoms depends on the depth and direction of the fracture.
4Worn or Damaged Fillings
Fillings that have deteriorated, cracked, or become loose may allow bacteria to reach the underlying tooth structure. This can cause sensitivity, discomfort, or, if decay develops beneath the filling, more significant pain.
5Gum Disease
Advanced gum disease can cause gum recession, bone loss, and deep pockets of infection around the teeth. This may present as a dull ache, tenderness when biting, or sensitivity at the gum line. Periodontal treatment may be needed to manage the condition.
6Teeth Grinding (Bruxism)
Habitual clenching or grinding can place excessive force on the teeth, leading to aching, sensitivity, and muscle pain in the jaw. Symptoms are often worse in the morning if grinding occurs during sleep.
7Impacted Wisdom Teeth
Wisdom teeth that are partially erupted or impacted may cause pain in the back of the jaw, swelling of the surrounding gum tissue, and difficulty opening the mouth. Infection of the overlying gum (pericoronitis) is a common complication.
This list is not exhaustive. Other causes — including referred pain from sinus conditions or jaw joint problems — may also present as toothache. A comprehensive is the most reliable way to identify the source.
Signs a Toothache May Indicate Infection
While not all toothaches are caused by infection, certain features may suggest that bacteria have spread beyond the initial cavity or damaged area. Being aware of these signs can help you make an informed decision about when to seek professional assessment.
Persistent Throbbing Pain
A deep, pulsating toothache that does not subside — particularly one that worsens over time or occurs spontaneously — may indicate inflammation or infection of the dental pulp.
Swelling of the Gum or Face
Localised gum swelling around a tooth, or more widespread facial swelling, may indicate that infection has spread to the surrounding tissues or that an abscess has formed.
Sensitivity to Pressure
If the tooth feels uncomfortable when biting or if you are aware of it when your teeth come together, this may suggest inflammation of the tissues around the root tip.
Bad Taste in the Mouth
A persistent unpleasant taste may indicate the presence of pus draining from an abscess. This is the body attempting to relieve pressure, but the underlying infection still requires treatment.
Fever or Feeling Unwell
Although uncommon, a dental infection can occasionally cause a raised temperature or a general feeling of being unwell. This may suggest the infection is having a broader systemic effect.
A Balanced Perspective
The presence of one or more of these signs does not necessarily mean a serious infection is present. However, they are features that generally warrant professional evaluation to determine whether treatment is needed and, if so, what approach is most appropriate.
Many dental infections are straightforward to manage when identified and treated in a timely manner. Professional assessment provides the clarity needed to make informed decisions about your care.
If you are unsure whether your symptoms warrant urgent assessment, please contact our team who can help advise on the most appropriate next step.
Risks of Ignoring a Toothache
A toothache that is left without professional assessment may, in some cases, lead to progressive issues. While not every toothache will worsen, understanding the potential consequences can help inform your decision about seeking care.
Infection May Progress
An untreated dental infection can spread from the pulp to the surrounding bone and soft tissues. In uncommon cases, this can lead to more widespread infection that may require hospital-level care.
Tooth Structure May Weaken
Ongoing decay or a crack that is not addressed may progressively weaken the remaining tooth structure. This can reduce the likelihood of being able to save the tooth with a filling or crown.
Treatment May Become More Complex
A problem that might have been resolved with a simple filling may, if left, develop to the point where root canal treatment, a crown, or even extraction becomes necessary.
Tooth Loss May Occur
In severe cases where infection or structural damage is extensive, it may no longer be possible to save the tooth. Extraction may then be the only viable option, followed by discussion of replacement alternatives.
These outcomes are not inevitable. Many dental problems are effectively managed when assessed and treated in a timely manner. The aim of professional evaluation is to identify the issue early and provide the most conservative and appropriate treatment.
Toothache Treatment Pathway
The treatment for a toothache depends on the underlying cause, which is determined through clinical examination and, where appropriate, radiographic assessment. Several treatment options may be considered depending on the diagnosis.
White Fillings
If the toothache is caused by decay that has not yet reached the pulp, a may be appropriate. The decayed material is removed, and the cavity is restored with a tooth-coloured composite material. This aims to treat the underlying cause of pain and seal the tooth against further bacterial invasion.
Suitable When
Decay has not reached the pulp
May relieve sensitivity and discomfort
Root Canal Treatment
When infection or inflammation has reached the dental pulp, aims to remove the infected tissue, clean and disinfect the root canal system, and seal the tooth. This approach aims to eliminate the source of pain and infection while preserving the natural tooth where possible.
Suitable When
The pulp is infected or irreversibly inflamed
Aims to save the natural tooth
Dental Crowns
A may be recommended when the tooth structure is significantly weakened — either by extensive decay, a fracture, or following root canal treatment. The crown covers and protects the remaining tooth, aiming to restore its shape, strength, and function.
Suitable When
Tooth structure is significantly compromised
Protective restoration for weakened teeth
Periodontal Treatment
If the toothache is related to gum disease, aims to address the infection and inflammation affecting the supporting tissues. This may involve deep cleaning below the gum line, drainage of periodontal abscesses, and ongoing management to support gum health.
Suitable When
Gum disease is the source of pain
May include deep cleaning & follow-up
Tooth Extraction
In some cases, the affected tooth may be too damaged or the infection too extensive for the tooth to be predictably saved. may then be recommended to remove the source of pain and infection. Following extraction, your dentist can discuss options for replacing the missing tooth.
Suitable When
The tooth cannot be predictably saved
Considered as a last resort
Treatment depends on clinical assessment. Your dentist will discuss the findings, available options, and recommended approach before any treatment is undertaken.
When Urgent Dental Care May Be Needed
While many toothaches can be managed within routine appointment timescales, certain situations may benefit from more prompt assessment. The following features may indicate that earlier evaluation is advisable.
Facial Swelling
Visible swelling of the cheek, jaw, or surrounding area may indicate that infection has spread beyond the tooth. Increasing or spreading swelling should be assessed promptly.
Severe or Worsening Pain
Pain that is intense, escalating, or unresponsive to over-the-counter measures may indicate a more significant underlying problem that would benefit from professional assessment.
Dental Trauma
If a toothache follows an injury — such as a blow to the face or a fall — the tooth may be fractured, loosened, or displaced. Early assessment can help determine the extent of damage.
Significant Functional Impact
If the pain is preventing you from eating, sleeping, or carrying out daily activities, this may warrant prioritising assessment to identify and address the cause.
Important Safety Information
If you experience difficulty breathing, difficulty swallowing, rapidly spreading facial swelling, a high fever, or feel severely unwell alongside a toothache, these may indicate a more serious situation. In such cases, attending your nearest Accident & Emergency department or calling 999 may be appropriate.
For most toothaches, however, an appointment with your dentist is the most suitable first step. Our team can help advise on the appropriate urgency when you contact us.
Temporary Measures Before Assessment
If you are experiencing a toothache, the following general guidance may help manage discomfort while you arrange a professional dental assessment.
General Guidance
Avoid chewing on the affected side to minimise discomfort and reduce pressure on the tooth.
Avoid very hot, cold, or sweet foods and drinks, which may trigger or worsen sensitivity.
Maintain gentle oral hygiene — continue brushing carefully and consider rinsing with warm salt water if comfortable.
Try to keep your head slightly elevated when resting, which may help reduce the sensation of throbbing.
Arrange a professional dental assessment at the earliest suitable opportunity.
Important Reminders
Do not place aspirin directly on the gum — this can cause a chemical burn to the soft tissue.
Do not ignore worsening symptoms, particularly increasing swelling or difficulty opening your mouth.
Do not attempt to self-diagnose or self-treat — the cause of toothache requires professional assessment.
Do not apply heat externally to a swollen area, as this may worsen inflammation.
Do not delay seeking care if pain is severe or if you notice facial swelling.
This guidance is for general information only and does not replace professional dental advice. If your symptoms are severe or rapidly worsening, please contact us or seek urgent care.
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Toothache Assessment
If you are experiencing ongoing tooth pain, a professional dental assessment can help identify the underlying cause and determine appropriate treatment options. Toothache assessment and treatment options are available at our London clinic, where professional dental evaluation can determine the most appropriate course of care.
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Whether you need urgent assessment for a toothache or ongoing restorative care, our South Kensington team can evaluate the situation and recommend the most appropriate treatment approach.
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Conservative dentistry specialist with postgraduate degrees from UCL Eastman. Believes in preserving as much natural tooth structure as possible.
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