Most tooth pain has an ordinary cause: decay, a crack, an old filling, or gums that have pulled back. Very little of it goes away on its own, but most of it is straightforward to treat once we know what it is.
Pain with cold or sweet things
A sharp twinge when you drink something cold, or bite into something sweet, usually means the softer inner layer of the tooth (dentine) is exposed. That can happen when decay has worked through the outer enamel, when a filling has worn or cracked, or when the gum has receded and left the root surface bare.
If the twinge stops as soon as the cold is gone, the nerve is usually still healthy. A filling, or treating the exposed root, is often all that's needed. If the pain lingers for more than a few seconds after the cold has gone, that's worth mentioning when you book. It can mean the decay is deeper.
An ache at night, or a throbbing pain
A dull ache that gets worse when you lie down, or a tooth that throbs on its own without anything touching it, often means the pulp inside the tooth (the nerve and blood supply) is inflamed. Lying flat raises the pressure a little, which is why nights can be worse than days.
This kind of pain rarely settles for long by itself. The usual treatment is root canal treatment, which cleans out the inflamed pulp and seals the tooth so it can stay. If the tooth is too damaged to save, taking it out is the other option, and we'd talk through what can replace it.
Pain when you bite
Pain that comes with chewing, and goes when you stop, usually has one of three causes. A crack in the tooth, which can be hard to see but easy to feel when pressure opens it. A filling or crown that sits slightly high, so that tooth touches before the others do. Or an infection at the root tip, which makes the tooth tender to tap.
Each of these is treated differently, so it helps if you can tell us which tooth it is and whether the pain is sharp or dull. If you can't tell which tooth, that's common too. An examination and a CBCT scan usually settle it.
Sensitivity is not the same as pain
Lots of people have teeth that react to cold or to a very sweet drink. A short, sharp sting that disappears straight away is sensitivity. It's uncomfortable, and worth mentioning at a check-up, but it is not nerve pain and it is not an emergency.
Pain that lingers, wakes you, throbs, or comes with swelling is a different thing. If you're not sure which you have, a short call with the doctor usually sorts it out.
Swelling
Swelling in the gum beside a tooth, or in the cheek, usually means an infection has collected (an abscess). This needs to be seen soon, and the tooth will need treatment rather than just a course of medicine. Don't wait for it to settle.
If you are in pain and cannot reach the clinic, or you have swelling that is spreading, a fever, or difficulty swallowing or breathing, go to a hospital emergency department straight away.
What helps tonight
Until you can be seen, these are the ordinary things that help. Take an over-the-counter pain reliever you've used before, as directed on the pack. Rinse gently with warm salt water. Keep very hot and very cold things away from the tooth, and chew on the other side. Keep the area clean; brushing gently around a sore tooth is better than leaving it.
Please don't put a painkiller tablet against the gum, and don't start antibiotics you have at home. They don't treat the cause, and they can make the picture harder to read when we see you.
What the dentist does
The visit starts with an examination: we look, we tap, we test the tooth with cold, and we ask what sets the pain off. A CBCT scan shows what's happening under the surface. If we need a 3D picture, for instance to see a root clearly, a CBCT scan is taken here in the clinic. Then we tell you what we found, the options, and what each involves, before anything is done.
Depending on the cause, the likely treatments are a filling, root canal treatment, or an extraction. If a tooth comes out, we'll talk about what can replace it.
When to come in
- Pain that lingers after cold or sweet things have gone.
- An ache that wakes you, or a tooth that throbs on its own.
- Pain on biting that keeps coming back.
- Any swelling, a bad taste, or a tooth that feels loose.
- A broken tooth or a lost filling, even if it doesn't hurt yet.
If none of these fit and it's a twinge now and then, mention it at your next check-up. If you're unsure, a pre-consult by video or phone is the quickest way to find out.
If you are in pain and cannot reach the clinic, or you have swelling that is spreading, a fever, or difficulty swallowing or breathing, go to a hospital emergency department straight away.