Toothache: What to Do, and When It's an Emergency

In short: Painkillers as directed on the packet, a cold compress outside the cheek, sleeping propped up and warm salt-water rinses help until you are seen. Never place aspirin on the gum. Go the same day for facial swelling, difficulty swallowing or breathing, or fever — and pain that suddenly stops can mean the nerve has died, not healed.

Toothache is the single most common reason people search for a dentist, and it almost never arrives at a convenient hour. This is what is likely causing it, what genuinely helps until you can be seen, and the signs that mean you should not wait.

What toothache usually means

Pain is a symptom, not a diagnosis. The common causes:

• Decay reaching the nerve. Sharp pain to cold or sweet that fades quickly suggests early involvement. Pain that lingers, throbs, or wakes you at night suggests the nerve is inflamed and the tooth may need a root canal.
• A cracked tooth. Classically a sharp jab on biting down, or on releasing the bite.
• Gum infection. Aching, tender to touch, often with bleeding.
• An abscess. Constant severe pain, often with swelling and a bad taste. This one needs urgent attention.
• Wisdom tooth. Pain at the very back, often with swollen gum over a partly erupted tooth.
• Something that is not a tooth at all. Sinus infection commonly mimics upper toothache.

You cannot reliably tell these apart yourself, and neither can a dentist without an examination and usually an X-ray.

What helps while you wait

• Over-the-counter painkillers as directed on the packet, or as your dentist advises.
• A cold compress on the outside of the cheek, twenty minutes on, twenty off.
• Sleeping with your head propped higher — lying flat increases pressure and is why toothache is worse at night.
• A warm salt-water rinse.
• Avoiding very hot, very cold and very sweet things, and chewing on the other side.

What to avoid

• Do not place aspirin against the gum. It does not work that way and it burns the soft tissue.
• Do not apply clove oil neat to gums. Diluted and on the tooth is traditional; neat on soft tissue causes chemical burns.
• Do not heat the outside of the face if there is swelling.
• Do not take antibiotics left over from last time. They will not fix the cause, and partial courses drive resistance.
• Do not wait for it to settle and assume it is fixed. Pain stopping can mean the nerve has died, not that the problem has gone.

Go today, not tomorrow, if

• Your face or jaw is visibly swollen
• You have difficulty swallowing, opening your mouth, or breathing
• You have a fever alongside dental pain
• The pain is severe and not touched by painkillers
• There is a bad taste with pus

Facial swelling with a dental infection can spread, and spreading infection in the face and neck is a medical emergency. If you have swelling and difficulty breathing or swallowing, go to a hospital, not a dental clinic.

Finding a dentist tonight

Every dentist on EnamDoc is verified against their dental council registration before they can accept a booking, so you are not choosing at random while in pain. See also our guide to dental emergencies in India.

This article is general information, not a diagnosis or clinical advice. Only an examination by a registered dentist can identify the cause of your pain.