Acute toothache: urgent dental care

Acute toothache is a sign that inflammation has reached the tooth nerve or the tissue around the root. It rarely goes away by itself: a painkiller may dull the pain for a few hours, but the cause remains and progresses. Toothache needs treatment in the dental chair. UKRMED provides urgent care during clinic hours: Mon-Sat 9:00-20:00.

Photo: https://www.myupchar.com/en, Wikimedia Commons, CC BY-SA 4.0

What to do for a toothache before your visit

• rinse your mouth with warm water and gently clear food from the tooth with floss;
• do not warm the cheek: heat increases inflammation and swelling;
• do not put aspirin, garlic or alcohol on the tooth: they burn the gum;
• do not chew on the painful side and avoid very cold, hot and sweet food;
• book a dentist as soon as possible.

How to stop a toothache temporarily

For emergency toothache relief, American Dental Association guidance names non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), alone or with paracetamol, as first-line medicines (the ones to try first) if there are no contraindications. Follow the leaflet and do not exceed the dose. A painkiller only helps you wait for the appointment; it is not treatment.

Do not take antibiotics on your own: according to the same guidance, they do not help most types of toothache and are needed only when infection spreads to the body (fever, weakness). The key is to remove the cause in the dental chair.

Toothache at night

Take a painkiller as directed, sleep with your head slightly raised (less blood flow to the inflamed area) and see a dentist in the morning.

When you need help immediately

If a tooth hurts and your cheek is swollen, it may be an abscess. Do not warm the swelling and do not delay, as infection can spread. If you have a fever, the swelling grows quickly, or it becomes hard to swallow, breathe or open your mouth, call emergency services. At the dental clinic, pus is released with abscess incision and drainage.

Common causes of toothache

Pain when biting. Most often inflammation around the root tip (periodontitis) or a cracked tooth. Sometimes a high filling that interferes with the bite.

Pain after a filling. A few days of mild sensitivity after a deep filling is normal. If pain is severe, throbbing or worse at night, the nerve may be inflamed and root canal treatment is needed.

Pain in a root-filled tooth. It often means inflammation at the root tip due to a poorly filled canal or a cracked root. An X-ray and possibly re-treatment are needed.

Pain under a crown. Causes include decay under the crown edge, nerve or root inflammation, or overloading. Sometimes the crown has to be removed to treat the tooth and a new crown made.

Pain around a wisdom tooth is often linked to gum inflammation over it and is handled by surgical dentistry.

What the emergency dentist does

1. Examination and X-ray. A targeted (one or two teeth) X-ray or 3D scan shows where the inflammation is.
2. Anaesthesia. All procedures are done under local anaesthesia.
3. First aid. Depending on the cause: opening the tooth and cleaning the canals, removing the inflamed nerve, a temporary filling, draining an abscess.
4. Follow-up plan. Once acute pain is relieved, the tooth is fully treated. If it cannot be saved, it is extracted.

Prices

Sources

1. Carrasco-Labra A., Polk D. E., Urquhart O. et al. Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. J Am Dent Assoc, 2024. https://doi.org/10.1016/j.adaj.2023.10.009
2. Lockhart P. B., Tampi M. P., Abt E. et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. J Am Dent Assoc, 2019. https://doi.org/10.1016/j.adaj.2019.08.020
3. NHS. Toothache. https://www.nhs.uk/conditions/toothache/