Tooth pain has a way of taking over your day. It can be a quick zing when you sip something cold, a dull ache that comes and goes, or a throbbing pain that keeps you up at night. The type of pain often gives clues about what is going on. This guide explains common causes of toothache, when a filling is usually enough, when a tooth may need more, and what you can do until you see a dentist.
Common causes of tooth pain
Tooth decay (cavities)
Decay happens when bacteria in plaque produce acids that break down the tooth’s hard outer layers. Early decay is usually painless. As it gets closer to the softer inner layer (dentin) and then the nerve (pulp), you may notice sensitivity to sweets, cold or biting.
A cracked or broken tooth
Cracks can come from biting something hard, grinding your teeth or large old fillings that weaken the tooth. A classic sign is a sharp pain when you bite down or release your bite, which can be hard to pin to one tooth.
Worn or broken fillings
Fillings do not last forever. When the edge of a filling breaks down, bacteria can get underneath and cause new decay that is not always visible.
Gum recession and sensitivity
When gums pull back, the root surface of the tooth is exposed. Roots are more sensitive than the crown of the tooth, which can cause short, sharp pain with cold drinks or brushing.
Gum disease or a gum infection
Pain, swelling or bleeding around a tooth may come from the gums rather than the tooth itself.
Inflamed or infected nerve
If decay or a crack reaches the pulp, the nerve can become inflamed or infected. This often causes pain that lingers after the trigger is gone, throbbing pain, pain that wakes you up, or sensitivity to heat.
Pain that isn’t from a tooth at all
Sinus congestion, clenching or grinding, and jaw joint problems can all feel like tooth pain, especially in the upper back teeth.
What your symptoms might be telling you
Only an exam and X-rays can confirm the cause, but these general patterns are useful to know:
| Symptom | Often associated with |
|---|---|
| Brief, sharp twinge with cold that goes away within seconds | Sensitivity, gum recession, an early cavity or a worn filling |
| Pain when biting or releasing your bite | A cracked tooth, a high filling or deeper decay |
| Pain with cold or heat that lingers for a while after | Inflammation of the nerve |
| Spontaneous throbbing, or pain that wakes you up | An inflamed or infected nerve |
| Swelling, a pimple on the gum or a bad taste | Possible infection (abscess) |
When is a filling enough?
A filling repairs a tooth after the decayed or damaged part has been removed. It is usually the right treatment when:
- The decay or damage has not reached the nerve
- Pain is mild and short-lived, triggered by cold or sweets
- There is enough healthy tooth left to support a filling
Most fillings today are tooth-coloured composite resin, which is bonded to the tooth. The procedure is usually done in one visit with local anesthetic. Your dentist removes the decay, shapes the tooth, places the filling material in layers, hardens it with a curing light and adjusts your bite.
After a filling, it is normal to have some mild sensitivity to cold or biting for a few days. If your bite feels “high” or the tooth is still sore when chewing after a few days, call your dentist – a small adjustment often helps.
When a tooth may need more than a filling
If damage or infection reaches the nerve, a filling alone will not solve the problem. Depending on the situation, your dentist may discuss:
- Root canal treatment – removing the inflamed or infected nerve tissue, cleaning and sealing the inside of the root, and then restoring the tooth. The goal is to keep your natural tooth.
- A crown – a covering over the whole tooth, often recommended when a tooth is cracked, heavily filled or has had a root canal, to protect it from breaking.
- Extraction – removing the tooth when it cannot be predictably saved. Your dentist will discuss options for replacing it, such as an implant, bridge or denture.
Your dentist should explain why a treatment is recommended, what the alternatives are (including doing nothing) and the costs of each, so you can make an informed choice.
Why you shouldn’t wait
It is tempting to wait and see if a toothache goes away. Sometimes pain does fade – but that can mean the nerve has died, not that the problem is fixed. An untreated infection can spread. Treating decay while it is small is generally simpler and less costly than treating it after it reaches the nerve.
What to do until your appointment
- Rinse gently with warm salt water.
- Floss around the sore tooth – sometimes trapped food is the cause.
- Over-the-counter pain relievers can help. Follow the package directions and check with a pharmacist if you take other medications or have health conditions.
- Avoid chewing on that side and avoid very hot, cold or sugary foods.
- A cold compress on the outside of your cheek can help with swelling.
- Never put aspirin or other tablets directly on your gum – they can burn the tissue.
When to seek urgent care
Go to an emergency department or call 911 if you have swelling that is spreading to your eye, neck or under your jaw, difficulty breathing or swallowing, or a fever with facial swelling. These can be signs of a serious infection.
Book an assessment
If you have a toothache, sensitivity or a broken filling, we can assess it and explain your options. Occlura Dental is at 136 Winges Road, Unit 10, in Woodbridge. Call (905) 851-0075, email care@occluradental.com or request an appointment online. Fillings and root canal treatment are among the services covered by the Canadian Dental Care Plan for eligible members – see our CDCP guide.
This article is for general information and is not a substitute for an examination or advice from your dentist.