Toothache is one of the most common oral problems that can disrupt daily life. The intensity and persistence of toothache is sometimes so great that it makes it difficult to concentrate and perform normal activities. This pain is usually a sign of an underlying problem in the tooth or surrounding tissues, and the pain will not go away completely until the underlying cause is addressed. However, controlling toothache at home before visiting the dentist is very important because it can reduce the patient’s suffering and prevent the condition from getting worse. Tooth decay is known to be the most common cause of toothache, but there are many other causes that may contribute to toothache, which we will discuss below. In this comprehensive and scientific article, we will review the methods of immediate treatment of toothache and precautions until receiving dental care.
Toothache can occur in various forms and for various reasons. Below are the most common types of toothache and their common causes:
Pain from tooth decay: Tooth decay occurs when bacteria in the mouth feed on sugars and produce acid that dissolves tooth enamel. The result is a cavity (cavity) in the tooth. The first sign of tooth decay may be a momentary toothache when eating sweet, very cold, or very hot foods. As the decay deepens and reaches the underlying layers of the tooth, the pain increases. Tooth decay is the most common cause of toothache in children and adults.
Inflammation or infection of the pulp (dental pulp): When advanced decay reaches the center of the tooth (the pulp containing the nerves and blood vessels), it causes inflammation of the pulp (pulpitis). Pulp inflammation can cause severe, throbbing, and constant pain that continues even after the stimulus (such as taking a cold or hot food) is removed. If the pulp is irreversibly damaged, infection and abscess formation at the root tip may occur, causing severe pain and sometimes swelling of the gums or face. The pain from a tooth abscess is usually severe and constant and may be made worse by touching the tooth or closing the mouth.
Pain from a cracked or broken tooth: Cracked tooth enamel or broken tooth structure can cause sharp, momentary pain, especially when biting down on food. Hairline cracks in the tooth sometimes only cause pain when chewing and are not painful under normal circumstances. If there is a deep crack or fracture that reaches the pulp, the pain can be more severe and persistent. A loose or broken filling can also irritate the nerve of the tooth, causing pain.
Pain from gum disease: Inflammation of the gums (gingivitis) and more advanced gum disease, such as periodontitis, can cause dull ache in the tooth and tender gums. Gum infections sometimes cause gum abscesses, which are accompanied by throbbing pain and localized swelling. Gum pain is usually accompanied by symptoms such as redness and bleeding of the gums and may be aggravated by chewing. In advanced cases, loose teeth may also occur, which can itself be a source of pain.
Impacted wisdom teeth or eruption: The eruption of new teeth (especially wisdom teeth in adolescents and young adults) can lead to pain and inflammation if there is not enough space in the jaw arch. A partially impacted wisdom tooth, where part of it has emerged from the gum and part remains under the gum, often causes painful inflammation of the surrounding tissue (pericoronitis). In addition to pain, this condition is also accompanied by difficulty opening the mouth and swallowing. In general, any impacted or erupting tooth that encounters a lack of space can cause pain and swelling.
Trauma to the tooth: A direct blow to the tooth or a fall and jaw injury can cause a cracked tooth, damage to the pulp, or damage to the ligaments around the tooth. The result can be immediate and severe pain. Even long-term teeth grinding (grinding and clenching) can lead to microscopic cracks in the enamel and chronic, dull pain in the jaw and teeth. Pain from trauma may be made worse by exposure to cold or heat or chewing, and requires immediate treatment if the pulp is damaged.
Other factors: Food stuck between the teeth (especially if there are spaces between the teeth) can cause pain by pressing on the gums and teeth. In this case, a person sometimes feels a distinct painful area between two teeth that continues until the foreign object is removed. Maxillary sinusitis is also an interesting cause; Inflammation of the maxillary sinuses can refer pain to the upper molars, causing the person to think they have a toothache when the real source of the pain is a sinus infection. Temporomandibular joint (TMJ) problems or jaw muscle pain can also present as diffuse tooth pain, even though they are not actually dental in origin.
In general, toothache is a warning sign that should not be ignored. Regardless of the cause, persistent pain is a sign that dental intervention is needed. In the following sections, we will discuss scientific methods for temporary pain control and precautions.
Before you can see a dentist, using scientific and proven methods can help control toothache at home. It is emphasized that these methods are not a definitive cure for the problem, but rather provide temporary relief until the time is right for you to receive basic treatment. The most important recommended strategies are:
Using common over-the-counter pain relievers: Using common oral pain relievers can temporarily relieve toothache. According to the American Dental Association (ADA) guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most effective options for reducing toothache and are recommended as the first line of treatment for acute pain. These drugs have a significant effect on relief by reducing inflammation at the site of the pain. Acetaminophen (paracetamol) is another pain reliever that can be used alone or in combination with an NSAID. Research has shown that the combination of ibuprofen and acetaminophen (in appropriate doses) has a synergistic effect in reducing toothache. Be sure to take your toothache reliever as directed and do not exceed the recommended daily dose. Note that children and adolescents under 16 should not take aspirin, as aspirin can cause serious complications (such as Reye’s syndrome) in this age group. If you have underlying medical conditions or are taking other medications, consult your doctor or dentist about choosing a safe pain reliever.
Mouthwash and oral hygiene: Keeping your mouth clean can help reduce pain. First, gently rinse your mouth with warm water to remove any food debris from around the painful tooth. Flossing to remove food particles or plaque between your teeth is also very helpful (of course, it should be done gently around the painful tooth). One simple and effective method is to rinse your mouth with lukewarm salt water. To do this, dissolve half a teaspoon of salt in a glass of warm water and swish the solution around your mouth for half a minute, then spit it out (don’t swallow). Salt water can help reduce gum inflammation and draw fluid out of swollen tissue. Salt water mouthwash is especially soothing if the gums around the tooth are inflamed. After rinsing, brushing your teeth gently with a soft toothbrush can help clean the area. Fluoride toothpaste and even fluoride mouthwash can help reduce pain by strengthening tooth enamel and reducing sensitivity. Be sure to brush gently around the painful area, and if the pain is severe, temporarily stop flossing in that area. Maintaining oral hygiene and keeping the area around the painful tooth free of bacteria and debris can help prevent further pain and infection.
Cold compress (cold therapy): If the toothache is accompanied by trauma or swelling, applying a cold compress can be very helpful. Place an ice pack wrapped in a towel or bag of frozen vegetables on the cheek next to the painful tooth. The cold helps reduce inflammation and numb the nerves by constricting blood vessels and reducing local blood flow. Leave the cold compress on for 15 to 20 minutes, then wait at least the same amount of time for the skin to rest, then repeat as needed. This is especially helpful for pain caused by an abscess or infection, as the cold can reduce swelling and slow down the growth of bacteria. Be careful not to put ice directly on the tooth or gum, as this can cause tissue damage or increase pain (especially in cracked or sensitive teeth).
Use local anesthetics with caution: Local anesthetic gels or drops for the mouth that contain ingredients such as benzocaine are available at drugstores and can temporarily numb the painful area. However, caution is advised when using these products. Benzocaine can cause a serious condition called methemoglobinemia, which reduces the blood’s ability to carry oxygen. For this reason, the U.S. Food and Drug Administration warns that benzocaine-containing products should not be used in children under 2 years of age and that adults should not use more than the recommended amount. If you decide to use a numbing gel or drop, be sure to apply a small amount to the painful area as directed and never swallow it. Note that the effects of these numbing agents are short-lived and may not be as effective if the pain is severe.
Modify your diet and avoid irritants: It’s best to avoid eating or drinking anything that triggers your toothache until you see your dentist. Very cold or very hot foods and drinks can make the pain worse; Also, sweet or acidic foods (such as chocolate, candy, or soda) may make the condition worse by feeding bacteria in your mouth. Try to eat soft, lukewarm foods that don’t require much chewing (such as lukewarm soup, mashed potatoes, yogurt, scrambled eggs). Also, chew on the opposite side of your mouth as much as possible to put less pressure on the painful tooth. In addition, avoid smoking and tobacco, as smoking can worsen gum inflammation and slow down the healing process. Following these tips will help minimize irritation of the affected tooth and gums and better control the pain.
Other temporary relief methods: Sometimes keeping your head elevated when you lie down can help reduce blood pressure in the head and control toothache at night. So when you sleep at night, keep your head elevated by placing an extra pillow under your head. Some people use herbal remedies or traditional treatments to relieve toothache; for example, cloves, for example, have analgesic and antiseptic properties due to the active ingredient eugenol, and have been used for toothaches since ancient times. Eugenol is still used in modern dentistry as a component of temporary fillings and has a soothing effect. Applying clove oil (or crushed cloves) topically to the painful tooth can reduce pain for a short time, although it may have a pungent taste and care must be taken to avoid irritating the surrounding soft tissue. Some herbal mouthwashes containing anti-inflammatory extracts (such as thyme, which contains carvacrol) can also be effective in providing temporary relief.
In addition to using pain relief strategies, some incorrect actions can worsen toothache or cause complications. Here are some things not to do:
Putting aspirin or painkillers on the tooth or gum: One of the old misconceptions is that putting aspirin on the tooth can relieve pain. The truth is that aspirin and many painkillers only work if swallowed and enter the bloodstream, and putting them topically on the tooth is of no benefit. On the contrary, aspirin is acidic, and direct contact with the gums and oral mucosa can cause chemical burns to the tissue. So never put aspirin, Gelofen, etc. on a painful tooth; instead, take the medicine as directed so that it works through the bloodstream.
Applying warm compresses to the face: While cold compresses are recommended for many toothaches, applying heat (such as a hot water bottle) to the face is not recommended for toothaches. Localized heat can increase blood flow and, if there is an infection, can spread inflammation and even infection. Avoid applying heat to the face, especially if you suspect an abscess or infected swelling, as it may worsen the swelling or spread the infection to nearby areas. Only in cases where the pain is of muscular origin (such as jaw pain or muscle cramps from teeth grinding), can moist heat be used to relieve muscle spasms, after consulting a doctor, and only indirectly (for example, a warm towel on the jaw muscles, not directly on the tooth).
Manipulating a painful tooth or gum: Avoid inserting sharp objects such as pins, wooden skewers, or toothpicks into the cavity of a decayed tooth or gum. This may further damage the soft tissue or pulp of the tooth and spread the infection. If food is stuck between your teeth, only use dental floss properly and avoid digging too much into the painful area. Also, do not try to move a tooth that is loose or painful too much; this can worsen the damage.
Self-medication with antibiotics or other medications: Some people resort to taking antibiotics as soon as they feel a toothache. It should be emphasized that antibiotics are only prescribed by a doctor in cases of bacterial infection, and taking them without a professional diagnosis can lead to microbial resistance and side effects. Also, avoid taking extra doses or combining different painkillers without medical guidance. Excessive use of acetaminophen can damage the liver, and excessive use of ibuprofen or aspirin can damage the digestive tract.
Smoking and alcohol: As mentioned, smoking can worsen the condition of a painful tooth and hinder the healing process. Drinking alcohol is also not the right solution to relieve pain; Some people mistakenly believe that holding strong alcoholic beverages in the mouth will reduce pain, when in fact alcohol can further irritate inflamed tissues and can cause dangerous interactions with painkillers.
In short, you should avoid any unscientific or superstitious measures when dealing with toothache. If a method is not scientifically proven or may be harmful, do not use it and pursue pain relief with safer methods.
Although the above measures can temporarily relieve pain, definitive treatment for toothache is only possible with dental intervention. So when should you definitely see a dentist? The short answer is: As soon as you can, especially if the pain is severe or has lasted more than a day or two. Some important conditions that require immediate attention include:
Pain lasting more than 48 hours: If your toothache has lasted more than a day or two and has not improved despite using the above methods, you should definitely see a dentist. Persistent pain is a sign that the problem has not resolved on its own and requires professional treatment.
Severe and uncontrollable pain: If the pain is so severe that it interferes with daily activities and is not relieved even by taking common painkillers, you should not wait. Severe pain can be a sign of an acute pulpitis or abscess that requires immediate treatment (such as root canal treatment or abscess drainage).
Fever and signs of infection: Fever with toothache, or local signs of infection such as facial or gum swelling, throbbing pain with redness and inflammation of the gums, or foul-smelling, pus-filled discharge from the gums or tooth are all signs of a spreading infection. If you experience these symptoms, you should see a dentist or a dental emergency room without delay. If a tooth infection is left untreated, it can spread to dangerous areas such as the sinuses or throat.
Difficulty opening your mouth, swallowing, or breathing: If the swelling from the infection becomes so severe that it makes it difficult to open your mouth or swallow, it is considered an emergency. Swelling in the floor of the mouth or throat, which may affect your breathing, is especially dangerous. In such cases, you may even need to go to the hospital emergency room (ear, nose, and throat department or emergency medical service). According to medical centers, widespread swelling in the face, around the eyes, or neck along with toothache requires you to call the emergency room and avoid driving in person.
Broken or knocked out tooth due to trauma: If your tooth is broken, cracked, or completely dislodged (expelled) due to an accident, you should see a dentist or emergency dental center as soon as possible. In the case of an impacted tooth, the golden time to put it back in place is about the first half to an hour. Any delay can reduce the chances of success. Therefore, pain caused by dental trauma is also considered an emergency.
In general, any toothache that occurs suddenly, is severe, is accompanied by unusual symptoms, or persists for more than two days should be taken seriously. Even if pain relief is achieved with pain relievers, but the underlying cause (such as decay or a crack) is still present, see your dentist as soon as possible to prevent further pain and more serious complications.
A toothache is an unpleasant experience that often indicates a problem with your oral health. In this article, we have seen that common causes of toothache include decay, pulpitis, cracked teeth, gum disease, and other factors, and each can cause a specific pain pattern. None of the immediate home remedies for toothache are a definitive cure, but they can help control the pain until you can see a dentist. Proper use of safe oral pain relievers, simple measures such as rinsing your mouth with warm salt water, applying cold compresses, and avoiding aggravating factors can all help temporarily reduce pain. On the other hand, unreliable or harmful methods should be avoided; Measures such as placing aspirin on the tooth or applying heat to the swelling are not only not helpful, but may be harmful.
It is important to note that toothaches should not be left untreated. Even if painkillers help, the underlying cause (such as tooth decay or infection) should be treated by a dentist, otherwise the pain will return and the problem will become more severe. Therefore, the general recommendation is to see a dentist as soon as possible after the initial pain is controlled. Also, maintaining good oral hygiene, brushing regularly with fluoride toothpaste, flossing daily, and getting regular dental checkups are the best ways to prevent future toothaches. Remember, prevention is always better than cure. By taking care of your oral health, you can minimize the likelihood of many causes of toothaches (including cavities and gum disease).
Ultimately, toothaches, no matter how severe, can be treated with proper and timely care. The methods mentioned for temporary relief will reduce your suffering and make it possible to control the toothache until the time comes for definitive treatment. By following scientific recommendations and visiting your dentist in a timely manner, you can prevent serious complications and restore health and peace to your mouth and teeth.
American Dental Association, Mayo Clinic, UK Public Health Service (NHS), Centers for Disease Control and Prevention (CDC), and PubMed scientific articles.
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