Toothache

Toothache is pain in or around a tooth. It is most often caused by decay reaching the nerve inside the tooth, but gums, cracked teeth, wisdom teeth, the jaw joint and even the sinuses can produce similar pain.

The type of pain is a useful clue. Brief sensitivity to cold usually means a reversible problem. Lingering, throbbing or spontaneous pain that wakes you suggests the nerve is inflamed beyond recovery or infected, which does not settle without dental treatment. Painkillers only buy time.

Symptoms

• Short, sharp pain with cold, sweet or air
• Throbbing pain that lingers after hot drinks
• Pain that wakes you at night or is worse lying down
• Tenderness when biting or tapping the tooth
• Swollen gum or a pimple on the gum that discharges
• A bad taste in the mouth
• Swelling of the cheek or jaw
• Pain spreading to the ear, temple or neck

Causes and risk factors

The leading cause is tooth decay advancing to the pulp (pulpitis), followed by a dental abscess at the root tip. Others are a cracked tooth, a lost or leaking filling, gum disease or a gum abscess, exposed root surfaces from gum recession, infection around a partly erupted wisdom tooth, a dry socket after extraction, and grinding. Pain felt in upper back teeth can come from sinusitis. Rarely, tooth-like pain is caused by trigeminal neuralgia or, in the lower jaw with exertion, the heart.

How it is diagnosed

• Dental examination: Looks for decay, cracks, gum pockets and swelling, with tapping and pressing to locate the source.
• Pulp sensitivity tests: Cold and electric tests judge whether the nerve is healthy, inflamed or dead.
• Periapical and bitewing X-rays: Show decay between teeth, deep fillings and infection at the root tip.
• Panoramic X-ray or cone beam CT: Used for wisdom teeth, hidden infection and sinus-related pain.
• Bite testing: Identifies a cracked cusp.

Treatment options

• Filling: Removes decay and seals the tooth when the nerve is still healthy.
• Root canal treatment: Removes the inflamed or infected nerve, disinfects and fills the canals, and keeps the tooth. Usually followed by a crown on back teeth.
• Drainage of an abscess: Through the tooth or the gum. Antibiotics are added only when there is spreading swelling or fever, as they do not cure the source.
• Extraction: When the tooth cannot be restored, with replacement planned afterwards.
• Gum treatment: Deep cleaning for periodontal causes, and irrigation or removal for a troublesome wisdom tooth.
• Desensitising care: Fluoride varnish, sensitive toothpaste or bonding over exposed roots.
• Short-term pain relief: Ibuprofen with paracetamol if safe for you. Do not place aspirin on the gum.

When it is urgent

Go to an emergency department locally if swelling spreads to the eye, under the jaw or down the neck, if you have difficulty opening your mouth, swallowing or breathing, or a high fever with feeling very unwell. Spreading dental infection can become dangerous quickly.

Travelling to Türkiye for treatment

Acute toothache should be dealt with by a dentist near you within days: do not book a flight around it, and flying with an untreated abscess can be miserable. Travel is reasonable for the definitive work that often follows, such as several root canal treatments and crowns, or implants to replace failed teeth, which commonly take 5 to 8 days. Bring recent X-rays.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions