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An illustration of a person from the middle of their torso upwards. They are holding their right hand to their slightly swollen cheek and are frowning. Three white squiggly lines come from their cheek. They have short blue hair and are wearing a navy blue short-sleeved t-shirt.
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Written by Jack Wilkinson, MD.
Fellow, Cornell/Columbia New York Presbyterian Child Psychiatry Program
Last updated February 18, 2021

Toothache quiz

Take a quiz to find out what's causing your ache.

That painful toothache is often a sign of decay caused by a buildup of bacteria in the mouth. Learn about the infectious, mechanical toothache causes & remedies.

Toothache quiz

Take a quiz to find out what's causing your ache.

Take toothache quiz

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Toothache symptoms

Tooth pain is an unwelcome surprise after gulping down a nice cold drink or chomping on some corn on the cob. Whether it's a nagging, dull ache or a sharp jolt that makes you jump, tooth pain can be cause for concern.

Good dental hygiene (yes, including, flossing) and regular visits to the dentist go a long way in preventing tooth pain, but even the pearliest whites aren't immune. Dental problems grow more common with age yet can begin in childhood, long before adult teeth come in.

Tooth pain may seem unimportant, but it can be a warning sign of worse things to come. Teeth and gums help shield the body from infection, and when they break down, the body loses this natural defense.

Common accompanying symptoms of a toothache

If you're experiencing a toothache, it's also likely to experience:

  • Ache over one or several teeth
  • Sharp pain with chewing
  • Tooth discoloration
  • Sensitivity to very hot or cold foods
  • Gum inflammation or bleeding
  • Pain or difficulty with eating

Causes of a toothache

That irritating toothache is often a sign of decay caused by a buildup of bacteria in the mouth. What starts as a colorless, sticky film, called plaque, can quickly progress to hardened, yellow or brown deposits called tartar. Without proper dental hygiene, the bacteria can cause erosions in teeth and infections in the surrounding area.

Infectious causes

Toothaches may occur due to an infection, such as the following.

  • Tooth decay: Acid produced by bacteria in the mouth can break down the hard tissues of the teeth.
  • Inflammation of the gums: Swollen gums can be quite uncomfortable and are a sign of bacteria buildup in the mouth.
  • Abscess: An infection that has been brewing for some time can produce a pocket of pus in teeth or surrounding tissues.

Mechanical causes

Mechanical causes of a toothache include the following.

  • Third molars: While some people are able to keep these "wisdom teeth," there's often not enough room in the mouth and overcrowding can cause pain.
  • Teeth grinding: This can occur during the day or at night while sleeping and can irritate the nerves in the teeth and other areas.
  • Dental work: Teeth can be especially sensitive after a visit to the dentist for a filling or crown.
  • Jaw joint inflammation: Problems with the jaw joint and muscles may cause pain that feels like it is coming from your teeth.
  • Trauma: A cracked tooth is not only painful and unsightly but can also increase the chance of infection.
  • Teething: In children, the eruption of baby teeth and later adult teeth commonly cause discomfort.

Other causes

Other causes of toothaches may include the following.

  • Poor diet: Eating lots of sugary snacks and drinks feeds bacteria in the mouth and can lead to painful infections and other problems.
  • Poor dental hygiene: Regular brushing and flossing helps keep dental problems at bay and can prevent toothaches.

his list does not constitute medical advice and may not accurately represent what you have.

Severe cavity

Dental cavity requiring a root canal or tooth extraction.

Rarity: Uncommon

Top Symptoms: dry mouth, toothache, spontanenous tooth pain, tooth pain that makes chewing difficult

Symptoms that always occur with severe cavity: spontanenous tooth pain

Urgency: Primary care doctor

Tooth abscess (infection)

A tooth abscess is a collection of infected material (pus) in the center of a tooth. It is due to a bacterial infection.

You should seek dental care within 24 hours. The diagnosis is made based on your history, an exam, and an x-ray of the mouth. If the abscess is affecting your breathing, it's considered a medical emergency and you should seek emergency care. Treatment involves incision and drainage of the abscess in addition to antibiotics.

Rarity: Uncommon

Top Symptoms: severe jaw or tooth pain, swollen jaw, jaw stiffness, tooth pain that gets worse with hot, cold, or sweet beverages, warm and red jaw swelling

Symptoms that always occur with tooth abscess (infection): severe jaw or tooth pain

Urgency: Primary care doctor

Temporomandibular joint (TMJ) dysfunction disorder

Temporomandibular joint (TMJ) dysfunction disorder refers to long-term pain and dysfunction in the TMJ, the joint that connects the upper and lower jawbones.

The TMJ is a complex joint with complicated movements and is subject to strain and injury. Symptoms may come and go for no apparent reason. Misalignment of the teeth and jaw, and tooth grinding, are no longer believed to be a cause. Women seem to be more susceptible than men.

TMJ disorder has three types:

  • Pain or discomfort in the muscles controlling the TMJ.
  • Dislocation or injury to the jawbone.
  • Arthritis of the TMJ.

Diagnosis is made through patient history, physical examination, and imaging. The goal is to rule out other causes such as sinus infection or facial nerve damage.

Due to the difficulty of diagnosing TMJ disorder, treatment begins with conservative methods that do not permanently change the jaw or teeth. Ice packs, soft foods, gentle stretching of the jaw muscles, and reducing stress are all encouraged. Short-term pain medications may be used. Splints, Botox, implants, and surgery are not recommended.

Rarity: Common

Top Symptoms: dizziness, pain, restricted movement, and clicking sounds from jaw, history of headaches, jaw pain, pain in the back of the neck

Symptoms that always occur with temporomandibular joint (tmj) dysfunction disorder: pain, restricted movement, and clicking sounds from jaw

Urgency: Primary care doctor

Osteonecrosis of the jaw

This is a condition where the jaw bone is exposed (this happens if it is not covered by gums). To be called osteonecrosis of the jaw (ONJ), this condition must persist for at least 8 weeks. This disease is common among people taking medications called bisphosphonates or RANKL inhibitors.

You should visit your primary care physician. This condition is usually treated conservatively with rinses, antibiotics, and pain medication for the mouth.

Infected wisdom tooth (pericoronitis)

Pericoronitis of the 3rd molar is an infection of the gums surrounding the 3rd molar (wisdom tooth). It almost never happens to normal teeth because wisdom teeth take a long time to break the gums (erupt). It's believed that once the wisdom tooth breaks the surface of the gums, the bacteria in the mouth get into the gums at that spot and cause an infection. This is also worsened by food particles that build up in the area.

You should go immediately to your dentist, or, if they are not available, go to the nearest urgent care center. There, the dentist/doctor will clean the area, drain any pus, and write for an antibiotic mouth rinse. Penicillin is reserved for severe cases. A follow-up with a dentist is required to see if you need to get the tooth pulled.

Rarity: Rare

Top Symptoms: possible wisdom tooth pain, moderate tooth pain, tooth pain that makes chewing difficult, severe tooth pain, mild tooth pain

Symptoms that always occur with infected wisdom tooth (pericoronitis): possible wisdom tooth pain

Urgency: In-person visit

Dental cavity

Dental cavities are bacterial infections of the tooth. The bacteria produce acid that breaks down the tooth.

You should visit your dentist within the next 24 hours. Once a toothache presents, the tooth might already be in big trouble, and it needs attention right away.

Acute bacterial sinusitis

Acute bacterial sinusitis, also called bacterial rhinosinusitis or "sinus infection," has symptoms much like viral rhinosinusitis but a different treatment.

Any sinusitis usually begins with common cold viruses. Sometimes a secondary bacterial infection takes hold. Like cold viruses, these bacteria can be inhaled after an infected person coughs or sneezes.

Anyone with viral sinusitis, upper-respiratory allergy, nasal passage abnormality, lung illness, or a weakened immune system is more prone to bacterial sinusitis.

Symptoms include thick yellowish or greenish nasal discharge; one-sided pain in the upper jaw or teeth; one-sided sinus pain and pressure; fatigue; fever; and symptoms that get worse after first improving.

See a doctor right away for severe headache, high fever, stiff neck, or vision changes. These can indicate a medical emergency.

Diagnosis is made with a simple examination in the doctor's office.

Bacterial sinusitis can be treated with antibiotics, but this is not always necessary.

Often rest, fluids, and over-the-counter pain relievers and decongestants are enough.

Prevention is done through good lifestyle and hygiene to keep the immune system strong.

Rarity: Common

Top Symptoms: fatigue, headache, cough, sinusitis symptoms, muscle aches

Symptoms that always occur with acute bacterial sinusitis: sinusitis symptoms

Symptoms that never occur with acute bacterial sinusitis: clear runny nose, being severely ill

Urgency: Primary care doctor

Acute viral sinusitis

Acute viral sinusitis, also called viral rhinosinusitis or "sinus infection," occurs when viruses take hold and multiply in the sinus cavities of the face.

It is most often caused by the same viruses that cause the common cold and spreads the same way, through an infected person's coughing or sneezing.

Because children have small, underdeveloped sinuses, this illness is far more common in adults.

Symptoms include clear nasal discharge (not greenish or yellowish,) fever, and pain if facial sinuses are pressed.

If there is rash, severe fatigue, or neurologic symptoms (seizures, loss of sensation, weakness, or partial paralysis,) see a medical provider to rule out more serious conditions.

Diagnosis can usually be made through history and examination alone.

Antibiotics only work against bacteria and cannot help against a viral illness. Therefore, treatment consists of rest, fluids, and fever/pain reducers such as ibuprofen. (Do not give aspirin to children.) Symptoms of viral sinusitis last for about seven to ten days. As with the common cold, the best prevention is frequent and thorough handwashing.

Rarity: Common

Top Symptoms: headache, cough, sinusitis symptoms, sore throat, congestion

Symptoms that always occur with acute viral sinusitis: sinusitis symptoms

Symptoms that never occur with acute viral sinusitis: being severely ill

Urgency: Self-treatment

Toothache treatments and relief

By the time tooth pain hits, there's usually an underlying problem that requires a thorough examination by a dentist. So, it's best to address the problem before it happens in the first place.

How to prevent toothaches

You can likely prevent a toothache by regularly practicing the following.

  • Brushing: Most people rush this basic part of dental hygiene. Be sure to clean all surfaces of your teeth with fluoride toothpaste and gentle back and forth motions for at least two minutes. Change your toothbrush at least every three months.
  • Flossing: There's a reason the dentist always asks about this important step. Cleaning the space between teeth and gums once a day removes bacteria and prevents infection and inflammation.
  • Fluoride rinse: These over-the-counter solutions are a popular supplement to the fluoride already found in toothpaste.
  • Antibacterial mouthwash: These rinses, which typically contain alcohol or chlorhexidine, reduce the amount of bacteria in the mouth.

After a toothache develops and before you make it to the dentist, there are a few remedies that can help relieve the pain.

  • Numbing gels: Products containing benzocaine, such as Orajel, are applied directly to an area of discomfort and can make it easier to eat or drink with a toothache.
  • Pain relievers: Ibuprofen (Advil, Motrin) or other NSAIDs are often helpful. Acetaminophen (Tylenol) is a good alternative and can be alternated with ibuprofen for even stronger pain relief.
  • Clove oil: A few drops of this natural remedy can be applied directly to the painful area in the mouth.
  • Salt rinse: A combination of salt dissolved in warm water can help fight the underlying cause of the pain.

When to see a doctor for a toothache

Once you get to your dentist's office, he or she may recommend or complete the following depending on the cause.

  • Filling: If the tooth has begun to decay, the dentist will replace the decay with a solid material so that bacteria do not continue to spread.
  • Root canal: If an infection has reached the center part of the tooth made up of living tissue, the dentist will clean this area out.
  • Crown: This is a cap placed over a damaged tooth to prevent spread of decay or infection.

When a toothache is an emergency

It's important to see a doctor/dentist right away if you have:

  • Toothache that is very severe or does not improve with medication
  • Fever with dental pain
  • Problems eating, swallowing or breathing
  • Loose adult tooth
  • A fractured or knocked-out tooth

FAQs about toothaches

What causes toothache?

Toothache is most often caused by tooth decay or cavity. The inside of your tooth, called the pulp, contains nerves and blood vessels that can become irritated and cause the sensation of a toothache. Nerves can be irritated by factors like bacterial toxins, chemicals, trauma, and even inflammatory chemicals produced by your own body in response to an infection.

Do I have a cavity?

Cavities are best diagnosed by your dentist, who can probe your teeth to look for soft spots indicating decay, or use X-rays to look between your teeth. Tooth decay occurs because of breakdown of enamel by acid-generating bacteria, and, if untreated, can progress to cavities. Signs that you may have a cavity include tooth pain after eating or drinking something sweet or hot/cold and visible cavitated lesions.

Can cavities cause jaw pain?

If a cavity has been left untreated for an extended period of time, bacteria can invade the area and begin to spread to adjacent bony tissues, causing significant jaw pain. Jaw pain does not necessarily indicate a tooth cavity, however. One common source of jaw pain that is often incorrectly thought to be related to tooth pathology is temporomandibular disorder.

What causes toothaches at night?

There are several reasons why toothaches can occur or become worse at night. One major reason is that lying flat causes increased blood flow to the head, causing increased pressure on sensitive areas of your teeth. Another reason is that food may still be lodged in between your teeth from your last meal and may cause irritation to the surrounding area. Finally, teeth grinding at night may also cause pain.

Why does toothache cause radiating pain in the sinuses?

The roots and nerves of your top back teeth lie very closely to the maxillary sinuses, which are two large, air-filled spaces under the eyes and adjacent to your nose. As a result, buildup of fluid in the maxillary sinus secondary to inflammation of the sinuses can cause increased pressure and pain to the teeth. Similarly, infection of the upper teeth can cause pain that seems to be stemming from the sinuses.

Questions your doctor may ask about toothache

  • Has your dentist or significant other ever told you that you grind your teeth in your sleep?
  • Were you hit or injured anywhere on your face? If so, where?
  • Is this tooth on the upper row (maxilla) or lower row (mandible)?
  • Do you take good care of your teeth?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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