What Causes Toothache: Home Remedies for Relieving the Pain
If you’ve ever had toothache you’ll know how excruciatingly painful it can be and how miserable it can make you feel. It’s something that can affect anyone of any age – even babies experience it when they start teething. So it’s hardly surprising that toothache is the most common reason for emergency dental appointments as well as why many people take time off work or school (i).
Described as a painful sensation that originates from the teeth or the tissues that surround them, toothache can be experienced in a number of ways.
The severity of pain it causes can vary from mild to severe. It can be sharp and sudden or a dull ache, and it may be constant or it may come and go. The pain is often worse at night too, including when you’re lying down, as well as when you’re eating and drinking (often when you’re eating or drinking something hot or cold).
The source of tooth pain can also be difficult to pinpoint, and you may not even be able to tell exactly which tooth or area of gum is causing it.
Sometimes the pain can be so general and widespread, you won’t be aware of whether it’s coming from your upper or lower teeth or gums. Some people may feel the pain in their ear too, which suggests a lower molar tooth may be affected. Meanwhile if the pain feels like it’s coming from your sinuses, it’s likely that one of your upper teeth is be the source.
Other symptoms include hypersensitivity. This is when you feel a sharp pain whenever you eat something cold or something sweet (or sometimes when you have hot food or a hot drink). Not being able to sleep well is often a sign too, as toothache can often wake you up in the middle of the night and keep you awake for hours.
What causes toothache?
One of the main causes of toothache is pulpitis, which is most commonly a result of tooth decay. This is when the soft tissue in a tooth – the pulp – becomes inflamed.
The pulp contains blood vessels and nerves, and is the innermost layer of a tooth. The outside layer is called enamel – this is the hard, protective outer coating that doesn’t contain any nerves or blood vessels.
Under the enamel is another layer called dentine. This forms the major part of the tooth, covering the pulp. It’s made of many dense layers of microscopic tubes that link the enamel to the pulp. So when the enamel is compromised, harmful substances such as bacteria and toxins can pass through the dentine’s tubes to the pulp. To protect itself, the pulp becomes inflamed (pulpitis).
Tooth decay is one of the things that can damage the enamel to such an extent that harmful substances can get to the pulp. This decay is the result of bacteria in our mouths reacting with the sugars from our food and making acid. Every time we eat or drink anything that contains sugars (including natural sugars found in carbohydrate foods), the acids our bacteria produce attack our teeth’s enamel, softening and dissolving it.
These acid attacks can last for an hour after eating or drinking, but then natural substances in saliva help the enamel to harden again (a process called remineralisation). But if too much acid is produced over a long enough period of time, it can dissolve a hole in the enamel.
As well as tooth decay, pulpitis can be caused by:
Broken or loose fillings
A cracked tooth
Receding gums (sometimes caused by brushing your teeth too hard)
A dental abscess or infection
Problems with orthodontic devices such as braces
Having a dental filling that’s too close to the pulp
When should you see a dentist?
If you have toothache that lasts for more than two days, it’s generally advisable to book an appointment with your dentist to have the problem diagnosed and treated. Other signs you should have a check-up include:
Toothache that doesn’t get better when you take over-the-counter painkillers
Toothache accompanied by a high temperature, as this could be a sign that you have an infection.
Pain when you eat or bite on something.
Toothache accompanied by red or swollen gums, or if your jaw or cheek is also swollen (also signs of infection).
Toothache accompanied by a bad taste in your mouth.
Severe pain after having a tooth taken out.
Losing, breaking or chipping a tooth as the result of an accident.
Toothache caused by a wisdom tooth.
Toothache accompanied by problems with swallowing.
Other reasons for oral pain
Pain that’s similar to toothache can be caused by a number of other conditions that don’t involve inflammation of the pulp. Here are some of the most common:
Periodontal infections (infections that develop in the space between the tooth and gum, often a symptom of gum disease)
Emerging wisdom teeth (these can cause sore or swollen gums or even an infection, called periocoronitis)
Sinusitis (when inflammation puts pressure on the nerves of the upper back teeth, causing pain in the upper jaw)
Damage to the temporomandibular joint, which attaches the jaw to the skull
Bruised ligaments around a tooth caused by biting on something very hard
Viral infections such as shingles
Trigeminal neuralgia (a condition that affects the trigeminal nerve, a facial nerve that connects with the brain)
Vitamin B12 deficiency (studies suggest this may cause a condition called glossodynia, also known as burning mouth syndrome (ii))
Treatment and prevention
How your toothache is treated will depend on what’s causing it. Your dentist will give you a thorough check-up, which may or may not include you having dental x-rays, to determine what’s wrong.
They may find you have an area of tooth decay, in which case the decayed part of the tooth will be removed and a filling put in its place. Meanwhile, if you have a loose or broken filling, the filling will be removed, any decay cleared away, then a new filling inserted. In either case, the damage to the pulp won’t be extensive, and correcting the problem will help it to heal.
If, however, there’s too much inflammation and damage to the pulp, your dentist may decide the best course of action is to have root canal treatment. This involves removing the damaged pulp, treating the remaining part of the tooth and then filling it with a special root filling to seal the tooth and prevent any more infections.
A more drastic option would be to have the tooth removed – which may be your option if there’s not enough of the tooth remaining after the decay has been removed. You may also need to have an extraction if the problem tooth is impacted, which means it can’t break through the gum properly (this can often happen with wisdom teeth).
Delaying or going without any treatment will increase the risk of the pulp being damaged significantly, which may be much more painful as the inflammation spreads to the bone and ligaments. This greatly increases your chances of having just root canal treatment or extraction as your only treatment options.
How to avoid toothache
A good oral hygiene routine is your best bet for preventing toothache as well as other problems such as gum disease. This includes:
Brushing your teeth twice a day for at least two minutes each time using a fluoride toothpaste
Cleaning between your teeth every day using floss, dental tape or interdental brushes to remove food and plaque
Using a fluoride mouthwash at a time when you’re not brushing to help remove plaque
You should also see your dentist for regular check-ups as often as they recommend – you may need more frequent appointments if you have a problem your dentist wants to keep an eye on, or they may advise you to come back in a year’s time.
Also consider giving up smoking if you’re a smoker, since cigarette smoke may make some dental problems worse. And it’s important to eat as healthily as possible, with limited amounts of sugary foods and drinks. For more information on how your diet may help and for tips on cutting down on sugar, read our guide to gingivitis (gum disease).
As some sporting activities carry a risk of injury – including damaging a tooth, losing a filling, breaking a tooth or even losing a tooth altogether – it’s also a good idea to wear a protective dental guard or protective headgear while playing to help prevent problems. Your dentist can advise you about suitable gum shields, depending on your activity.
Self-care for tooth pain
While you’re waiting for your dental appointment there are some things you could do at home to ease the pain of toothache, including the following:
Over-the-counter painkillers such as ibuprofen or paracetamol may help to relieve mild to moderate pain, with ibuprofen also helping to ease inflammation. However ibuprofen isn’t suitable for everyone, so always check with a pharmacist before buying and read the patient safety leaflet carefully. Aspirin, meanwhile, isn’t suitable for children under the age of 16.
You can also buy pain-relieving gels and pastes over the counter that help numb the affected area. Or if you want to try a natural remedy, clove oil has been used traditionally to treat toothache as it contains a natural anaesthetic called eugenol. Try putting a few drops on a cotton bud and apply to the affected area, or soak a cotton ball in clove oil and bite down on it gently. Clove oil is available at most pharmacies.
Rinsing your mouth with warm water may provide some relief too. Some natural health practitioners recommend warm salt water, as salt may help relieve inflammation. Put a teaspoon of salt in a cup of boiled water, then let the water cool a little so it’s warm rather than hot. Then rinse your mouth with the salt water for at least 30 seconds before spitting out (not suitable for children with toothache).
If you have toothache and your face looks swollen, putting something cold next to your cheek may help. Place a clean flannel or piece of cloth in cold water, wring it out and hold it against the affected part of your face (some ice or a packet of frozen peas wrapped in a cloth or tea towel is another option). Don’t try this, however, if your teeth feel sensitive, as the cold could make the problem worse.
While you have toothache it may be painful to eat, so avoid having to chew hard or crunchy foods until the problem has been treated. Instead have soft foods such as yoghurt. mashed potatoes and scrambled eggs, or have soup with a smooth rather than chunky texture. Try to make sure your food is neither too hot or too cold – aim for warm or room temperature. Also avoid eating sweet foods, and if you do have something you have to chew, avoid chewing with the affected tooth.
Toothache can be troublesome but this guide should help to make it a little easier. For more information on a number of common health conditions, feel free to visit our health library
Available online: https://patient.info/oral-dental-care/toothache
Jihoon. K., et al. Oral manifestations in vitamin B12 deficiency patients with or without history of gastrectomy. BMC Oral Health. (2016). 16: 60. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884371
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.