Toothache: What Causes It and How to Stop It

Toothache has a habit of arriving at nine o’clock on a Friday evening. Here is what is actually causing it, what genuinely helps until you can be seen, and the warning signs that mean you should not wait at all.

The short answer

Toothache is almost always a sign that something structural has gone wrong: decay that has reached the nerve, a cracked tooth, an infection at the root, or a gum problem. Painkillers taken as directed on the packet will take the edge off, but they treat the pain rather than the cause, and the cause does not resolve on its own. If a tooth has hurt for more than a day or two, book an appointment.

What is actually causing it

• Decay reaching the nerve. A deep, throbbing ache that is worse when you lie down and lingers after something hot. This is the most common cause and usually needs a filling or root canal treatment.
• A cracked or broken tooth. A sharp jolt when you bite on something, then nothing. Cracks are easy to miss because the tooth can look perfectly normal.
• An abscess. Constant throbbing, the tooth feels raised or tender to touch, and there may be a bad taste or a gum boil. This is an infection and needs treating rather than waiting out.
• Gum problems. A duller ache along the gumline rather than in one tooth, often with bleeding when you brush. Usually a hygiene issue rather than a problem with the tooth itself.
• A wisdom tooth pushing through. Ache at the very back, sometimes with a stiff jaw or a flap of sore gum over a partly erupted tooth.
• Recent treatment. A tooth can be sensitive for a few days after a filling. If it is getting worse after a week rather than better, get it checked.

When toothache is an emergency

Go to A&E or call 999 if you have swelling that is spreading towards your eye or down into your neck, difficulty swallowing or breathing, or you cannot open your mouth properly. Those are signs of a spreading infection and they are genuinely serious.

Short of that, ring a dentist the same day if you have facial swelling, a fever alongside the pain, or pain that is stopping you sleeping. Out of hours, NHS 111 will direct you to the urgent dental service. During the day, call us on 01625 574609; we keep time in the diary for urgent problems.

What helps until you are seen

• Take painkillers as directed on the packet. Ibuprofen tends to suit dental pain well because the problem is usually inflammatory, but follow the packet and your pharmacist’s advice.
• Sleep propped up on an extra pillow. Lying flat increases pressure at the root, which is why toothache is so often worse at night.
• Avoid very hot, very cold and very sweet things, and chew on the other side.
• Rinse gently with warm salty water if the gum is sore.
• Never hold an aspirin against the gum. It burns the soft tissue and does nothing for the tooth.

What it costs to get sorted

An examination to find out what is going on is £89 for new patients including X-rays, or £60 if you are already with us. Treatment depends on the cause: fillings start from £125, root canal treatment from £305, and an extraction from £126. On the NHS, urgent treatment is charged at Band 1, currently £27.90 in England. Every price we charge is on our fees page, and you will always know the cost before we start.

In pain right now? Our two-minute urgency checker tells you honestly whether this is a call-us-today problem or one that can wait, with practical advice in the meantime.

Frequently asked questions

Will toothache go away on its own?

The pain sometimes does, and that is the trap. When a nerve dies the tooth can stop hurting for weeks while the infection quietly continues at the root. Pain stopping is not the same as the problem stopping, so get it looked at either way.

Why is toothache always worse at night?

Two reasons. Lying down increases blood pressure in the head, which increases pressure inside an already inflamed tooth. And in the evening there is nothing else competing for your attention. Propping yourself up on an extra pillow genuinely helps.

Do I need antibiotics for toothache?

Usually not. Antibiotics do not cure toothache, because they cannot reach inside a tooth where the problem sits. They have a place where an infection is spreading, but they only buy time and the tooth still needs treating afterwards. Prescribing them instead of treatment is how people end up in real trouble a fortnight later.

Can I be seen if I am not registered with you?

Yes. Ring as early in the day as you can and we will do our best to see you during opening hours. We will always tell you what it will cost before any treatment starts.

If a tooth is keeping you awake, do not wait for it to become an abscess. Call us on 01625 574609. We are ten minutes from Macclesfield with free parking outside.

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