Toothache
Symptoms, Causes & Treatment
Understanding toothache: what causes it, when it is a dental emergency, and what to do while waiting to see a dentist.
What Is Toothache?
Toothache is pain originating from a tooth or its surrounding structures. It is one of the most common reasons for emergency dental and GP presentations in the UK. Pain can range from mild sensitivity to severe throbbing agony that prevents sleep.
The most common causes are dental decay (caries), dental abscess, cracked tooth, and gum disease. Most toothache requires definitive dental treatment. GPs and online clinicians can provide pain relief and antibiotics where appropriate while you access dental care.
A dental abscess causing facial swelling near the throat or airway is a life-threatening emergency. Call 999 immediately.
What Does Toothache Feel Like?
Toothache varies in character depending on the underlying cause. Describing the pain accurately helps identify the most likely cause.
Severe throbbing tooth pain · Pain radiating to jaw, ear, or neck · Sensitivity to hot and cold · Swelling in gum, cheek, or jaw · Fever and feeling unwell · Difficulty opening mouth or swallowing · Visible decay, broken tooth, or abscess
Dental abscess with facial swelling affecting breathing or swallowing (Ludwig's angina) — call 999 · Rapidly spreading facial cellulitis · Toothache with fever and confusion (septicaemia) · Severe trismus (inability to open mouth)
A dental abscess causing facial or neck swelling near the throat is a life-threatening emergency. If swelling is affecting your airway, making it hard to breathe or swallow, call 999 immediately — do not wait for a dentist appointment.
What Causes Toothache?
Toothache has specific causes that a clinician or dentist can identify and treat. Understanding the likely cause helps you communicate effectively and get appropriate care faster.
Dental caries (tooth decay) is caused by acid produced by oral bacteria (Streptococcus mutans) metabolising sugar. The acid demineralises enamel and dentine, creating cavities. Untreated cavities progress to pulpitis and then periapical abscess.
A dental abscess is a collection of pus caused by bacterial infection of the tooth pulp or periodontal tissue. It produces severe throbbing pain, facial swelling, and systemic infection. It is a dental emergency when airway involvement is suspected.
Cracked tooth syndrome causes sharp pain on biting, released on opening. Cracks may not be visible on X-ray. Temperature sensitivity is common. Severe cracks may require extraction.
Gingivitis is reversible inflammation of the gum margin caused by plaque accumulation. It is the earliest stage of periodontal disease and is completely reversible with good oral hygiene. The hallmark is bleeding on brushing.
Periodontitis is irreversible destruction of the periodontal ligament and alveolar bone supporting the teeth. It causes gum recession, tooth mobility, and tooth loss. It is the most common cause of adult tooth loss in the UK.
Aphthous ulcers (canker sores) are the most common oral mucosal disease. Minor aphthae resolve in 7–14 days; major aphthae are larger and heal in weeks. Recurrent aphthous stomatitis (RAS) affects ~20% of the population.
Key Risk Factors
How Is Toothache Investigated?
Diagnosis is based on clinical history, examination, and dental X-rays. The pattern of pain (spontaneous, hot/cold-triggered, on biting) and examination findings guide the diagnosis.
How Is Toothache Treated?
Definitive treatment requires dental intervention. A GP or online clinician can provide bridging treatment while you await dental care.
Supportive Measures
Take ibuprofen (if tolerated) and paracetamol alternately. Apply clove oil gel to the affected area for temporary numbing. Avoid extremes of temperature. Do not place aspirin directly on the tooth or gum. Rinse with warm salt water if an abscess is suspected.
Recurrent Toothache
Recurrent toothache despite treatment may indicate treatment failure, new decay, or a cracked tooth root. If symptoms recur after root canal treatment, repeat root canal or extraction may be necessary. Discuss further treatment options with your dentist or an endodontist.
When Should You Seek Medical Advice for Toothache?
Facial swelling affecting the throat or neck · Difficulty breathing or swallowing · Inability to open the mouth · High fever with rapidly spreading redness from the jaw. Call 999 immediately.
Severe toothache preventing sleep · Facial swelling from a dental abscess · You cannot access a dentist urgently · Fever alongside dental pain.
How Can You Prevent Toothache?
Most toothache is preventable with good oral hygiene and regular dental check-ups.
Brush teeth twice daily with fluoride toothpaste for 2 minutes. Use interdental brushes or floss daily. This removes the plaque that causes both decay and gum disease. Electric toothbrushes are more effective than manual.
See a dentist every 6–12 months (or as recommended). Early decay is painless and cheaply treated; advanced decay requires root canal or extraction. Regular dental checks are the most cost-effective dental investment.
Fluoride toothpaste (1000–1450 ppm) protects teeth from acid attack. Fluoride mouthwash provides additional protection. Do not rinse with water after brushing — spit only to keep fluoride in contact with teeth.
Reduce sugar intake — especially frequency of consumption. Every sugar exposure causes a 20-minute acid attack. Fruit juice and fizzy drinks are particularly damaging. Drink water between meals.
Do not smoke. Smoking causes periodontal disease, masks gum bleeding (a key warning sign), impairs healing after dental treatment, and is the most significant risk factor for oral cancer.
Gum disease is the primary cause of bad breath. Good oral hygiene — brushing, flossing, tongue cleaning, and regular dental hygienist visits — treats the root cause more effectively than mouthwash alone.
Speak to a Clinician About Dental Pain
Through The GP Service, a clinician can assess dental pain, prescribe antibiotics where appropriate for spreading infection, and advise on emergency dental access while you await treatment.
Expert clinical advice, when you need it.
Toothache FAQs
See a dentist or attend an emergency dental service. If facial swelling is affecting your throat or making it difficult to breathe or swallow, call 999 immediately — this is a life-threatening dental abscess.
Ibuprofen and paracetamol taken together (not both at once) provide better pain relief than either alone. Ibuprofen has anti-inflammatory properties particularly beneficial for dental pain. Do not place aspirin directly on the tooth or gum.
Toothache with facial or neck swelling, fever, difficulty swallowing, or a feeling of general illness indicates a dental abscess spreading beyond the tooth. This requires same-day emergency dental or A&E assessment.
NHS emergency dental treatment is available via 111, who can direct you to an emergency dentist. Private emergency dental services are also widely available. If you cannot access dental care and have severe symptoms, attend A&E.
Short-term: avoid extreme temperatures, use desensitising toothpaste (Sensodyne), and take ibuprofen. Long-term: only a dentist can definitively treat the underlying cause (filling, root canal, or extraction).
A root canal removes infected pulp tissue and saves the tooth. It is no more painful than a filling when performed under local anaesthetic. Without treatment, a tooth with a dead pulp will abscess and eventually require extraction.
Cold sensitivity often indicates dentine exposure or early decay. Hot sensitivity with persistent pain typically indicates pulpitis (nerve inflammation). Sensitivity to biting suggests a cracked tooth or abscess. All warrant dental assessment.
Oral antibiotics are sometimes prescribed for dental abscesses, but they do not replace definitive dental treatment (drainage, root canal, or extraction). Antibiotics alone cannot cure a dental abscess.