Toothache

Symptoms

DEFINITION

• Pain or discomfort in a tooth

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.

See More Appropriate Topic (instead of this one) If

• Toothache followed TOOTH INJURY

FIRST AID Advice for Lost Crown:

• Obtain 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

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 Medicines:
   • For pain relief, take acetaminophen, ibuprofen or naproxen.
   • Acetaminophen (e.g., Tylenol):
     • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
     • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
     • The most you should take each day is 3,000 mg.

   • Ibuprofen (e.g., Motrin, Advil):

     • Take 400 mg by mouth every 6 hours

     • Another choice is to take or 600 mg by mouth every 8 hours.

     • Use the lowest amount that makes your pain feel better.

   • Naproxen (e.g., Aleve)

     • Take 250-500 mg by mouth every 12 hours.

     • Use the lowest amount that makes your pain feel better.

   • Extra Notes

     • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An overdose can hurt the liver.

     • Before taking any medicine, read all the instructions on the package.

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.