Causes of toothache and treatment options


A toothache, described as any pain, ache, or discomfort in or around a tooth, can be an unpleasant and unpleasant experience. In addition to the sharp or dull pain, your tooth may be sensitive to temperature or painful when chewing or biting. To understand the cause of toothache, your healthcare provider will consider several possible diagnoses based on your medical history, dental exam, and sometimes an imaging test, usually an X-ray.

Here's a rundown of the most common causes of toothache, ranging from sensitivity and cavities to serious infections like abscess formation.

Illustration by Alexandra Gordon, Get Meds Info


Among the things that can cause toothache, the most common are cavities, inflammation of the dental pulp, abscesses, cracked or damaged teeth, gum disease, and sensitive teeth .


Let's look at each of these possible causes separately.

Gum disease

Gum disease is characterized by infection of the gums. Particularly with gingivitis , the gums become inflamed, warm, red, and swollen. When a gum infection occurs, periodontitis occurs .

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Ultimately, if left untreated, the infection causes bone loss and worsening gum health. The gums are detached from the teeth, forming pockets that fill with a large number of bacteria. The roots of the teeth are exposed to plaque and become susceptible to cavities and sensitive to cold, touch, and chewing.


Caries is defined as the erosion and formation of cavities on the outer surface ( enamel ) of the tooth. When plaque, a sticky coating of bacteria, forms on tooth enamel, it feeds on the sugar and starch from food particles in your mouth. This produces an acid that corrodes the enamel, causing weak spots and holes. Over time, the enamel breaks down and a cavity forms .

Although tooth decay is generally painless because decay spreads inward to the middle layer of the tooth ( dentin ), it can cause symptoms such as sensitivity to temperature and touch .

Sensitive teeth

Sometimes you may experience discomfort when your teeth or a specific tooth are exposed to cold air, liquids, and certain foods. This means that your teeth can develop sensitivity associated with one or more irritants, such as cold temperatures .

Tooth sensitivity develops due to exposed dentin, the tissue under the enamel (the hard outer layer of the tooth), and cementum (the tissue that covers the root of the tooth) .

Dentin can be exposed as a result of cavities, worn fillings, or cracked teeth. Gums that sag due to gum disease (or vigorous brushing) can also expose dentin, leading to tooth sensitivity.


Bruxism, which is characterized by clenching and grinding of teeth, often during sleep, can occur without your knowledge. But, especially over time, it can cause tooth sensitivity and toothache or facial pain .

Inflammation of the dental pulp (pulpitis)

When decay penetrates deep into the pulp of the tooth, pulpitis occurs. This means that the tissue in the center of the tooth (tooth nerve / pulp ), rich in blood vessels and nerves, becomes inflamed and irritated. This inflammation causes increased pressure within the tooth and then on the surrounding tissues.

Besides tooth decay, other conditions that can cause pulpitis include:

  • Dental trauma
  • A tooth that requires multiple invasive procedures.

The main symptom of pulpitis is hypersensitivity to various stimuli, mainly temperature (hot or cold) .

It is important to note that there are two types of pulpitis: reversible pulpitis and irreversible pulpitis .

If the pulpitis is reversible, the pain or tenderness disappears within seconds after the stimulus is removed. If the pulpitis is irreversible, the pain may persist for several minutes after the stimulus is removed .

Cracked tooth

A cracked or broken tooth can result from trauma to the mouth, such as when an athlete is punched in the face. Also, the force of a bite on a hard object such as ice or a popcorn kernel can sometimes cause a tooth fracture. Severe bruxism can also damage teeth and cause cracks.

Symptoms of a broken tooth can include a sharp pain when biting or chewing. A cracked tooth can also be sensitive to hot and cold temperatures or sweet and sour foods .

Keep in mind that there are different types of cracks in your teeth, and identifying the type of cracks will ultimately help guide your treatment plan.

The American Association of Endodontists (AAE) has identified five types of cracked teeth :

  • Lines of Madness: when superficial, small cracks form in the outer enamel.
  • Broken tuber: when a piece of the chewing surface of a tooth breaks, usually around the filling.
  • Cracked tooth: when a crack extends from the occlusal surface of the tooth vertically to the root of the tooth. the crack may or may not extend below the gum line.
  • Split tooth: when a tooth is split in two.
  • Vertical root fracture – when a crack forms in the root of a tooth; Since the roots of the fracture are usually not visible, it may go unnoticed until an infection develops.


A tooth abscess , which is usually the result of an untreated cavity or pulpitis, is caused by a build-up of bacteria within the pulp chamber. Then the infected pulp cavity tries to leak from the tip of the tooth root .

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Pressure from an oozing infection causes constant pain that is aggravated by chewing or percussion (pounding). If left untreated, the pain can become severe with swelling.

Broken tooth

Teeth can be damaged if other teeth, gums, or bones prevent them from fitting properly in the mouth .

Most of the time, wisdom teeth break because they are the last to erupt. When the jaw cannot accommodate these extra teeth, the teeth remain under the gum. This pinch can cause pressure, pain, and even pain in the jaw .


There are several possible, though rare, medical emergencies that can cause toothache or result from untreated dental conditions.

Angina Ludwig

Very rarely, an infection of the submandibular space, also called Ludwig's angina, can cause pain in the teeth and mouth. This very serious and life-threatening infection of the submandibular space, an area deep within the mouth, is usually the result of an infection of the second or third molar of the lower jaw .

Submandibular infection is very serious and spreads rapidly, causing fever, chills, sore mouth, stiff neck, drooling, muffled voice, and difficulty swallowing. If the infection spreads to a person's airways, it may be difficult for them to breathe .

Cavernous sinus thrombosis

In very rare cases, a condition called cavernous sinus thrombosis, in which a clot forms in the cavernous sinus at the base of the skull, can be the result of untreated infections of the face, sinuses, ears, or ears. teeth. In addition to a high fever, other symptoms of cavernous sinus thrombosis include a severe headache, often located behind the eyes, as well as eyelid swelling and muscle weakness.

When to contact a healthcare provider

If you haven't brushed your teeth in the last year, be sure to make an appointment with your dentist. Regular professional dental cleaning will improve the health of your teeth.

Also, make an appointment with your dentist if you experience any dental discomfort, tooth sensitivity, persistent bad breath , loose teeth, increasing gaps between teeth, or notice that your gums are bleeding , swollen, or receding.

Call your dentist immediately if you experience any of the following:

  • Toothache associated with fever, swelling, suppuration, or purulent bursa.
  • Cracked or chipped tooth

Go to the emergency room if you have a high fever with a headache, pain in your mouth or teeth, and / or neurological symptoms.


To determine the cause of your toothache, your healthcare professional will work in stages, starting with your medical history.

History of the disease

To narrow down the possible causes of dental discomfort, your doctor will ask you a few questions about the types of symptoms you have.

Some of these questions can lead to the following:

  • How long does a toothache last?
  • Is the pain persistent or does it only occur after a trigger has been activated (for example, by drinking a cold drink)?
  • Is your tooth sensitive to hot or cold, sugary foods, chewing and / or brushing your teeth?
  • Did your toothache wake you up in the middle of the night?
  • Do you have any accompanying symptoms (such as facial pain or swelling, pain when leaning forward, headache, fever, or vision problems)?
  • Have you had a tooth or mouth injury?
  • Have you had any dental procedures recently?

Physical exam

After reviewing your medical history, your dentist will examine your face and mouth for swelling and pain. During an oral exam, your dentist will examine the inside of your mouth, including your gums, for inflammation. They will also examine your teeth for cavities or signs of infection (such as swelling at the base of a tooth).

With a tongue depressor, your healthcare provider may tap or bump the teeth in the area of pain and / or apply an ice cube or cold air puff to different areas of the tooth to find out where the sensitivity is coming from. They can also test the bite pressure with a bite stick or cotton-tipped applicator to determine which area of the tooth is causing pain.

For people with more unusual or alarming accompanying symptoms, such as fever or vision problems, a dentist can examine the cranial nerves.

Visualization and other tests

After a medical exam, your dentist may want to take an X-ray of the affected tooth to check for abscesses, cavities, or any other hidden problems.

Computed tomography (CT) or magnetic resonance imaging (MRI) is generally used to diagnose very serious and rare diagnoses, such as Ludwig's angina or cavernous sinus thrombosis.

Differential diagnosis

Believe it or not, there are times when a toothache or hypersensitivity has nothing to do with your teeth.

For example, if you have a sinus infection , your teeth may be more sensitive than usual. You may even experience pain or discomfort that seems to be coming from multiple teeth. This is especially true for the upper teeth, as they are located directly below the sinus cavities. Any pressure or pain in the sinuses can affect these teeth.

Another medical condition that a person may describe as toothache is a temporomandibular joint (TMJ) disorder . This disorder refers to dysfunction of the jaw joint located in front of the ear. Symptoms generally include a dull ache or ache near the ear, which is worse with jaw movement and chewing. The clicking of the jaw when opening and closing the mouth is also common, as well as headaches, earaches, and neck pain.

Watch out

Once your dentist has determined the cause of your toothache, they will explain what is needed to correct the problem.


Depending on your underlying diagnosis, your dentist may recommend or prescribe a variety of medications.


Your dentist may recommend taking Tylenol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. If the pain is severe, your doctor may prescribe an opioid. Local nerve block injections may also be given for severe pain or during a dental procedure.


If you have an abscess, pulpitis, gingivitis, or periodontitis, your doctor may prescribe an antibiotic such as amoxicillin. Antibiotics will also be prescribed for bacterial sinusitis.

Mouthwashes and topical fluoride

Your dentist may prescribe chlorhexidine mouthwashes to treat gingivitis. Your dentist may also prescribe a fluoride rinse or topical fluoride treatment to prevent or treat tooth decay.

For sensitive teeth, in addition to brushing with a special toothpaste designed for tooth sensitivity, such as Sensodyne, your dentist may apply fluoride to your teeth (especially those parts of your teeth that come into contact with the gums).

Oral devices

If you have sleep-related bruxism, your dentist may recommend wearing a mouth guard at night .

Keep in mind that a mouth guard will protect your teeth from damage, but it will not reduce the number of bruxism attacks. That's why addressing the main triggers for bruxism – stress or nighttime alcohol or caffeine use – will also be an important part of your treatment plan.

Dental procedures

Sometimes different dental procedures are needed to treat your diagnosis. For example, for cavities and cavities, the main treatment is restorative therapy, which involves removing cavities by drilling and then filling the removed area with durable material (called a filling) .

In the case of irreversible pulpitis, the dentist will have to cut the root canal . In an abscess, the main therapy is to cut and drain the infected bursa .

Finally, the treatment of a fractured tooth depends on the location and direction of the crack, as well as the extent of the damage.

For example, if a tuber is broken, the dentist may simply place a new filling or crown on the broken tooth to protect it. Similarly, if the cracked tooth does not protrude beyond the gum line, your dentist may cut the root canal and place a crown to prevent further spread of cracks.

More serious fissures, such as a fissure that extends below the gum line or a root fracture with a concomitant infection, may require tooth extraction.


The key to good oral health is preventing problems before they occur. For example, to avoid breaking teeth, it is important to wear a mouth guard during contact sports and not to chew on candy or ice.

To prevent tooth decay, gum disease, and tooth sensitivity, try these preventive strategies:

  • Brush your teeth gently twice a day with a soft-bristle toothbrush and fluoride toothpaste.
  • Floss daily
  • Drink fluoridated water
  • Get a professional dental cleaning regularly
  • Change your toothbrush every three to four months or more.
  • Avoid smoking
  • Eat a regular, balanced diet rich in fruits, vegetables, protein, and oily fish, and minimize sugar-rich foods or beverages.

Get the word of drug information

Due to the fact that most causes of toothache require qualified dental care, be sure to contact your dentist if you have a new toothache. This is true even for mild or intermittent toothache. If left untreated, you can develop serious complications and / or require a more invasive dental procedure.

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