Toothache is pain in and around the teeth and jaws that is usually caused by problems such as dental caries (tooth decay). The pain can range from mild discomfort to a severe, sometimes sharp or throbbing, pain in your head and ear. The inside of your teeth is made up of soft, delicate tissue that contains sensitive nerves and blood vessels. This tissue is called dental pulp and it is surrounded by layers of hard tissue called dentine and enamel for protection. The outermost layer of enamel is harder than bone. If the pulp becomes infected, it will be inflamed (pulpitis). It will also usually be painful (toothache).
Toothache can be caused by a number of things including: Dental decay (caries) - which can lead to cavities (holes) forming in the hard surface of the tooth A fracture (crack) in the tooth - which is often so small that it cannot be seen with the naked eye Some types of dental treatment - such as a filling that has become loose or broken Receding gums - where the gums contract (shrink) exposing softer, more sensitive parts of the tooth root Repetitive motions, such as chewing gum or grinding teeth
There are a number of other conditions that can cause pain that is similar to toothache, even though the pulp of a tooth is not affected. These include an abscess in the gum (lateral periodontal abscess), ulcers on the gums (acute ulcerative gingivitis) and sore or swollen gums around a tooth that is breaking through, such as when your wisdom teeth start to come through (pericoronitis). Sinusitis (inflammation of the sinuses) can also sometimes causes pain around the upper jaw, as can injury to the joint that attaches the jaw to the skull, which is known as the temporomandibular joint.
Symptoms of a toothache may include tooth pain that may be sharp, throbbing, or constant (in some people, pain results only when pressure is applied to the tooth) and swelling around the tooth. There may also be a high temperature or a headache, or foul-tasting drainage from the infected tooth.
Pain in or around your tooth can have multiple causes, from decay over time to a slipped filling or ill-fitting brace, or you may have an abscess or a wisdom tooth coming through. Tooth pain can make it hard to think of anything else, but there are simple measures you can take to relieve the pain, and it may ease by itself.
If it’s still niggling after 2 days, or if you feel unwell with a fever, there’s a bad taste in your mouth, it’s painful to bite down, the gum looks red or with a lump and pus, and your cheek or jaw looks swollen, this is time to seek attention. Dentists are the health professionals to help, and your regular dentist should accommodate emergencies within their clinic. If it’s out of their working hours, their website or answer service will tell you how to find emergency help. NHS dentists are available, but there’s a possibility you may have to pay for treatment.
Unfortunately, your doctor cannot help with tooth and gum conditions, and they may feel unable to prescribe antibiotics for tooth problems – a dentist can prescribe these if they think necessary.
Dentists are the tooth and gum experts. However, you should attend the Emergency Department urgently if a lump in your mouth is causing difficulty breathing, speaking, or swallowing, or if you have significant swelling around your eye or neck.
If pain is controlled and you feel well, there’s no reason to stay off work, but you should prioritise a dentist’s appointment if you think you need urgent attention.
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