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Tooth pain has multiple causes that sometimes overlap. Tooth decay, injuries, or infections in or around your teeth can all cause a toothache.
Depending on the cause and location of the problem, you may feel an acute, throbbing pain that comes and goes, or a constant, dull ache. Dentists can treat and help prevent tooth pain.
A toothache can cause pain to occur or worsen from:
Dr. Khushbu Aggarwal, one of NewMouth’s in-house dentists, says tooth pain can sometimes be spontaneous, coming on suddenly or gradually without a specific trigger.
Pain from a toothache may spread to other parts of your jaw, head, or ears. It may be accompanied by swelling, pus or other leakage (exudate), or a visible sore inside your mouth.
You may be able to take steps at home to reduce or relieve tooth pain. But the underlying cause may require professional treatment from a dentist or doctor.
If your toothache is severe, it’s time to see a dentist. Contact your dentist as soon as possible if you notice symptoms of an infection, such as:
The following are possible toothache causes, many of which overlap.
For example, tooth decay and gum disease can contribute to each other, and both can cause abscesses. All three of these conditions can result in tooth pain.
Tooth decay (cavities or dental caries) is a common cause of tooth pain. Cavities are caused by oral bacteria that produce acid. This acid breaks down the hard, mineralized tooth tissues.
Once the bacteria acid dissolves enough enamel (outer layer of the tooth), it begins to affect the dentin underneath. This can cause the nerves within the inner part of the tooth (pulp) to feel pain.
The oral bacteria that cause tooth decay feed on carbohydrates such as sugar. This makes diets high in sugar a risk factor for the development of cavities.
Another tooth decay factor is saliva. Saliva helps remineralize teeth, but bacteria can cause too much mineral breakdown for your saliva to compensate, especially if you suffer from a decreased quantity or quality of saliva.1
Diabetes, certain medications, and habits such as smoking can cause your mouth to produce less saliva than normal.
Besides causing your teeth to hurt, tooth decay can cause increased sensitivity to heat and cold. It can also cause a foul taste or bad breath that doesn’t go away after brushing or rinsing.
Cavities are generally treated with fillings, which can be made from composite materials or various metals. Dentists remove decayed tissue from the tooth and replace it with the filling material.
If the cavities have progressed significantly, more extensive treatments may be needed, such as root canal treatments, crowns, or tooth removals.
You can prevent cavities from forming with good oral hygiene and a low-sugar diet.
A dental abscess is an accumulation of pus that forms near or around a tooth. Advanced tooth decay can cause abscesses, due to an infection of the pulp (pulpal necrosis).2
Gum disease can also cause an abscess to form on the gums or near a tooth, which could also cause a toothache.
Failed root canal treatment is another common cause of abscesses.
Abscessed teeth are especially sensitive to touch. Abscesses often cause swelling that may even be visible outside of your mouth.
The side of your face where the abscess is located may become painful and swollen.
Dentists treat abscesses by draining them and addressing the underlying infection. This may include prescription antibiotics.
If the affected tooth is salvageable, your dentist may perform a root canal. Otherwise, they will need to remove the tooth.
Gum disease (periodontitis) can cause or contribute to tooth pain.
Bacteria affecting the gums can spread to the teeth. And because gum disease can cause gum recession, more of your tooth surface can be exposed to the bacteria that cause tooth decay.
Advanced gum disease can cause teeth to loosen, which may also contribute to pain, especially when chewing.
Early-stage gum disease (gingivitis) may cause your gums to appear red and swollen and to bleed easily when brushing or flossing.
Symptoms of more advanced gum disease include:
Gum disease is treated by cleaning or deep cleaning the tooth roots. Severe cases may be treated with surgery to remove or replace damaged tissue.
Diabetes and other systemic illnesses are associated with gum disease.3
A fractured or broken tooth can be painful, as the sensitive nerves within the tooth may be exposed. Tooth injuries can happen due to falls, contact sport-related incidents, or other accidents.
The presence of other symptoms depends on the cause of the injury. A fractured tooth may be accompanied by a broken jaw or other facial bones or bleeding of the injured area.
An internally cracked tooth where no part of the tooth has completely broken off may experience pain when releasing the tooth after biting.4
Broken teeth can be treated in different ways depending on the nature and severity of the injury. A tooth with no exposed pulp may be filled to its normal shape or shaved down and fitted with a dental cap (crown), or the lost fragment may be reattached.
In some cases, a broken tooth may require root canal therapy or have to be removed altogether.
Some people experience dentinal hypersensitivity, which occurs when dentin becomes exposed. While dentin itself isn’t highly innervated (full of nerves), it connects to the pulp inside the tooth, which contains the nerves.
The dentin can become exposed via enamel loss or gum recession. Tooth wear is a common cause of enamel loss, which may be due to bruxism (tooth grinding) or overly vigorous brushing.
Acid reflux, bulimia, and an excessively acidic diet can also cause enamel loss.
Cold air, food, or drinks are the most common triggers of dentin hypersensitivity.5
Exposed dentin may also be sensitive to heat or sugary or acidic foods. It can also make brushing and flossing painful.
While there is no one standard treatment for dentin hypersensitivity, a variety of desensitizing toothpastes and other products are available.
These products may contain arginine, strontium, potassium salts, or hydroxyapatite.
Ask your dentist about treatments or products that seal dentin tubules or reduce nerve sensitivity.
A tooth that is still emerging, or can’t emerge properly due to lack of space (impaction), can cause pain. This can apply to:
Emerging teeth may cause a feeling of pressure. In the case of impacted wisdom teeth, you may experience swelling or have trouble opening your mouth wide.
Pain from emerging teeth is manageable, but ultimately the teeth must erupt and fill into their natural space in the mouth.
Wisdom teeth that are impacted or fail to emerge fully may be removed. This is usually done when people are younger because increasing age can make the surgery and recovery difficult.6, 7
In some cases, advanced decay or trauma can cause a tooth to stop receiving adequate blood flow. Such a tooth is referred to as being dead, or necrotic.
A dead tooth itself may not hurt, but if the tooth is still in the process of dying, the inflamed pulp at the center of the tooth may be very painful. The surrounding tissues may be in pain as well.
Root canal therapy or complete removal may be necessary.
A loose crown or filling may also cause tooth pain, as can failed implants or other restorations. Your dentist may need to repair or replace them.
Tooth pain can also be caused by:
Dentists offer a variety of treatments, including fillings and other restorations, root canal therapy, and tooth extraction.
To determine which treatment is appropriate for your situation, your dentist will assess the extent of damage to your teeth and surrounding tissues.
They’ll also take into account which parts of your tooth are damaged or exposed. Worn enamel, for example, warrants a different treatment than inflamed pulp.
Sometimes a root canal is necessary due to a failed filling, while an extraction is necessary because of a failed root canal. Talk to your dentist about any concerns you may have.
Numbing gels or creams, over-the-counter (OTC) pain medication, and desensitizing products are all ways to manage tooth pain at home.
If you’re using any of these kinds of products, be sure to carefully follow their instructions. Don’t use them to replace going to the dentist if your situation requires professional attention.
Dr. Aggarwal also mentions the following as possible home remedies:
Some causes of tooth pain, such as accidental injury, don’t have any one foolproof method of prevention.
But you can prevent some of the most common causes, including tooth decay and gum disease, with:
Both of these can prevent the bacteria that cause tooth decay and gum disease from building up in your mouth.
Toothaches have a variety of causes, some more serious than others. You can’t prevent every possible cause of tooth pain, but some can be kept at bay through diet and oral hygiene.
Talk to your dentist as soon as possible if you’re in severe pain or have symptoms such as fever or swelling.
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