A throbbing, sharp, or persistent ache in your tooth is one of the clearest signals your body can send: something is wrong and needs attention immediately. Trying to guess the cause of your pain with home remedies can lead to serious complications if the problem is a spreading infection. This guide provides a detailed breakdown of what causes toothache, detailing 12 of the most frequent reasons, so you can quickly understand your symptoms and know precisely when to seek professional help.
Understanding Your Tooth Pain
A toothache is defined as any pain felt in or around a tooth or the supporting jaw structure. The pain originates from the dental pulp, the soft tissue inside the tooth that contains blood vessels and the nerve. When the pulp becomes inflamed or infected, whether from decay, fracture, or trauma, it swells, and the enclosed nerve registers this swelling as pain. It is important to understand that while a toothache signals a problem, most issues can be resolved with timely dental care.
The 12 Common Causes of Toothache
Identifying the exact source of your discomfort is the first step toward effective treatment. The causes can be broadly grouped based on whether the issue is internal (affecting the nerve), external (affecting the surrounding tissues), or a form of referred pain.
1. Dental Decay (Cavities)
This is the most frequent cause. Decay begins when bacteria in the mouth produce acid that slowly erodes the protective enamel. As the cavity deepens, it penetrates the underlying dentin, getting closer to the nerve (Dental Pulp). Once decay is close to the pulp, you may feel pain when consuming sweets, cold air, or hot drinks.
2. Pulpitis (Nerve Inflammation)
This term describes the inflammation of the pulp tissue. When the pulp is mildly irritated, the pain is called Reversible Pulpitis, meaning the inflammation and pain will subside once the cause (like a shallow cavity) is fixed. However, if the inflammation is severe and chronic, it becomes Irreversible Pulpitis, where the pulp tissue is dying. This pain is intense, persistent, and often requires immediate Root Canal Therapy.
3. Tooth Abscess (Periapical Abscess)
An abscess occurs when bacteria from decay or a fracture reach the pulp chamber, killing the nerve and pushing infection down to the tip of the tooth root. This creates a pocket of pus in the jawbone. The result is intense, throbbing pain, often accompanied by swelling of the face or a small pimple on the gum (a fistula). We provide urgent diagnosis and treatment for abscesses, including Root Canal Therapy or Extractions where necessary.
4. Cracked Tooth or Fractured Filling
A crack in the tooth, which may be invisible to the naked eye, can cause pain that is highly intermittent and often sharp, particularly when you bite down or release the bite. This sensation is characteristic of Cracked Tooth Syndrome (CTS), where chewing forces cause the crack to flex and irritate the underlying nerve. Our services include using Crowns and large Restorations to stabilize and protect fractured teeth.
5. Gum Disease (Gingivitis/Periodontitis)
While not typically a sharp toothache, inflammation from severe Periodontitis can cause generalized ache, pain when brushing, and bleeding. The exposed tooth roots resulting from gum recession can also become sensitive. We offer comprehensive Periodontal Care, including Scaling and Root Planing, to manage gum disease.
6. Exposed Tooth Roots (Receding Gums)
If your gums have receded, the exposed root surface is highly porous (Dentin) and sensitive. The sharp, shooting pain when cold air or liquids hit the root is called Dentin Hypersensitivity, a common cause of brief, intense pain. Our team offers treatments for sensitivity and can refer for Gum Grafting where necessary to cover the exposed root.
7. Recent Extraction Sites (Dry Socket)
Pain after a tooth removal is normal, but if the pain increases several days after the procedure and is accompanied by a foul taste, it may signal Dry Socket (Alveolar Osteitis). This occurs when the blood clot protecting the healing bone dissolves prematurely. Post-operative care and treatment for dry socket issues.
8. Food Impaction
A sudden, very sharp pain that occurs after eating is often caused by a piece of food (like meat fibre) being forcefully wedged between two teeth, pressuring the gums and bone. This is often solved by proper flossing, but if it is chronic, it may signal the need for a new filling or crown to close the space.
9. Teeth Grinding (Bruxism) and Clenching
Many people clench or grind their teeth, especially while sleeping, due to stress. This excessive force causes fatigue in the jaw muscles and can result in generalized tooth and jaw soreness, often contributing to Tension Headaches and causing visible wear on the biting surfaces. Custom-fitted Mouthguards and Nightguards to treat Bruxism.
10. Malocclusion (Bad Bite)
If your teeth do not fit together correctly when you bite down (malocclusion), one or two teeth may be subjected to constant, uneven pressure. This can inflame the supporting ligaments around the tooth root, causing persistent discomfort. We can assess your bite and discuss options, including Orthodontics, to correct misalignment.
11. Impacted Wisdom Teeth
Wisdom teeth that are partially erupted or stuck (impacted) can cause a dull ache or sharp pain in the back of the jaw. This often leads to inflammation of the gum tissue covering the tooth, a condition called Pericoronitis, making it difficult and painful to bite down. We offer thorough check-ups and can easily handle necessary Wisdom Teeth Extractions to stop the pain.
12. Sinus Infection (Referred Pain)
The roots of the upper back teeth (molars) are close to the Maxillary Sinus. When the sinus cavity is infected or inflamed (e.g., during a cold or flu), the pressure can be felt as a dull, generalized ache in the upper jaw, making it appear as a toothache. While we don’t treat the sinus infection itself, we can diagnose that the pain is referred to and not dental, saving you an unnecessary dental procedure.
When to See a Dentist Immediately?
While almost all toothaches require a professional examination, certain symptoms indicate a severe infection that could quickly become dangerous if left untreated. Knowing these warning signs is crucial, as they signal a dental emergency requiring same-day care.
Signs That Indicate a Dental Emergency
You should contact St Leonards Dental immediately if you experience any of the following symptoms:
- Swelling: Any swelling of the jaw, face, or neck. This is the most serious sign, as it means the bacterial infection from the tooth has spread into the surrounding soft tissues and potentially toward the airway or brain.
- Fever: A toothache accompanied by a fever or general malaise indicates a spreading systemic infection.
- Severe, Throbbing Pain: Pain that is so intense it prevents you from sleeping, does not improve significantly with over-the-counter medication, or is accompanied by a foul taste.
- Trauma: If you have a knocked-out tooth, a major chip, or sustained any facial injury that has affected your teeth.
- Difficulty Breathing or Swallowing: This is a life-threatening symptom resulting from deep, severe infection and requires immediate emergency medical attention.
What to Do While Waiting for Your Appointment
If you have a toothache but are waiting for your urgent appointment, taking simple steps can help manage the pain and prevent the situation from worsening:
- Pain Relief: Use over-the-counter anti-inflammatories, such as Ibuprofen, as directed on the packaging, as these can help reduce the swelling around the nerve.
- Cold Compress: Apply a cold compress or an ice pack wrapped in a cloth externally to the cheek for 15-minute intervals to help reduce swelling and temporarily dull the pain.
- Rinsing: Gently rinse your mouth with warm salt water several times a day to help clean the area and reduce inflammation.
- Avoidance: Never place aspirin directly on the gum tissue or tooth, as the acidity can cause a severe chemical burn without providing effective pain relief.
Professional Diagnosis and Treatment
A toothache cannot be properly diagnosed over the phone or at home. A dentist uses specialized tools and knowledge to pinpoint the exact source of the pain, which is essential because treating the symptom (the pain) without treating the cause (the infection) will only lead to greater problems later.
How a Dentist Determines the Cause of Pain
The diagnostic process is methodical to ensure the correct treatment path is chosen. It starts with a clinical examination, where the dentist will carefully review your symptoms. They use diagnostic tests, such as the Percussion Test (gently tapping the tooth to check for sensitivity in the ligament) and the Pulp Vitality Test (using cold or heat to assess the health of the nerve).
Crucially, Digital X-rays are taken to visualize the tooth root, bone level, and check for deep decay or abscesses that are invisible above the gum line. This helps differentiate a local issue from Referred Pain.
Common Professional Treatments
The treatment selected depends entirely on the cause determined by the diagnosis:
| Cause of Pain | Treatment Option |
| Simple Decay (Cavity) | Restorations (Fillings, or potentially Inlays/Onlays) |
| Irreversible Pulpitis or Abscess | Endodontic Treatment (Root Canal Therapy – RCT) to remove the infected nerve |
| Severe Fracture or Decay | Extractions (Tooth removal), followed by replacement options like implants |
| Large, Weakened Filling | Crowns (Protective caps) to cover and stabilize the tooth structure |
| Impaction or Gum Disease | Scaling and Root Planing or surgical removal of the offending tooth |
Frequently Asked Questions
Why Does My Tooth Only Hurt When I Lie Down?
If your toothache feels worse when you are lying down or sleeping, this is often a key indicator of internal nerve inflammation (Pulpitis). When you lie down, the blood pressure in your head increases. This increased pressure pushes against the already swollen and inflamed nerve tissue inside the rigid structure of the tooth, intensifying the pain and making it harder to ignore than when you are upright.
Can Stress Really Cause My Teeth to Ache?
Yes, stress is a major contributor to dental discomfort. Stress commonly leads to parafunctional habits like Teeth Clenching and Grinding (Bruxism). This constant, unconscious pressure strains the jaw joints (TMJ) and the ligaments holding the teeth in place. The resulting pain is often a dull ache, felt most strongly in the mornings, and can be mistakenly attributed to a cavity when it is actually muscle and ligament strain.
Is Tooth Sensitivity the Same as a Toothache?
No, they are different. Tooth sensitivity is typically a sharp, brief pain that occurs only when an external trigger (like cold air or sweets) is present, usually caused by exposed root surfaces or minor enamel wear. A true toothache is generally a longer, deeper, and often spontaneous pain that persists after the trigger is removed, signaling significant inflammation or infection within the tooth’s nerve tissue.
What is the Most Common Cause of Severe Tooth Pain?
The most common cause of severe, debilitating tooth pain is Irreversible Pulpitis, where the tooth’s nerve is dying or infected, requiring definitive treatment. This happens when bacteria have penetrated deep into the tooth, causing intense inflammation that the nerve cannot recover from.
Conclusion
A toothache is not something that should be endured or treated only with temporary painkillers. It is a critical warning signal that your dental health is compromised and will rarely resolve on its own. Ignoring the pain allows the infection to deepen, increasing the likelihood that you will require more drastic and complex treatments later, such as tooth extraction or advanced surgical intervention.
If you are experiencing any of the 12 causes of toothache, especially if accompanied by swelling or fever, it is vital to seek professional care promptly. We offer comprehensive dental care, including Emergency Dental Care when required.
If you are experiencing tooth pain, do not delay, contact St Leonards Dental today to schedule an urgent consultation and get the professional diagnosis and relief you need.
