What is Toothache?

Dental pain is common in the UK, with tooth decay being a leading cause of toothache. 80% of adults in the UK have had tooth decay in at least one tooth, leading to fillings or extraction. 20% of children in the UK have tooth decay, and according to the Dental Wellness Trust, an estimated 60,000 days of school are missed yearly because of poor dental care, whilst over one million parents in the UK have never taken their child for a dental check-up.

What is toothache?

The term toothache describes pain in and surrounding the teeth and jaws, including the gums. The pain of toothache is not consistent in every case, as there are many different types of toothache. Toothache is usually a signal that there is an issue with one or multiple teeth, or the gums.

This is typically related to tooth decay or gum disease. However, not all toothache is due to an issue in the teeth or jaws. Sometimes, pain in the jaw can be secondary, and caused by somewhere else in the body. Toothache can be mild and can go away by itself, or it can be serious and require immediate attention.

What causes toothache?

Toothache can be caused by the following conditions:

Tooth decay

Tooth decay is the most frequent cause of toothache. Tooth decay occurs when plaque, which is a build-up of bacteria, develops on the surface of the teeth. The bacteria in the plaque produce acid when food and drink that is high in carbohydrates is consumed.

The acid breaks down the enamel of your teeth over a period of time. This can lead to dental cavities, gum disease and abscesses. It can be prevented by practising good oral hygiene. If cavities are left unfilled, the acid and bacteria can reach the dentine layer of the tooth, which causes the decaying to accelerate. The longer the tooth is left unfilled, the more likely that the bacteria will reach the nerves and vessels which will cause pain.

Tooth abscess

Tooth abscesses occur when pus, caused by a bacterial infection, builds up in the gums and teeth. An abscess can happen in different areas in and around the tooth, sometimes at the tip of the root, and sometimes at the side of the root.

Abscesses usually occur due to a cavity going untreated, causing a lot of pain. A tooth abscess must be treated by a dentist, and will not go away by itself. It can also cause extreme complications if left untreated.

Damaged or broken filling

Tooth pain can occur when a filling has been damaged or fallen out. A metal filling will last about 15 to 30 years, depending on the type of metal, before it has to be replaced. It may need replacing sooner if the filling has experienced more wear and tear.

Composite resin fillings don’t last as long, needing replacement around every 7 years. Older people are more likely to have issues with their teeth, as visiting the dentist may be harder, and their teeth may be weaker and more easily damaged. You can read more about dental care for the elderly by visiting our knowledge base.

Wisdom teeth

Wisdom tooth pain is a common cause of tooth pain, felt at the back of both the top and the bottom jaws. Pain in wisdom teeth is common in late adolescence and in early adulthood, as this is when wisdom teeth erupt. As they come through, it can cause severe pain in the jaw and gums, as well as causing migraines.

Sometimes, pain can continue after the wisdom teeth have erupted, which can be indicative that there is not enough room in the mouth for the new teeth. A tooth extraction may be required in this case.

Growing teeth

Toothache is normal for teething babies, and does not usually require any medical assistance. Signs that a baby is teething include crying, a high temperature, fussiness, biting and itching gums, and sleeplessness. Some babies do not experience teething pain badly, whilst others do. Relief can usually be provided through teething gel, teething rings, and sucking on a cold spoon.

Broken teeth

Toothache occurs when a tooth has been damaged, including being chipped or broken completely. If a tooth has broken dental care should be sought as soon as possible.

Tooth grinding and clenching

Tooth grinding and clenching the jaw can be responsible for tooth and jaw pain, as well as facial pain and migraines. This might occur when the individual is unaware that they are doing it, for example, in their sleep.

After dental procedures

Tooth pain is expected after certain dental procedures such as tooth extraction and root canals. Once local anaesthetic wears off, pain can persist for hours or days, which can be eased with medication.

Referred pain

Toothache can also be a secondary pain, caused by other conditions that are unrelated to the teeth, such as sinusitis. Sinusitis can cause pain in the upper jaw as the sinuses, which become inflamed, are close to the upper jaw.

In rare instances, toothache can be caused by underlying conditions such as heart disease and lung cancer, due to the vagus nerve which runs directly from the brain to the heart and lungs, via the jaw.

Neurological conditions can also cause tooth pain, where the inflammation of the occipital nerves in the head can feel as though it is in the teeth.

What are the symptoms of a toothache?

Symptoms of toothaches are different depending on what is causing the pain.

Symptoms can include:

• High temperature.
• Pain when eating or biting down.
• Pain and sensitivity when you drink and eat hot or cold food and drinks.
• Pain around the tooth, in the jaw.
• Ear pain.
• Pain in the side of the face.
• Swollen jaw, cheek or gum.
• Throbbing pain.
• Feeling of tightness.
• Bad breath.
• Bad taste in the mouth from fluids from an infected tooth.
• Headaches/migraines.

What can happen if toothache is left untreated?

Some toothaches are not a cause for concern, and can go away on their own. However, some toothaches that are left untreated can go on to secrete bacteria into the bloodstream, which can lead to septicaemia. Septicaemia can very quickly lead to sepsis, when the entire body becomes infected.

Sepsis is a major cause of death in the UK, with around 50,000 people dying of sepsis yearly. Some experts note that the increase in resistance to antibiotics may be the leading factor in sepsis as a growing cause of death in the UK. You can read more about different types of infections and how to stop them from spreading by visiting our knowledge base.

It may only take a matter of weeks or months for tooth infection to spread to other tissues and cause life-threatening complications. Once the infection has spread, sepsis can occur suddenly. If tooth pain is accompanied by a fever, earache, or swelling and has lasted for more than two days, you should seek dental care as soon as possible.

How is toothache treated?

There are many ways that a toothache can be treated, depending on the severity of the pain and the root cause.

Going to the dentist

Home remedies will not be helpful in the long term for tooth pain that is getting worse, and a trip to the dentist will be necessary. It is likely that the dentist will perform an x-ray of the jaw to determine the cause of the pain.

• They may prescribe antibiotics if there is an infection present. Dental procedures are not usually performed until the tooth is clear of infection, but the dentist may perform deep cleaning of the tooth if they believe that the infection is caused by something stuck in the teeth. Common antibiotics that may be administered are penicillin, amoxicillin, metronidazole and azithromycin.
• If the tooth pain is caused by a cavity, the dentist will fill the hole. If the cavity is too deep or wide, the dentist may remove the tooth or insert a crown.
• The dentist may perform a root canal if the infection has affected the nerve of the tooth.

Mouth guard

If you are prone to tooth clenching and grinding, your dentist may recommend the use of a mouth guard at night to protect the teeth from being worn down. The dentist will take a mould of the jaw and create a mouth guard that fits.

Home remedies

The underlying cause of a toothache will always need to be treated by a dentist, but some temporary relief may be found in natural remedies for tooth pain.

These include:

• Rinsing the mouth with warm saltwater. Saltwater has disinfectant properties and helps to reduce inflammation. Dissolving half a teaspoon of salt in warm water and gargling, swishing the water around the mouth, can help to loosen food between the teeth.
• Using pain relief. Taking anti-inflammatory medications such as ibuprofen and aspirin can help to reduce pain for a short period of time.
• Using a cold compress. If your teeth and jaw are swollen, holding an ice pack or cold compress on the affected area can help to reduce swelling. This is particularly useful after a dental procedure such as a root canal.
• Herbal remedies are often used to relieve tooth pain temporarily. These include clove oil, vanilla extract, peppermint tea and garlic. Clove oil and garlic have antiseptic qualities that can kill bacteria and reduce pain. Peppermint and vanilla extract aim to soothe the pain. You can read more about pain management by visiting our knowledge base.

How to prevent toothache?

The best way to prevent problems with the teeth is by practising good oral hygiene. This means brushing your teeth with fluoride toothpaste, at least twice a day, but after every meal for excellent tooth care.

Flossing daily is also necessary to remove food and plaque from in between the teeth. Rinsing the mouth with dental mouthwash daily can also rid acid from the surface of the teeth. Additionally, avoiding sugary drinks and foods can help to reduce the likelihood of teeth problems.

Regular dental check-ups are important to ensure that your teeth and gums are healthy. The NHS recommends that you visit the dentist every 6 months, although some people may need to visit more frequently. Toothache can also be prevented by visiting a hygienist, who is different from a dentist.

A hygienist performs a deep clean of the teeth, and uses tools to get to difficult-to-reach parts of the mouth to remove plaque and debris. Many people avoid visiting the dentist for years, due to a fear of dentists. Fear of dentists is a common fear in the UK, affecting around 8 million people. You can read more about dentophobia by visiting our knowledge base.

When should you go and see a dentist about a toothache?

If tooth pain is accompanied by any of the following symptoms and has lasted for more than two days, you should seek dental care as soon as possible:

• Fever.
• Earache.
• Swelling.
• Pain when you bite down.
• Sore or red gums.
• Bad taste in the mouth.

Where can you get more information on dental care?

• Dentaid is a charity that aims to help homeless and vulnerable people access healthcare. Many people are not registered with a dentist and are at risk of infection that could spread. Dentaid provides mobile dental care units that visit shelters to offer free dental care and treatments.
• The Oral Health Foundation is a charity that aims to improve people’s health and wellbeing by raising awareness around good oral hygiene. They have a dental helpline which is open to the public, and lobby the government to improve education. They work with deprived and vulnerable people to close the gap of inequality in oral healthcare.
• The Dental Wellness Trust helps to tackle the oral health crisis by improving education around oral hygiene and health. They offer free toothbrushing programmes for children across London and the South East of England, and help to train dental care providers and teachers. They also distribute toothbrushes globally.