Toothache

Authored by Dr Ben Williams, 19 May 2017

Reviewed by:
Dr Hayley Willacy, 19 May 2017

Toothache is a painful sensation originating from the teeth or the tissues that surround them. It is caused by inflammation of the dental pulp - the nerves and blood vessels inside our teeth. When the pulp becomes inflamed, this is called 'pulpitis'.

Anybody who has experienced an episode of severe toothache will probably shudder at the memory. The pain can be excruciating and is described by many people as the worst pain they have ever experienced. This explains why toothache remains the most common reason for emergency dental attendance and is a frequent reason for absence from work or school.

Toothache can affect adults and children of almost any age. To help your teeth remain healthy and pain-free it is important that you maintain an effective daily dental hygiene regime. Children's teeth should be cared for in a similar fashion as soon as they erupt through the gums.

The pain from toothache is not always severe or constant. It can vary along a spectrum from minor discomfort to extreme agony. Severe episodes of pain may be preceded by days and even weeks of warning signs such as a minor discomfort when biting on a tooth, or an increase in tooth sensitivity to cold, hot or sweet things (this is called hypersensitivity). These early symptoms may only last for only a few seconds at a time but if you experience them repeatedly for more than one or two days you should have your teeth assessed by a dentist as soon as possible. With prompt action you stand a far better chance of avoiding severe toothache and of requiring only simple procedures, like having a tooth filled, to address the problem.

Read more about the symptoms of toothache.

Teeth are composed of three layers. The innermost layer is called the pulp and this contains the blood vessels and nerves. If the protective coat above it is damaged then harmful things like germs (bacteria), toxins and hot, cold or sweet stimuli are able to damage the living pulp underneath.

Learn more about the causes of toothache.

If you are unable to get a dental appointment at short notice you can try to relieve your symptoms by taking painkillers. Paracetamol and ibuprofen can be effective for reversible pulpitis; however, the symptoms of irreversible pulpitis are rarely improved significantly using over-the-counter medication. Ensure that you read the advice sheet prior to taking any medication and do not exceed stated doses. Your pharmacist may be able to advise alternative options if standard painkillers are not effective.

The main aims of treating toothache are:

  1. Cure the pain by identifying and removing the cause of the pulpitis. This is most commonly done by removing dental decay.
  2. Restore the tooth to prevent further pulpal irritation. This is done by sealing off the dentine layer and placing a filling.
  3. If the pulpitis is irreversible then it will be necessary to remove the dead/dying pulp.

Read more about the treatment of toothache.

If you delay for too long then you will increase the likelihood of significant pulp damage. This is usually extremely painful and eating will become much more uncomfortable as the pulpitis spreads to affect the bone and ligament around the root tip. Coupled with an inability to eat properly, the experience of one or two sleepless nights in constant pain is what makes toothache such a debilitating and intolerable experience for those who develop it. Without treatment, the pulp will eventually die and break down to form a dental abscess in the bone around the root of the tooth. When this happens, the dentist is left with only two options: root canal treatment or tooth extraction.

Several other dental conditions have symptoms which may be confused with toothache but do not actually involve the pulp. These include sinusitis, mouth ulcers and gum infections, especially if you have partially erupted wisdom teeth or have gum disease. For a brief explanation of these conditions see the cause section.

PLEASE HELP.Just a quick bit about me, I'm 20, female, smoker of 5 years, trying to quit as pregnant now.I've had this small lump on the roof of my mouth for at least a few years now from what I can...

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