Toothache

Symptoms

DEFINITION

• Pain or discomfort in a tooth

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The main cause of toothache is tooth decay (cavities). Complications of tooth decay can also cause pain. For example, a periapical abscess (pus pocket) can develop around the base of tooth with a cavity.

Dental Causes of Toothache

• Dental caries (tooth decay): pulpitis, periapical abscess
• Food stuck between teeth
• Lost Crown
• Lost Filling
• Periodontal disease (gum disease): gingivitis, periodontal abscess, pericoronitis
• Tooth fracture (broken or cracked tooth)

Other Causes of Toothache

• Canker sore (aphthous ulcer)
• Heart attack
• Ludwig's angina
• Sinusitis
• TMJ Syndrome
• Trigeminal Neuralgia

Complications of Tooth Decay

• Cellulitis of the cheek
• Periapical dental abscess
• Ludwig's Angina: This serious infection is a rapidly progressive cellulitis of the floor of the mouth that usually is a complication of a dental abscess or tooth extraction. The presenting symptoms are fever, a swollen/tender tongue and difficulty swallowing.
• Submandibular lymphadenitis

Caution: Rarely individuals may have a toothache or jaw pain as the sole symptom of a heart attack. Usually there will be other accompanying symptoms of a heart problem, such as: chest pain, shortness of breath, nausea and/or sweating.

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See More Appropriate Topic (instead of this one) If

• Toothache followed TOOTH INJURY

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FIRST AID Advice for Lost Crown:

• Obtain some some over-the-counter dental cement from your local pharmacy.
• Coat the inside of the crown with the dental cement.
• Place the crown back over the tooth.

Notes:

• You can use dental adhesive if you cannot obtain dental cement.
• Remember to see your dentist as soon as possible.

FIRST AID Advice for Lost Filling:

• Push a piece of sugarless chewing gum into the cavity hole.

Notes:

• You can use over-the-counter dental cement instead of chewing gum.
• Remember to see your dentist as soon as possible.

FIRST AID Advice for Pain from Braces Wire Poking Cheek, Gum, or Tongue:

• Cover the end of the wire with orthodontic wax or a cotton ball.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Very weak (can't stand)

Call Your Dentist or Doctor Now (night or day) If

• You feel weak or very sick
• Severe pain and not improved after taking pain medication
• Fever is present
• Face is swollen
• Tongue is very swollen and tender

Call Your Dentist Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Toothache present longer than 24 hours
• Brown cavity visible in the painful tooth
• Red or yellow lump (pus pocket) present at the gum line of the painful tooth
• Lost crown
• Lost filling
• Broken braces wire or end of braces wire is jabbing into gum, cheek, or tongue

Call Your Dentist During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Mild toothache present less than 24 hours and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MILD TOOTHACHE

1. Reassurance: Most toothaches are temporary and due to a sensitive tooth. If the pain becomes worse or does not resolve in 24 hours, it could be due to a small cavity.
2. Floss: Floss on either side of the painful tooth to remove any wedged food.
3. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Local Cold: Apply an ice pack to the painful jaw for 20 minutes.
5. Expected Course: Most minor causes of toothache resolve in less than a day.
6. Call Your Dentist If:
   • Toothache persists longer than 24 hours
   • The toothache becomes worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.