Severe Tooth Pain

erica medical reviewer
Medically Reviewed
by Dr. Erica Anand
Michael Bayba
Written by
Michael Bayba
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Evidence Based
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6 sources cited
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Severe tooth pain is usually a sign that you need to see a dentist. It can cause additional symptoms such as sleep loss, headaches, and fever. Tooth decay, a cracked tooth, or infections are the most common causes of severe tooth pain.   

Severe tooth pain can manifest in several ways, including:

  • A constant dull ache
  • Throbbing pain that comes and goes
  • Severe pain when biting
  • Sensitivity to hot and cold food and drinks
  • Tingling teeth
  • Swollen mouth or gums
  • Jaw pain or aches
  • Redness
  • Pus or fluids
  • Bad taste 
  • Bad smell
  • Fever

Usually, you can prevent severe tooth pain through proper oral and dental care including regular checkups, brushing your teeth with an effective toothbrush, fluoride toothpaste, flossing regularly, and using mouthwash.

However, if you experience any of the symptoms of severe tooth pain, contact a dentist immediately. 

Causes of Severe Tooth Pain (and Their Treatments)

Tooth Decay (Cavities)

Tooth decay, also known as a cavity, occurs when bacteria eat through your tooth's enamel. This is caused by the build-up of food particles, sugars, saliva, and acids. Eventually, the bacteria reach through to the dentin, which houses tubes to the tooth's nerves. After that, the decay reaches the pulp, where your nerves and blood vessels are. This is the stage that causes severe tooth pain.  

Treatment

A general dentist can treat cavities with a filling. The dentist removes the decayed tooth tissue and fills it with a filling material such as silver, composite resin, glass ionomers, gold, or porcelain. If the nerve dies, a root canal may be necessary. If the doctor cannot repair the damaged pulp, a tooth extraction may be required.

Dental Abscess

A dental abscess is a localized bacterial infection. They can occur at the root of your tooth, between your gums and teeth, or within the tissues of your gums. They are caused by objects such as popcorn or a toothpick lodged in your teeth, plaque build-up, gum disease, or untreated cavities. They cause inflammation, swelling, pain, and a red or soft white swollen bubble of pus with a shiny surface. 

Treatment

If the abscess gets treated early on and the infection hasn't spread, a dentist can drain the abscess, and antibiotics will be prescribed to prevent further infection. If the infection has spread to the tooth's pulp and roots, a root canal or tooth extraction may be necessary.

Tooth Fracture

Cracked teeth can cause severe tooth pain, especially when biting. They are typically caused by excessive teeth grinding (bruxism), chewing hard substances, aging and naturally weakened teeth, injury or trauma, or large fillings that weaken tooth structure over time.

Treatment

Dentists can treat fractured teeth with dental crowns, dental bonding, root canals, tooth extractions, or implants. 

Gum Disease

Gingivitis or periodontitis (advanced gum disease) can be caused by poor oral hygiene, diet, hormonal changes, smoking, medications, and other health conditions such as diabetes or cancer. Gum disease can cause many symptoms such as severe tooth pain, shrinking gums, bone damage, loose teeth, or cavities.

Treatment

Depending on the severity of your gum disease, the dentist may treat it with medicated mouthwash, antibiotics, or scaling and root planing (deep cleaning). In severe cases, a patient may need oral and maxillofacial surgery.

Old or Damaged Filling

As fillings age, they may become weaker and susceptible to damage. The filling material may decompose over time, or the filling can be damaged by normal chewing, biting something hard, or grinding your teeth. The filling may pop out, chip, crack, or crumble.

Treatment

Your dentist can replace lost or damaged fillings. If the tooth has been damaged excessively, a crown can be placed on the tooth to restore its standard form and function.

Bruxism

Grinding or clenching your teeth usually occurs during sleep. It is caused by genetics, anxiety, stress, certain medications, alcohol, smoking, age, and certain disorders such as ADHD and Parkinson's disease. Bruxism can cause many symptoms, including jaw disorders, facial pain, headaches, damage to tooth enamel, chipped or cracked teeth, and severe tooth pain.

Treatment

Treatment for Bruxism may include mouth guards, medications, and stress management.

Loose Crown

A crown, sometimes referred to as a cap, is a cover placed over a damaged tooth. They are used to treat fractured teeth and dental decay if the cavity is too large for a filling. Crowns can become loose, crack, or chip due to normal wear and tear, bruxism, or chewing hard foods. A loose crown can allow bacteria to get under the material and infect or damage the tooth causing throbbing nerve pain. 

Treatment

A loose or damaged crown will need to be removed, the tooth treated with a cavity or root canal, followed by a new crown.

Tooth Eruption or Impacted Tooth

When a new tooth is growing in, it may cause sensitive teeth or dental pain, especially if the tooth is impacted (growing in sideways). This may happen with teething babies, children who lose their baby teeth, and adults when their wisdom teeth grow in.

Treatment

If the pain is coming from the tooth eruption, an oral numbing gel or otc pain medication such as acetaminophen or ibuprofen can help manage it. If your teeth are impacted, minor surgery may be necessary to make room for the new teeth.

Other causes that don’t require professional treatment:

  • Sinus infection
  • Food stuck in your teeth or gums

When to See a Dentist for Severe Tooth Pain

If you experience any of the following symptoms, you should make an appointment with your dentist immediately:

  • Pain when chewing or biting down
  • Pain that lasts for more than one day
  • Fever
  • Swelling that lasts for more than one day
  • Red gums
  • Bad taste or smell
  • Presence of pus or abscess
  • Trouble swallowing
  • A broken or fractured tooth

When Is Severe Tooth Pain an Emergency?

Severe tooth pain is an emergency if it is caused by injury or trauma, or if the infection has begun to spread. If you experience any other symptoms besides a toothache, call your doctor immediately and or seek emergency medical attention.

Home Remedies for Severe Tooth Pain Relief

If you are experiencing severe tooth pain, the first thing you should do is call your doctor. 

Once you have received their medical advice and made an appointment for professional dental treatment, there are several things you can do to alleviate the pain, including:

Pain Medication

Over the counter pain relievers such as acetaminophen or ibuprofen can help alleviate pain. Take as directed on the packaging.

Salt Water Rinse

Mix a half teaspoon of salt with one cup of warm water. Rinsing with this mixture will help disinfect your mouth and help loosen food or other debris stuck in your teeth. It can also help reduce inflammation.

Hydrogen Peroxide Rinse

Mix 3 percent hydrogen peroxide with equal parts water. This rinse can help kill bacteria, relieve pain, reduce inflammation, and reduce plaque. Be sure to use it as a mouthwash and do not swallow.

Cold Compress

Apply a cold compress (you can use a bag of ice wrapped in a towel) to the affected area for twenty minutes. Wait at least an hour before applying again. This reduces pain and swelling by constricting the blood vessels in the area.

Peppermint Tea Bags

Peppermint has been shown to potentially help relieve headaches, increase blood flow, and fight bacterial infections. Soak a tea bag in hot water, then remove it. Allow it to cool down to a comfortable temperature (it should still be warm) and apply it to the area in pain.

Clove Oil

Clove oil is a traditional pain reliever that also has anti-inflammatory properties. Mix a couple of drops of clove oil in a carrier oil, such as olive oil or almond oil (you can use water if you don’t have any carrier oils), dab it onto a cotton ball, and apply to the infected area.

Resources

Koh, Sky Wei Chee et al. “Managing tooth pain in general practice.” Singapore medical journal vol. 60,5 (2019): 224-228. doi:10.11622/smedj.2019044. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535452/ 

McKay, Diane L, and Jeffrey B Blumberg. “A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.).” Phytotherapy research : PTR vol. 20,8 (2006): 619-33. doi:10.1002/ptr.1936

Okeson JP, Falace DA. Nonodontogenic toothache. Dental Clinics of North America. 1997 Apr;41(2):367-383. https://europepmc.org/article/med/9142490 

Lewis C, Stout J. Toothache in US Children. Arch Pediatr Adolesc Med. 2010;164(11):1059–1063. doi:10.1001/archpediatrics.2010.206 https://jamanetwork.com/journals/jamapediatrics/article-abstract/383915 

Cohen, Leonard A., et al. Coping with Toothache Pain: A Qualitative Study of Low‐Income Persons and Minorities. 13 Mar. 2007, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1752-7325.2007.00005.x   

Cohen, Leonard A., et al. “Toothache Pain: A Comparison of Visits to Physicians, Emergency Departments and Dentists.” The Journal of the American Dental Association, Elsevier, www.sciencedirect.com/science/article/abs/pii/S0002817714619292.

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