Toothache

TOOTHACHE

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
  • 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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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
  • Fever is present
  • Face is swollen
  • Tongue is very swollen and tender
  • Severe pain

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

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
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HOME CARE ADVICE

  • 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.
  • Floss: Floss on either side of the painful tooth to remove any wedged food.
  • Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • 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.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  • Local Cold: Apply an ice pack to the painful jaw for 20 minutes
  • Expected Course: Most minor causes of toothache resolve in less than a day.
  • Call Your Doctor 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.

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REFERENCES

  1. Annino DJ Jr, Goguen LA: Pain from the oral cavity. Otolaryngol Clin North Am. 2003; 36(6): 1127-35, vi-vii.
  2. Douglass AB, Douglass JM. Common dental emergencies. Am Fam Physician. 2003;67(3):511-6.
  3. Flynn TR. The swollen face. Severe odontogenic infections. Emerg Med Clin North Am. 2000;18(3):481-519.
  4. Ma M, Lindsell CJ, Jauch ED, Pancioli AM. Effect of education and guidelines for treatment of uncomplicated dental pain on patient provider behavior. Ann Emerg Med. 2004;44(4):323-329.
  5. MacDonald DE. Principles of geriatric dentistry and their application to the older adult with a physical disability. Clin Geriatr Med. 2006; 22(2): 413-34; x.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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