Tooth pain that throbs, keeps you awake or makes it hard to eat can feel overwhelming. A severe toothache usually means something inside or around the tooth needs a dentist’s attention, so it is worth acting early rather than waiting. This guide explains the common causes, the warning signs that need urgent care, and what you can do to ease the pain in the meantime.
Of course, not every ache is an emergency. However, strong or lasting pain rarely settles on its own, because the cause is often decay, infection or a crack. Therefore, knowing what your symptoms may mean can help you decide how quickly to call.
What Causes a Severe Toothache?
Most strong tooth pain comes from inflammation or infection in the nerve, or from damage that exposes the inner layers of the tooth. In addition, gum problems and wisdom teeth can cause pain that feels as if it comes from a tooth. The sections below cover the most common causes.
Deep Tooth Decay
First, decay slowly eats through the hard outer enamel and into the softer dentine below. At first, you may only notice twinges with sweet, hot or cold food. As the decay gets closer to the nerve, however, the pain often becomes sharper and lasts longer.
Inflamed Tooth Nerve (Pulpitis)
To begin with, the pulp is the soft centre of the tooth that holds the nerve and blood supply. When decay, a crack or an old deep filling irritates it, the pulp can swell inside its hard shell. As a result, you may feel a throbbing toothache that lingers after a hot drink or flares up when you lie down.
In the early stages, your dentist may calm the nerve with a filling. Once the inflammation goes too far, though, the nerve may not recover. In that case, root canal treatment or removing the tooth may become the main options.
Dental Abscess
Simply put, an abscess is a pocket of pus caused by a bacterial infection. It can form at the tip of the root or in the gum beside the tooth. Typical signs include constant, intense pain, a bad taste, tenderness when you bite, and swelling in the gum or face. Because an abscess will not clear up without treatment, it needs a dentist promptly. The NHS guidance on dental abscesses describes the symptoms in more detail.
Cracked or Broken Tooth
Similarly, a crack can let bacteria and temperature changes reach the nerve. For example, you may feel a sharp pain when you bite down and then release. Some cracks are too small to see, so your dentist may need to test the tooth and take an X-ray to find them.
Wisdom Teeth and Gum Problems
In some cases, a wisdom tooth that only partly breaks through can trap food under the gum. Consequently, the gum may become sore, swollen and infected, and the pain can spread to your jaw or ear. Similarly, advanced gum disease can cause deep, aching pain and loose teeth.
Pain That Is Not From a Tooth
Occasionally, the problem lies elsewhere. Sinus infections, for instance, can make the upper back teeth ache. Meanwhile, clenching or grinding at night can leave several teeth and the jaw muscles sore. Your dentist can check these possibilities during the examination.
Signs Your Tooth Pain Needs Urgent Care
As a rule, call a dentist soon if a severe toothache lasts more than two days or keeps returning. In particular, the following signs suggest that you should not wait for a routine check-up.
- Pain that wakes you at night or stops you eating
- Throbbing pain that painkillers barely touch
- Swelling in the gum, cheek or jaw
- A bad taste, pus or a raised spot on the gum
- Fever or feeling generally unwell alongside the pain
- Pain after a knock, or a tooth that feels loose or broken
The table below gives a simple guide to how quickly different symptoms usually need attention. Even so, every case is different, so phone for advice if you are unsure.
| Symptom | Possible Cause | How Soon to Act |
|---|---|---|
| Brief twinge with cold or sweet food | Sensitivity or early decay | Mention it at your next routine visit |
| Lingering pain after hot or cold drinks | Inflamed nerve (pulpitis) | Call a dentist within a few days |
| Constant throbbing pain, worse when lying down | Advanced pulpitis or abscess | Call a dentist promptly |
| Pain with gum or face swelling | Dental abscess | Call a dentist the same day |
| Swelling affecting breathing, swallowing or the eye | Spreading infection | Call 999 or go to A&E straight away |
When to Go to A&E or Call NHS 111
A dentist is the right person for most tooth pain. However, some symptoms mean an infection may be spreading, and these need medical help first. Go to A&E or call 999 if you notice any of the following.
- Swelling in the mouth, face or neck that makes it hard to breathe, swallow or talk
- Swelling that spreads to your eye or makes it hard to open your eye
- A high temperature with a fast heartbeat, or you feel very unwell
- Heavy bleeding that will not stop with firm pressure
If you cannot reach a dentist and the pain is getting worse, NHS 111 can tell you where to get urgent dental care. In addition, the NHS toothache advice lists the symptoms that need urgent help.
How to Ease Tooth Pain Until Your Appointment
In the meantime, home measures can make you more comfortable for a short time. Nevertheless, they do not treat the cause, so still book a dental visit.
- Take paracetamol or ibuprofen as the packet directs, unless a pharmacist or doctor has told you not to
- Never place an aspirin tablet on the gum, because it can burn the soft tissue
- Rinse gently with warm salt water if you are an adult
- Choose soft, lukewarm food and chew on the other side
- Avoid very hot, cold or sugary food and drinks
- Prop your head up on an extra pillow at night, as this may ease throbbing
Above all, ask a pharmacist for advice if you take other medicines or have a health condition. Also, if you find yourself needing painkillers for more than a couple of days, take that as a clear sign to see a dentist.
What Your Dentist Does at an Emergency Visit
At an urgent appointment, your dentist aims to find the cause and relieve the pain. Then they explain your longer-term options, so you can make a decision without pressure.
Examination and X-rays
First, your dentist asks about your symptoms, such as when the pain started and what makes it worse. Next, the clinician checks the tooth and gums and may tap the tooth or test it with cold. Finally, an X-ray helps your dentist see decay, infection at the root tip or bone changes that the eye cannot see.
Treatment Options
Overall, the right treatment depends on the cause and on how much healthy tooth remains. For example, your dentist may:
- Remove decay and place a filling if the nerve can still recover
- Start root canal treatment to remove an inflamed or infected nerve
- Drain an abscess to release pressure and ease the pain
- Protect a cracked tooth, often with a crown later on
- Remove the tooth if saving it is not possible
However, antibiotics do not cure toothache on their own. Instead, dentists usually prescribe them only when an infection is spreading or you feel unwell. For a weakened or cracked tooth, our guide to dental crowns explains how a crown can protect it. Likewise, if your dentist has to remove a tooth, a single dental implant is one way to fill the gap once the area heals.
Getting Help for a Severe Toothache in Islington
If you have a severe toothache near Islington, phone Digismile Group first. During the call, the clinic asks about your symptoms and decides how soon you need to come in. For most urgent problems, the clinic can typically offer an appointment within a week.
For very urgent cases, such as pain with swelling, an appointment in the same week may be possible. However, this depends on your symptoms and on availability, so it is always a conversation rather than a set promise. At the visit, Dr Ilhan examines the tooth personally and talks you through each option. Afterwards, you receive a personalised quote at consultation for any further treatment.
To learn more, read our guide to what counts as a dental emergency. If an injury caused the pain, our knocked-out tooth guide covers what to do next. You can also see how urgent visits work in our emergency dentist in Islington article, or visit the emergency dentist page. Digismile Group is at 92 Essex Rd, London N1 8LU.
Frequently Asked Questions
When is tooth pain an emergency?
Tooth pain needs urgent care if it is intense, lasts more than two days, keeps you awake, or comes with swelling or fever. If swelling affects your breathing, swallowing or eye, go to A&E.
Can a toothache go away on its own?
At times, mild sensitivity settles. However, strong pain usually has a cause such as decay or infection, and that cause needs a dentist to treat it.
Why does my toothache get worse at night?
When you lie down, more blood flows to your head, which can increase pressure around an inflamed nerve. In addition, you have fewer distractions at night, so you notice the pain more.
Will I need root canal treatment?
Not always. A filling may be enough if the nerve can recover. By contrast, an infected or badly inflamed nerve often needs root canal treatment or removal of the tooth.
Should I go to A&E for toothache?
Usually not. A&E is for serious symptoms, such as swelling that affects breathing, swallowing or your eye. For other tooth pain, call a dentist or NHS 111.
Disclaimer: This article is for general information only and does not replace professional dental or medical advice. Every case is different, so please contact a qualified dentist for an assessment of your own situation. In a medical emergency, call 999 or go to A&E.
