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If a toothache is not met with timely and proper treatment, even a minimal degree of soreness in and around the affected tooth can escalate to an unbearable radiating pain. The pain can extend to your jaw bone.
The dental pulp is made up of soft connective tissue and is located in the innermost cavity of the tooth. The central core of the tooth is embedded with soft tissue, blood vessels, and numerous nerve endings.
Hence, it is highly sensitive to even the slightest form of irritation or inflammation.
This delicate nucleus is covered by two calcified layers, namely, the dentin and enamel.
This hard outer shell called enamel undergoes a lot of wear and tear, which can compromise its integrity over time.
If the protective cover of the pulp is damaged or infected, you will most likely experience increased tooth sensitivity and pain. These can make it difficult to eat, drink, talk, and sometimes even breathe.
The easiest thing you can do to preserve the integrity of this protective shield is to follow a stringent daily oral hygiene regimen.
Does Tooth Sensitivity Cause a Toothache?
Dentin hypersensitivity, or tooth sensitivity, is one of the most commonly reported dental complaints. It causes short spells of sharp, shooting pain emerging from the cervical area of the tooth.
The dentin is an absorptive layer of calcified tissue that covers the soft dental pulp. It contains numerous microscopic fluid-filled channels called tubules that serve as passages for nerve endings.
When there is loss of overlying enamel and gingival tissue, the dentin becomes increasingly sensitive to various types of external stimuli.
These include thermal, gaseous, tactile, osmotic, and chemical irritants. Exposure to these elements can lead to the onset of tooth pain.
If you do develop a toothache, it is in your best interest to seek immediate advice from a dentist before the problem worsens.
Causes of Toothache
Regular cases of toothache usually result from:
- Tooth decay or cracked tooth
- Tooth infection
- Cavities or dental caries
- Exposed roots
- Jaw joint disorder
- Gum disease
- Loose filling
- Negligent or improper dental care
- Getting something stuck in between teeth
- Severe flossing
- Biting something hard
Some conditions also cause a toothache: (1)
1. Impacted tooth
The wisdom teeth are a specific set of grinding teeth located at the rear end of the mouth.
Also known as third molars, the wisdom teeth typically emerge at a later stage in life (17–25 years), long after all the adult teeth have already matured.
Thus, the budding wisdom tooth has to fight for space with the fully grown neighboring teeth that have already established their position on the gumline.
Due to this delayed emergence, the newly formed wisdom tooth may push against the existent teeth to break through the gums. The tooth may fail to erupt completely or come out crooked.
When the late-blooming molar is unable to grow in alignment with the adjoining teeth or all the way through, it can become impacted or remain partially embedded in the gum.
The impacted wisdom tooth can exert a great deal of pressure on the surrounding teeth, gum tissue, and jaw bone. It can cause:
- Throbbing pain in and around the tooth
- Red, swollen, and sore gums
- Increased risk of infection
2. Tooth decay
Decay extending into the tooth close to the pulp tissue (nerves) causes lingering pain to hot and cold stimuli.
When the decay reaches the pulp tissue, the pulp tissue dies, called necrotic pulp, which then results in an abscess below the tooth.
An abscess/infection causes pain on biting. It may create a bump on the gum or cause facial swelling if left untreated.
3. Cracked tooth syndrome
Biting on a hard object can crack/fracture your tooth. This kind of dental injury can cause intense pain on biting and can make your tooth hypersensitive to hot and cold temperatures.
4. Recession of gingival tissue
Receding gums pull away from the base of the tooth, thereby exposing the dentinal tubules to external irritants. These microscopic canals in the dentinal layer lead to the nerve endings in the dental pulp.
Due to the loss of gingival covering, the dentinal tubules are exposed to external stimuli. This causes the fluid in the dentinal tubules to move, increasing sensitivity.
Several factors can cause recession of gum tissue.
Unhealthy oral habits such as excessive teeth grinding, rigorous brushing of the teeth, and using a hard-bristled toothbrush can injure your gum tissues.
Wearing improperly fitted dental fixtures or fillings, smoking, and chewing tobacco can also cause your gum line to move away from the tooth bed.
The tooth sensitivity brought on by gingival recession can resolve if met with proper care.
5. Periodontal abscess/gum abscess
An infection of the gingival tissue can lead to the formation of an abscess on your gum line. This is a severe form of periodontal disease that can make your gums red, swollen, and increasingly tender.
The infected abscess can cause the gums lining the root of your tooth to pull away, triggering a mild degree of pain and tenderness in and around the affected tooth.
Bruxism refers to the compulsive grinding, gnashing, or clenching of the teeth, which can weaken or damage your dental structure if left unchecked. A dull toothache may be caused as a result of this continued damage to the teeth.
People diagnosed with this involuntary disorder are usually advised to wear a night guard to control their teeth grinding tendency, particularly during sleep.
7. Sinus infection
A sinus infection can also cause referred pain in the tooth, which may extend to the surrounding jaw. This kind of toothache is usually accompanied by other more characteristic symptoms of sinus infection, such as headache and chest congestion.
8. Dry socket
Surgical removal of a tooth can lead to a dry socket if the extraction site fails to heal adequately.
Once the tooth is pulled out, you can tell that the extraction site is healing properly if the empty socket forms a blood clot within the next 3-5 days.
This clot serves as a protective covering over the wound. If the clot fails to form in due time, the alveolar bone and nerve endings in the empty socket become exposed to external irritants such as air, food particles, drinks, bacteria, and virtually anything that enters your oral cavity.
Also, the food and debris may settle into the vacant cavity and irritate the bony nerve endings, resulting in a toothache.
9. Health conditions
A toothache can stem from several other underlying health conditions as well, which include:
- Heart attack
- Cluster headache
- Viral infections, such as shingles
- Systemic diseases such as diabetes
- Nerve-related diseases, such as trigeminal neuralgia
- Excessive consumption of alcohol
- Drug abuse, especially overuse of methamphetamines
- Insufficient intake of vital vitamins such as B12
The intensity of the toothache can range from mild to severe depending upon the underlying cause or the extent of tooth damage.
In the case of early-stage gum recession or tooth erosion, you are likely to experience only a mild degree of pain and tooth sensitivity.
The severity of the condition is relatively more intense if:
- You get a fracture or crack in your tooth.
- You develop a dental cavity.
- You lose a dental filling.
Signs and Symptoms of Toothache
A toothache can manifest in different ways.
Here are some of the most commonly reported features of a typical toothache:
- Pain in the lower molar tooth usually feels like its originating from the ear.
- The intensity of the toothache can range from mild to severe.
- The affected tooth becomes hypersensitive to foods or beverages that are particularly hot, cold, sweet, or sour. Thus, the pain usually worsens after eating or drinking.
- Touching the affected tooth may aggravate the pain.
- You may experience soreness and pain in the jaw, particularly the area that is near the affected tooth.
- The pain may worsen at night, especially when you are lying down.
- Toothache can feel like a sharp, piercing pain or a deep, dull ache.
- Your tooth may ache consistently or have sporadic outbursts of pain that may occur briefly and then recede.
- Toothaches often have a sudden onset.
- It can be hard to trace the source of the toothache, as sometimes you are unable to specify whether it is stemming from the upper or lower set of teeth.
Diagnosing a Toothache
The underlying cause of a toothache needs to be determined for a dentist to prescribe the appropriate treatment. To that end, your dentist will review your medical history, inquire about your symptoms, and then conduct a visual examination of your teeth.
The doctor may also order dental x-rays to assess the internal state of the affected tissues, bones, and teeth.
Your dentist will take into account the underlying cause and intensity of your toothache before suggesting the appropriate treatment for your individual case.
In some cases, the pain can be resolved with a single therapy while others may require a combination of different treatments to address your toothy troubles.
If the tooth decay is still in its initial stage, something as simple as a dental filling can suffice to undo the damaged and prevent the condition from worsening.
Delayed treatment, on the other hand, can cause the tooth decay to spread further and deeper. To address extensive tooth decay and damage, your dentist will have to resort to more invasive treatment methods like a root canal or dental crowning.
The doctor may need to clinically drain the infection-carrying pus from an abscessed tooth.
You may have to undergo a root canal treatment, dental crowning, or even tooth extraction if the tooth is severely damaged.
Tooth extraction is also routinely recommended for toothache induced by an impacted wisdom tooth.
Besides these clinical procedures, you can manage your pain by using certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs).
These drugs include ibuprofen, naproxen, and acetaminophen. They may help reduce the localized pain and swelling around the affected tooth.
You can also apply pain-relieving gels to the affected area to soothe the discomfort.
Early treatment is key in minimizing the pain and damage caused by dental decay. So, if you notice even the slightest sign of enamel erosion, staining, or cavities, get your teeth evaluated and treated by a professional dentist.
Note: Overuse of NSAIDs can have adverse consequences on your general health and must be avoided. Additionally, these pain meds can aggravate liver problems. If you have liver disease, do not use NSAIDs unless advised by your medical doctor.
Ways to Get Relief from a Toothache
1. Self-Care Tips
Flossing: Sometimes, a toothache may stem from the accumulation of food particles and other debris between your teeth. This usually happens when your oral hygiene regimen is lacking in some way.
Flossing is an essential but often overlooked step in cleaning your teeth. To prevent the accumulation of gunk between your teeth, floss at least two times a day.
If you already have a toothache, you must do it extra gently to avoid worsening the pain.
Desensitizing toothpaste: For a mild toothache, you can use desensitizing toothpaste and gels to numb the affected area for temporary pain relief.
Cold compress: You can employ a bit of gentle cold therapy to alleviate the toothache that develops after a dental procedure such as tooth extraction.
The application of a cold compress to the affected site can help relieve the soreness, swelling, and bleeding.
The cold travels through the hard shell of the tooth and desensitizes the nerve endings in the pulp and the surrounding gingival tissue.
This numbing effect usually wears out after a while. Hence, you can only expect temporary pain relief from this type of topical therapy.
Moreover, cold compresses are largely ineffective in easing severe toothaches that stem from dental cavities or tooth decay.
To make a cold pack, simply put a few ice cubes in a plastic bag and wrap it in a thin towel. Apply this compress to the outside of the cheek, in the area where the toothache is felt most intensely.
Note: It is not advisable to use this treatment if you have exposed nerves as it may aggravate the pain instead of relieving it.
Ice creams and other cold foods can temporarily numb the affected area and alleviate the pain.
Clove oil: It contains a chemical compound called eugenol, which is known to exhibit pain-relieving, anti-inflammatory, and antiseptic properties that may help in easing your toothache.
You can apply the oil directly to the affected area or dip a small piece of cotton in the oil and dab it on the sore tooth.
As the oil seeps into the dental and gingival tissue, it exerts an anesthetic effect on the underlying nerve endings, making you feel less pain.
However, this kind of pain relief is usually short lived and does not provide any permanent solution to the problem.
A number of animal and cell-based studies have demonstrated this therapeutic effect of clove oil, but more extensive research is required to properly establish its efficacy in managing tooth pain. (2)(3)
Garlic: It is credited with potent antimicrobial activity, which can be utilized to address various oral problems, including pain-inducing periodontal infections.
The medicinal effect of garlic can be traced back to a specific organic compound called allicin. This compound is known to hamper the action of sulfur-containing enzymes that promote bacterial growth in the mouth. (4)
Garlic use for toothache relief has been associated with oral burns, and so it is best to seek your doctor’s approval before trying this therapy.
Note: You must consult your doctor before initiating any home remedy involving the oral consumption of garlic for the appropriate dosage.
Steam: A clogged sinus can cause pain in your tooth. You may use steam or a dehumidifier to open your sinuses and relieve the pain.
Quit smoking: Smoking can exacerbate your toothache. It is best to quit the habit, at least for as long as the condition persists.
Antiseptic cream: Apply a thin layer of an antiseptic cream containing benzocaine directly to the affected site for short-term relief from a toothache.
Extraction: If the wisdom teeth do not find enough space to grow, get them pulled out to avoid intense pain.
2. Salt and Pepper
Consider using a salt and pepper paste to diminish the intensity of tooth pain.
Topically apply the paste to the irritated tooth and gums. Let it sit for a few minutes so that the product is absorbed adequately before rinsing it off.
Repeat this application for a few days until you register noticeable relief.
This treatment option has a considerable amount of anecdotal support but lacks scientific evidence. Although there are some studies highlighting the benefits of salt for overall oral hygiene, it is still unclear how the salt-pepper mix helps in alleviating toothache.
3. Salt Water Rinse
A warm salt water rinse may help reduce the intensity of tooth pain when used frequently and regularly.
The gentle heat helps alleviate the inflammation, pain, and overall discomfort. The salt helps destroy the oral bacteria that are often responsible for dental decay.
A 2014 comparative study suggested that gargling with a saline solution two times a day may be a convenient adjunctive therapy for preventing dry socket after getting a routine dental extraction. (5)
According to a 2017 study published in the Journal of Indian Society of Pedodontics and Preventive Dentistry, exosmosis of water from the bacterial cell occurs when there is enough salt in the mouth.
This causes dehydration of the bacteria and their consequent death. (6)
Studies have supported the use of warm saline mouth rinse for relieving toothache and improving overall oral health. This complementary therapy is not a standalone treatment for your dental problems. Additionally, it can only be beneficial when used along with a proper oral hygiene regimen.
4. Oil Pulling
Oil pulling essentially means to use oil as a mouthwash in order to maintain and improve dental health.
The oil cleanses the mouth of all toxic substances as the fats in it become soapy after hydrolyzation.
The high viscosity of the oil stops the deposition of plaque on the gums. It also decreases the adhesion of bacteria.
According to a 2017 review published in the International Journal of Health Sciences, oil pulling has been used since time immemorial for the maintenance of dental health. (7)
Recent studies have also concluded that oil pulling can be advantageous in treating a variety of common dental problems and maintaining the overall health of the teeth and gums. (8)
Oil pulling is an age-old technique for improving your overall oral health. This method enjoys scientific support as well. But for this adjunct therapy to yield any beneficial effects, it must be done correctly and in combination with proper oral care.
5. Guava Leaves
Fresh guava leaves may help alleviate a toothache, due to their anti-inflammatory, antimicrobial, and analgesic properties. (9)
According to a 2014 study published in Pharmacognosy Reviews, guava contains quercetin, flavonoids, and guaijaverin, which confer it with antimicrobial properties. Guaijaverin hinders the development of bacteria, thus acting as an antiplaque medium. (10)
The same study stated that mouthwashes with aqueous extracts of guava leaves had a number of bioactive components that attacked oral pathogens. (10)
Guava leaves may be an effective adjunctive therapy for toothache with no reported side effects. This therapeutic ingredient may help prevent and treat periodontal diseases. It is also traditionally included in several oral care products.
How to Deal with Toothache at Night?
In some cases, the toothache may surface only at night when you are lying down to sleep.
Nighttime aggravation of toothache is particularly observed in people with certain other preexisting conditions, such as sinusitis or nocturnal teeth grinding (bruxism).
This kind of pain may also be associated with tooth infection.
Postural changes can cause movement of abscess and more pain when lying down.
People who regularly engage in late-night snacking or go to bed without brushing their teeth are more likely to feel the pain solely or more intensely at night.
Unlike during daytime when you are preoccupied with your routine activities, you do not have any distractions to take your mind off the pain as you prepare to sleep.
This is another reason why people tend to become more conscious of their toothache during the late hours of the night.
One simple trick to diminish the intensity of the nighttime toothache is to elevate your head while sleeping. Prop one or two extra pillows under your head to inhibit the rush of blood to your head.
Conversely, if you lie flat on your back, there may be increased blood pressure in your head, which can exacerbate the toothache.
Here are some preventive measures that can help keep your oral cavity in the best condition and thereby prevent the onset of toothache:
- Limit your sugar intake.
- Have a light dinner free from acidic, hard, or sweet foods.
- Supplement your diet with fruit and vegetable salads as these help in keeping the teeth healthy.
- Cut down on smoking as much as possible to avoid complications.
- Use a fluoride-containing toothpaste and brush your teeth two times a day.
- Instead of brushing your teeth with vigorous, horizontal strokes, use gentle, circular motions to clean the frontal surface of your teeth and gums.
Do not forget to clean the inner and biting surfaces of the teeth as well. Because it is difficult to move the brush around on the inside of your teeth, it is recommended to use gentle vertical strokes to clean this often-overlooked section.
- Food particles often settle on the tongue, making it a breeding ground for oral bacteria.
It is therefore essential to clean the tongue, either with your toothbrush or with a specially designed tool called a tongue scraper.
Some toothbrushes come with a tongue scraper at the back of its head.
- Floss twice a day to dislodge the debris stuck between your teeth.
- Rinse your oral cavity with mouthwash to help disinfect it further.
- You should go for a dental checkup at least twice a year. A regular assessment of your oral cavity enables the dentist to spot any sign of tooth decay or dental problems in the early stages and treat the issue timely before it escalates to a serious degree.
Given that children are more prone to tooth decay, take them to the dentist every 6 months to prevent cavities and other dental problems.
- Make sure to replace your used toothbrush with a new one every 3–4 months or as soon as its bristles start to look damaged or worn out.
- Electric toothbrushes are usually preferred over regular ones, as they tend to be more effective in plaque removal.
- Excessive consumption of carbonated beverages such as sodas and sports drinks triggers the erosion of your tooth enamel and is to be avoided.
- Limit your alcohol intake to minimize the dental damage and resulting tooth pain.
Some people are more susceptible to toothache and other dental problems than others. Also, some diseases can make the gums weak, making the teeth vulnerable to decay.
Some risk factors for toothache include:
- Aging: As the age increases, mineralization in the teeth increases. This makes the teeth fragile and prone to fracture.
- Diabetes: Consistently high glucose levels in the blood can damage the salivary glands. Consequently, saliva production is decreased, in turn drying your mouth.
As a result, bacteria multiply in the mouth and cause plaque accumulation on your teeth. This may lead to toothache and other oral problems.
- Periodontal diseases: Oral diseases affecting dental tissues around the teeth and the gum are known as periodontal diseases. In the initial stages, inflammation of the gums and sometimes bleeding may occur.
There are some complications associated with a toothache. They are largely dependent on the cause of the pain.
Cause: Tooth decay (most common)
If tooth decay is the cause of your toothache, the following complications may arise:
- Tooth loss
- Gum/jaw/brain infections
- Reduced appetite and consequent malnutrition followed by significant weight loss in severe cases
Cause: Abscess or some other infection
Infection or abscess may lead to:
- Tooth loss
- Dental infection (if left untreated)
- Cellulitis (when the infection from the abscessed tooth spreads to the facial tissue and causes swelling on your face)
- Brain abscesses (if the infection spreads to the brain tissue)
Dietary Tips: Do’s and Don’ts
Toothache can make it very difficult for you to bite down or chew foods as any extra strain on the affected tooth or teeth can aggravate the pain.
This is particularly true in the case of solid foods, which are harder to break down in the mouth.
In fact, if the toothache is emanating from a cracked tooth, the pressure exerted on it while chewing or biting can deepen the dental fracture to an irreparable degree.
Thus, anyone with a toothache is advised to consume a soft diet as long as the condition persists.
Moreover, you should chew on the unaffected side to avoid exerting undue pressure on the painful tooth and prevent your condition from worsening.
Including the following soft foods in your diet may help minimize your dental discomfort while eating:
- Soft, easy-to-chew fruits like peaches, watermelon and bananas
- Applesauce and apricot nectars
- Diary products such as cottage cheese, yogurt, etc.
- Scrambled eggs
- Pureed soups
Mindful eating is not just about what to eat, but also about what to exclude from your diet. People with a toothache are usually advised to:
- Avoid unnecessary snacking between meals
- Limit their sugar and starch intake in general
- Stay away from spicy or acidic foods
- Limit their consumption of carbonated beverages such as sodas and sports drinks
- Avoid consuming anything that is either too hot or cold
When to See a Doctor
Although toothache can generally be treated at home, there are times when you need professional assistance.
Consult a doctor if:
- The toothache is unbearable.
- The toothache persists for more than 2 days.
- The toothache is accompanied by pain in the ears or when opening your mouth and fever.
- Bleeding, swollen gums
- Injured tooth
- Difficulty swallowing or eating
What your doctor may ask you:
- Are the pain and sensitivity restricted to only one tooth or several teeth?
- Have you taken any painkillers for the toothache?
- Did you get any dental work done in the recent past?
- Is your toothache getting progressively worse?
- What is your daily oral care routine?
What you may ask your doctor:
- What is the reason behind my toothache?
- How can I improve my overall oral health?
- Is it okay if I take a painkiller every time I have a toothache?
- What is the least invasive method to relieve my toothache and cure the underlying problem?
- How long will it take for the toothache to resolve completely?
“Prevention is always better than cure.”
The thought that people go to the dentist only when their tooth hurts is not helpful because by then it is already quite late and a lot of damage is already done. As a result, extensive treatment is needed to resolve the pain. Like any part of your body, constant maintenance is required to avoid long-term damage.
Expert Answers (Q&A)
Answered by Dr. Wessam Atteya, BDS, FRACDS (Dentist)
Yes. Toothache can cause fever when it is associated with an infection.
Cold foods/drinks act as noxious stimuli to nerves (including nerve endings in teeth) by causing:
1) Direct nerve irritation (causing the fluids within the tooth microcanals to move and trigger pain)
2) Contraction of the blood vessels next to the nerves (consequently causing the nerves to react by sending pain impulses to the brain)
Cold foods/drinks can irritate nerve endings in teeth in the following situations:
• Tooth decay
• Receding gums/gum disease
• Vigorous brushing
• Teeth grinding
• Exposed tooth roots
• Cracked teeth
Make sure you regularly see a dentist to catch any problems early. Ask your dentist to take an x-ray to detect hidden decay. The most important measure is maintaining good oral hygiene/care (brushing and flossing).
Occasionally whiskey can relieve toothache due to its partial numbing effect. However, using whiskey for toothache relief may mask a major dental problem that needs attention.
The most effective way is to see a dentist to identify the source of sensitivity and treat it. Many factors can contribute to tooth sensitivity and they need to be identified.
Yes. When you cannot see a dentist, this can be a good temporary remedy.
It greatly varies according to the cause of the toothache and whether it was managed. For example, if the cause is nerve inflammation, a root canal can relieve the pain immediately.
As mentioned above, a toothache can be related to many root causes. Seeing a dentist is the best way to identify the cause and treat it.
About Dr. Wessam Atteya, BDS: Dr. Atteya has almost 20 years of experience treating patients which he gained in public and private practices both in Melbourne and in Cairo.
He practices almost all facets of dentistry with a special interest in implant dentistry, oral surgery, and cosmetic dentistry.
Dr. Atteya worked at the Royal Dental Hospital of Melbourne and lectured for the Clinical Training Unit of the Dental Health Services of Victoria.
He is also a Mentor for the Royal Australasian College of Dental Surgeons – Sydney and serves on the Continuing Professional Development Committee of the Australian Dental Association – Victorian Branch.