Toothache, Why It Hurts and What To Do About It

What Toothache Is

Toothache is a symptom, pain in or around a tooth, not a diagnosis. The pain pattern (sharp vs dull, brief vs lingering, provoked vs spontaneous, localised vs diffuse) tells you what is causing it. The most common causes are dental decay (caries), inflamed pulp (pulpitis), tooth abscess, cracked tooth, dentine hypersensitivity, post-restoration sensitivity, and impacted wisdom teeth. Less common causes include sinus pain referred to upper teeth, temporomandibular joint dysfunction referred to teeth, atypical odontalgia (chronic neuropathic pain), and rarely cardiac pain referred to the lower jaw.

The decision tree we run on toothache presentation begins with severity and pattern, identifies the likely cause, and routes treatment accordingly. There is no single treatment for "toothache", every cause has its own treatment, and treating the wrong cause will fail predictably.

The Common Causes in Detail

1. Caries (Dental Decay)

The most common single cause. Bacterial breakdown of tooth structure creates a cavitated lesion; as the lesion deepens, it approaches the pulp. Early caries: sensitivity to sweet foods. Deeper caries: sensitivity to cold. Caries reaching pulp: pulpitis.

Treatment: filling (composite, glass-ionomer, amalgam) for shallow-to-moderate; root canal or extraction for caries reaching pulp.

2. Pulpitis

Inflammation of the dental pulp. Two clinical categories:

• Reversible pulpitis, sharp pain to cold, brief duration, settles when stimulus removed. Pulp can recover if the cause (typically caries) is treated.
• Irreversible pulpitis, sharp pain that lingers after stimulus, spontaneous pain, often worse at night when lying down. Pulp cannot recover; root canal or extraction is required.

3. Tooth Abscess

A localised collection of pus from bacterial infection at the apex of a non-vital tooth (periapical), in a periodontal pocket (periodontal), or under the operculum of a partially-erupted tooth (pericoronal). Pain pattern: throbbing, intense, often worse at night, may be accompanied by swelling and a "tooth feels lifted" sensation. See Tooth Abscess page for full diagnostic and treatment detail.

4. Cracked Tooth Syndrome

A fracture in enamel and dentine that may not be visible. Pain pattern: sharp pain on biting at one specific tooth, often relieved when biting pressure is released. Diagnosis by tactile fracture test, transillumination, and (sometimes) staining of the fracture line.

Treatment: crown to splint the cracked tooth (full coverage prevents further crack propagation), with or without prior root canal depending on whether the crack reaches the pulp. Cracks below the gum line have hopeless prognosis and the tooth is extracted.

5. Dentine Hypersensitivity

Sharp, brief pain to thermal/sweet/acid stimuli where no other dental disease is present. Cause: exposed dentine (gum recession, enamel erosion, abrasion). See Tooth Sensitivity page.

6. Post-Restoration Sensitivity

Sensitivity in the days/weeks after a filling, crown, scaling, or root canal. Usually transient (resolves in 2-4 weeks). Persistent sensitivity beyond 4 weeks warrants reassessment.

7. Pericoronitis

Inflammation around the partially-erupted wisdom tooth. Typical pattern: pain at the back of the lower jaw, radiating to the ear or down the throat. Often recurs in cycles. Treatment: drainage and irrigation, antimicrobial mouthrinse, decision on operculectomy vs extraction of the wisdom tooth.

8. Sinus-Origin Pain

The roots of upper posterior teeth sit very close to the floor of the maxillary sinus. Sinusitis can present as pain in upper molars and premolars, typically multiple teeth at once, accompanied by nasal congestion or sinus tenderness on palpation. Cold tests on the affected teeth will be normal (vital pulps). Treatment: address the sinusitis (GP or ENT referral); the dental "pain" resolves when the sinusitis does.

When To See Whom

What To Do Before Your Appointment

• Take paracetamol or ibuprofen as directed on the packaging (combination of both is evidence-supported for dental pain and is more effective than either alone).
• Apply a cold compress to the cheek if there is swelling.
• Avoid heat to the affected area (heat can accelerate spread of infection).
• Avoid chewing on the affected side.
• If a clove-oil home remedy is at hand it is harmless on intact gum but should not delay professional assessment.
• Do NOT place an aspirin tablet against the gum (causes chemical burn).
• Do NOT delay assessment if the pain is severe, spontaneous, lingering, or accompanied by swelling/fever.

Diagnosis at the Clinic Visit

The diagnostic work-up:

• Focused dental history, pain onset, character, duration, factors that aggravate or relieve, medications, recent dental work.
• Clinical examination, tooth identification, percussion test, palpation, tooth mobility, occlusion check, soft-tissue assessment, sinus palpation if indicated, jaw-joint examination if indicated.
• Pulp testing, cold test, electric pulp test, to determine vitality of the suspect tooth and adjacent teeth.
• Imaging, periapical radiograph at the suspect tooth; bitewing radiograph for adjacent teeth; CBCT if cracked-tooth or unusual anatomy is suspected.
• Differential reasoning documented in the consultation note.

What Treatment Looks Like, Cause by Cause

EMI options on RCT-and-crown packages and on full-mouth treatment plans.

Prognosis

Treatment-cause-matched: 95%+ resolution of toothache. Untreated toothache: typically progresses; the underlying cause does not resolve spontaneously in most cases. Untreated pulpitis becomes pulp necrosis becomes abscess becomes (rarely) systemic infection. Untreated cracked teeth typically split further and become unsalvageable.

What We Do at Stunning Dentistry for Toothache

The toothache pathway is triaged at first contact (in-clinic, phone, or WhatsApp). Acute presentations are scheduled same-day; routine presentations within the appropriate window. The diagnostic work-up is documented in the consultation note; the treatment plan is presented with the cause-and-rationale framing before any irreversible work begins. Endodontic treatment is performed under microscope by Dr. Vivek Menon (Lead Endodontist); restorative work by Dr. Aditya Verma; surgical extractions and impacted-tooth cases by Dr. Ravi Sharma.

Lead Clinicians On Your Case

The named bench you are paired with on day one of diagnosis:

• Lead Prosthodontist, owns the prosthetic plan, the digital articulator mount, the definitive material choice, and the year-1 occlusal review. Signs every case decision.
• Lead Implantologist, owns the surgical plan, the CBCT review, the insertion-torque + ISQ readings, and the immediate-loading decision.
• Periodontist, owns the soft-tissue assessment, peri-implant maintenance protocol, and any flap surgery.
• Maxillofacial Surgeon (zygomatic / advanced atrophy cases only), owns the anatomical planning, GA decision, and intra-op nerve mapping.

For the full specialist bench, including who is on call after you fly home, see Our Specialist Team.

Related Conditions

• Tooth Abscess
• Tooth Sensitivity
• Bleeding Gums
• Periodontal Disease
• Bruxism