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Toothache

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"Toothache" refers to pain in and around the teeth and jaws that's usually caused by tooth decay.

You may feel toothache in many ways. It can be intermittent or constant. Eating or drinking can sometimes trigger the pain or make it worse, especially if the food is very hot or cold.

The pain can also vary in severity. It may feel "sharp" and start suddenly. It can be worse at night, particularly when you're lying down. A lost filling or broken tooth can sometimes start the pain, but it is most commonly caused by tooth decay.

It can often be difficult to locate the pain and patients can find it difficult to tell if the pain is coming from the upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like it's coming from the ear.

Toothache in other upper teeth may manifest as pain from the sinuses (the small, air-filled cavities behind your cheekbones and forehead). Conversely sinus inflammation can feel like a tooth problem. If the toothache is being caused by an infection the part of the jaw adjacent to the infected tooth may feel sore or tender to touch. It's also possible for gum disease to give rise to a "dull" pain.

When to see your dentist

If your toothache persists for more than one or two days, visit your dentist as soon as possible to have it treated. If the problem is left for a long time it can become more difficult to treat.

If your toothache is due to dental decay and is left to progress the pulp inside your tooth will eventually become infected. This can usually lead to a dental abscess, with severe and continuous throbbing pain.

Painkillers, such as paracetamol and ibuprofen, may reduce the pain and discomfort while you're waiting for an appointment. Children under 16 years of age shouldn't be given aspirin.

What causes toothache?

Toothache occurs when the innermost layer of the tooth (dental pulp) becomes inflamed. The pulp is the nerve within a tooth and comprises of sensitive nerve tissue and blood vessels.

Dental pulp can become inflamed as a result of :
  • tooth decay – that leads to cavities (holes) forming in the hard surface of the tooth
  • a cracked tooth – the crack is often microscopic and is too small to be seen. Fluid movement through the crack which occurs when the tooth is compressed leads to pain.
  • loose or broken fillings
  • receding gums – when gums receded exposing more sensitive portions of the tooth can lead to pain. Often this pain is just triggered by thermal stimuli but can cause a tooth to feel inflamed without the presence of something hot or cold.
  • periapical abscess – a collection of pus at the end of the tooth caused by a bacterial infection
There are a number of other conditions that can cause pain similar to toothache, even though the pulp isn't affected. These include :
  • periodontal abscess – this is a type of abscess which occurs to due to bacteria aggregating in a crevice adjacent to a tooth (called a 'pocket') and is caused by having poor gum health.
  • ulcers on your gums
  • sore or swollen gums around a tooth is erupting – for example, when your wisdom teeth start to come through
  • sinusitis – this is the inflammation of the spaces found in the skull adjacent to the nose
  • Injury or inflammation of the joint that attaches the jaw to the skull (temporomandibular joint)

Babies can also experience discomfort when their teeth start to develop. This is known as teething.

Treating toothache

The treatment for toothache will depend heavily on the cause of the problem. Your dentist will take a full history of the problem and examine the area in question. They may also take an x-ray of the area to assess the problem.

If your toothache is caused by tooth decay and the cavity has not breached the pulp your dentist should be able to remove the decay and fill the tooth.

If your toothache is caused by a loose or broken filling, the filling will be taken out, any decay will be removed and a new filling put in place.

If the pulp inside your tooth is infected, you may need root canal treatment. This procedure involves removing the infected pulp and then inserting a special type of filling to seal the tooth and prevent re-infection. You can read more about root canal treatment in the section titled 'Abscess/Swelling/Infection'.

If your toothache can't be successfully treated with these methods, or if your tooth is impacted (wedged between another tooth and your jaw), it may need to be extracted.

Preventing toothache

The best way to avoid getting toothache and other dental problems is to maintain your oral hygiene meticulously and keep the sugar in your diet to a minimum. To do this, you should :
  • limit your intake of sugary foods and drinks; you should have them as an occasional treat and only at mealtimes (read more about cutting down on sugar)
  • brush your teeth twice a day using a fluoridated toothpaste. Use of a fluoridated mouthwash can be a useful adjunct.
  • regularly cleaning between your teeth using dental floss or inter-dental brushes
  • not smoking, because it can make some dental problems worse
  • Having regular dental check-up's will also reduce the chances of suffering toothache as minor problems can be addressed before they cause pain. The time between check-ups can vary, depending on how healthy your teeth and gums are and your risk of developing future problems. Your dentist will discuss what will be an appropriate interval for your dental check-up's using the general state of your oral health as a guide.

    Children should have a dental check-up every six months, so that tooth decay can be spotted and treated early.

    Read more about taking care of your teeth and keeping your teeth clean