A toothache usually means a cavity, but a cracked tooth, an infection, gum disease, or even a sinus infection can make a tooth hurt, and the only way to know which is an exam. That’s why the ADA says a toothache should be evaluated by a dentist right away, and why a few symptoms, such as facial swelling or trouble swallowing, mean going to an emergency room instead of waiting for an appointment.
Table of Contents
What Usually Causes a Toothache
Tooth decay is the usual cause, but it isn’t the only one:
| Possible cause | What’s going on | How a dentist checks |
|---|---|---|
| Tooth decay (a cavity) | Plaque bacteria make acids that wear through the enamel. Early decay usually has no symptoms, but a growing cavity can cause pain or sensitivity to sweets, heat, or cold. | An exam and X-rays |
| A tooth infection (abscess) | A pocket of pus from a bacterial infection in or around the tooth, which can follow deep decay, a crack, gum disease, or an injury | An exam, tapping on the tooth, hot and cold tests, and X-rays |
| A cracked or broken tooth | Grinding, an injury, or brittle teeth can crack a tooth. The crack may not show, even on an X-ray, and chewing may hurt. | An exam and X-rays, though a crack can be hard to see |
| A worn or damaged filling or crown | Old fillings can weaken, crack, or leak at the edges, where decay can start | An exam and X-rays |
| Gum disease | Often painless, but it can hurt, for example when an abscess forms in the gum | A gum exam |
| Grinding or clenching | Grinding and other wear or injury to the teeth can cause a toothache | An exam, and telling your dentist if you think you grind |
| Wisdom teeth coming in | A little discomfort is normal as they come in, but pain means seeing a dentist right away. Wisdom teeth that have partly come through can let bacteria into the gums and cause an infection | An exam and an X-ray |
| Sensitive teeth or exposed roots | Worn enamel or receding gums expose the dentin underneath, so hot, cold, acidic, or sticky foods reach the nerve | An exam to find the source |
| Something stuck in your gums or between teeth | Something like a popcorn hull stuck in the gums can hurt, and an object stuck in the teeth might cause an infection | An exam |
| Pain from somewhere else | A sinus infection or an earache can cause pain that’s felt in a tooth | An exam of your mouth, ears, nose, and neck; your doctor may need to treat the cause |
Cleveland Clinic says you can’t know for sure what’s causing a toothache until you see a dentist.
How a Dentist Finds the Cause
Your dentist diagnoses the source of the pain first, then recommends treatment. Expect questions about when the pain started, where it is and how bad it is, whether it wakes you at night, what makes it better or worse, any medicines you take, and whether you’ve had a fever or an injury.
The exam covers your teeth and gums, and can include your tongue, throat, ears, nose, and neck. X-rays can show problems that aren’t visible during an exam, and if an infection is suspected, your dentist may tap on the tooth or test it with hot and cold.
Sometimes the pain isn’t coming from a tooth at all. Research reviews on tooth pain that doesn’t come from the teeth stress that dental treatment should go ahead only once a tooth-related cause has actually been found.
Everett, WA
Tooth pain that won’t settle?
An exam is how the cause gets found.
What Treatment Depends On
The treatment depends on the cause. Dentists commonly treat a cavity by removing the decay and placing a filling, while a larger cavity or a fracture may need a crown. Gum disease is treated according to its type and how far it has progressed, and a tooth that’s too badly damaged to save may have to be removed.
Easing the pain doesn’t treat the cause. Cleveland Clinic notes that even when antibiotics clear an infection, it comes back unless the underlying problem is treated.
How Long Is Too Long to Wait?
Not more than a day or two, and sooner is better. MedlinePlus says to get care for a toothache that lasts longer than a day or two, and Cleveland Clinic says treating the problem early can keep it from getting worse.
Book a dental visit if you have:
- severe tooth pain
- pain that lasts longer than a day or two
- an earache, or pain when you open your mouth wide
- pain when you chew
- a bump like a pimple on your gums
- a broken or chipped tooth
Until your appointment, ask your dentist or doctor how to manage the pain.
If the Pain Stops, Is the Problem Gone?
Not necessarily. An infected tooth can stop hurting if the nerve inside it dies or the pressure is relieved, while the infection keeps spreading. A tooth abscess won’t go away on its own, and the CDC calls it a myth that you can skip the dentist once a tooth stops hurting: waiting limits the options for fixing a large cavity.
When to Go to the Emergency Room
Go to the nearest emergency room if a toothache comes with any of these:
- swelling in your face, below your eye, or along your jaw
- a fever (Cleveland Clinic’s threshold with a tooth abscess is 100.4°F or higher)
- trouble swallowing or breathing
- confusion
- severe pain with fever and chills
These can mean an infection is spreading. Left untreated, a tooth infection can spread to the jawbone and the soft tissues of the face and neck, and it can become life-threatening. Icon Dental Center doesn’t provide emergency dental care, so go straight to the ER if you have any of these signs.
Tooth or jaw pain can also be a sign of a heart attack. If it comes with chest pain, shortness of breath, nausea, or weakness, call 911.
Toothaches in Children
If your child has a toothache, the American Academy of Pediatric Dentistry’s advice is to see a dentist as soon as possible. The CDC says cavities are the most common chronic disease of childhood in the US, and that untreated ones can cause pain and infections that affect eating, speaking, and learning. If your child has any of the emergency signs above, go to the emergency room.
At Icon Dental Center, our general dentists provide children’s dentistry for kids from 6 months old.
How to Lower Your Risk
You can’t always prevent a toothache, but you can make one less likely:
- Brush twice a day with a fluoride toothpaste, and clean between your teeth every day.
- Limit sugary foods and drinks, and don’t use tobacco.
- Avoid chewing ice, popcorn kernels, and hard candy, which can crack a tooth.
- Tell your dentist if you think you grind your teeth.
- Get regular checkups, as often as your dentist recommends. Treating decay early lowers the risk of an abscess.
Toothache lasting more than a day or two? Call our Everett dental office to book an exam.
Getting a Toothache Checked in Everett
At Icon Dental Center, our general dentists, Dr. Aboulhosn, Dr. Valentine, and Dr. Kwok, look for the cause of tooth pain at a routine exam. If the cause is gum disease, our periodontist, Dr. Betsy Mosquera, provides gum disease treatment.
Common Questions About Toothaches
How long does a toothache last?
There’s no way to know, because it depends on the cause. Gum irritation should settle in a day or two, but with a cavity or an abscess the pain may come and go without going away completely. See a dentist if it lasts longer than a day or two.
Can a sinus infection cause a toothache?
Yes. Toothache is one of the symptoms of acute sinusitis, along with pressure-like pain, pain behind the eyes, and tenderness of the face. A dentist can check whether a tooth is the problem, and your doctor may need to treat the sinus infection.
Can a toothache cause an earache?
The two can be linked. Pain from a tooth abscess can spread to the ear, jaw, or neck, and an earache can sometimes cause tooth pain.
Can I go to the ER for a toothache?
Yes, if it comes with warning signs such as facial swelling, a fever, trouble swallowing or breathing, or confusion. For a toothache without those signs, see a dentist as soon as you can: the dentist is the right person for most causes of tooth pain.