Toothache: causes, symptoms, diagnosis, treatment and prevention

Typical symptoms

Symptoms vary but often include localized throbbing, sharp pain when biting, sensitivity to hot or cold, swollen gums, or a bad taste if an infection is present. Pain that spreads along the jaw, toward the ear, or causes facial swelling may signal a more serious problem. Fever and difficulty opening the mouth suggest systemic involvement and need urgent assessment.

Common causes

• Dental decay: Progressive enamel and dentin breakdown by acids produced from plaque bacteria.
• Infection/abscess: Bacterial invasion of the pulp can form a pocket of pus and intense pain.
• Cracked or fractured tooth: Pain on release of biting pressure or intermittent sharp pain.
• Gum disease and recession: Exposed root surfaces cause sensitivity.
• Trauma: Injury to a tooth or its supporting structures may cause immediate or delayed pain.
• Non-dental sources: Sinusitis, temporomandibular disorders or neuralgia can mimic a toothache.

For basic orientation about where pain originates see tooth anatomy, and for the role of bacteria in decay see plaque and cavities. Injuries and accidents that damage teeth are discussed at dental trauma resources.

Diagnosis

A dentist diagnoses a toothache by medical history, visual exam, percussion and bite tests, and often X-rays. Pulp testing, periodontal probing and sometimes referral for imaging are used to identify the affected tissue and plan treatment. Timely assessment reduces the risk of spreading infection.

Treatment and first aid

• Short-term relief: over-the-counter pain relievers, warm salt-water rinses, and avoiding extreme temperatures or hard foods.
• Definitive dental care: fillings for cavities, root canal treatment for infected pulp, extraction for non-restorable teeth, or periodontal therapy for gum disease.
• Antibiotics are reserved for spreading infections or systemic signs and are used alongside dental procedures—not as a substitute for definitive treatment.

Preventive measures—regular oral hygiene, fluoride use, balanced diet, protective mouthguards for sports, and routine dental check-ups—reduce the likelihood of new toothaches. Seek urgent dental or medical care for severe, rapidly worsening pain, swelling, fever, breathlessness, or difficulty swallowing, as these may indicate a serious infection needing immediate attention.