What should I do if I have tooth pain?

What to Do for Tooth Pain

If you have tooth pain, seek dental care promptly, as the majority of acute tooth pain originates from dental pathology (decay, infection, or periodontal disease) that requires definitive dental treatment. 1

Immediate Assessment: Rule Out Emergencies First

Before assuming your pain is simply a cavity or infection, certain red flags require urgent evaluation:

• If you are over 50 years old with jaw pain, especially with jaw claudication (pain with chewing), temple tenderness, scalp tenderness, visual changes, fever, or malaise, you need immediate blood work (ESR and CRP) within hours to rule out giant cell arteritis, which can cause irreversible vision loss if untreated 2, 3, 4
• Giant cell arteritis requires high-dose corticosteroids (minimum 40 mg prednisone daily) immediately—do not delay treatment while awaiting further testing 3

When to See a Dentist Urgently

Most tooth pain requires dental evaluation. Seek dental care within 24-48 hours if you have: 1

• Sharp pain with hot, cold, or sweet foods (suggests pulpal inflammation or decay) 1
• Throbbing, pulsatile pain that worsens when lying down (suggests dental abscess) 1
• Visible tooth decay, broken tooth, or swelling of the gums or face 1
• Pain localized to a specific tooth that you can point to 1
• Recent dental trauma (see pediatric guidelines for specific trauma management) 1

Dental causes include: tooth decay (caries), pulpitis (inflamed tooth nerve), dental abscess, periodontal disease, cracked teeth, and post-dental procedure complications 1

Initial Self-Care While Awaiting Dental Appointment

• Ibuprofen is effective for dental pain relief—take 400-800 mg every 6-8 hours with food (do not exceed 2400 mg daily) 5
• Avoid ibuprofen if you have: history of stomach ulcers, kidney disease, heart failure, are pregnant (especially after 20 weeks), or take blood thinners 5
• Avoid chewing on the affected side and stick to soft foods 2
• Maintain oral hygiene but brush gently around the painful area 1

When Tooth Pain May NOT Be Dental

Critical warning signs that your "toothache" may not be tooth-related: 6, 7, 8

• Pain persists despite appropriate dental treatment (fillings, root canals, or extractions) 6, 9
• No visible dental pathology on examination or X-rays to explain the pain 8
• Pain described as burning, tingling, or electric shock-like rather than throbbing 1, 6
• Pain is constant and unremitting for months without variation 8
• Multiple teeth hurt simultaneously without clear dental cause 8
• Local anesthetic injection to the tooth does not eliminate the pain 8

Non-Dental Causes Requiring Different Treatment

Temporomandibular Disorder (TMD) is the most common non-dental cause of chronic facial pain (5-12% of population): 1, 2, 4

• Pain in jaw muscles (masseter, temporalis) that worsens with chewing, clenching, or jaw movement 1
• May have jaw clicking, limited mouth opening, or ear pain 1, 2
• Treatment: jaw rest, soft diet, avoid gum chewing, physiotherapy, nighttime mouth guard from dentist, and addressing stress/anxiety 1, 2, 4

Trigeminal Neuralgia presents as: 1, 3

• Sudden, severe, electric shock-like pain lasting seconds to minutes 1, 3
• Triggered by light touch, eating, brushing teeth, cold wind, or washing face 1, 3
• Pain-free intervals between attacks 3
• Requires MRI to rule out tumors or multiple sclerosis, and treatment with anticonvulsants (carbamazepine first-line) 1

Post-Traumatic Trigeminal Neuropathic Pain (after dental procedures, extractions, implants, or facial trauma): 1, 6

• Continuous burning, tingling, or aching pain in tooth/jaw area 1, 6
• Starts within 3-6 months of dental procedure or injury 1
• May have altered sensation (numbness, hypersensitivity) in the area 1, 6
• Treatment: gabapentin (starting 300 mg at night, titrating to 900-3600 mg daily in divided doses) or tricyclic antidepressants 1, 2, 6

Maxillary Sinusitis can mimic upper tooth pain: 1

• Pain in upper back teeth (premolars/molars) that worsens when bending forward 1
• Nasal congestion, facial pressure, or nasal discharge 1
• Multiple upper teeth hurt simultaneously 1

Salivary Gland Disorders (stones or infection): 1, 3, 4

• Pain in jaw angle that occurs just before or during eating 1, 3, 4
• Tender, swollen gland under jaw or in front of ear 3, 4
• Requires ultrasound imaging and possible referral to oral/maxillofacial surgery 3, 4

When to Seek Specialist Referral

Refer to oral/maxillofacial surgeon, neurologist, or pain specialist if: 2, 4

• Pain persists after appropriate dental treatment 6, 9
• Suspected neuropathic pain (burning, electric, triggered by light touch) 1, 2
• Progressive pain with palpable mass (concern for malignancy—refer within 1-2 weeks) 2, 4
• Psychological factors (depression, anxiety, catastrophizing) are prominent and affecting quality of life 1, 2

Common Pitfalls to Avoid

• Do not undergo multiple dental procedures (root canals, extractions) without clear evidence of dental pathology on examination and imaging 6, 7, 9
• Up to one-third of chronic facial pain patients have had unnecessary irreversible dental procedures before correct diagnosis 6
• Do not assume all jaw/tooth pain in patients over 50 is dental—always consider giant cell arteritis first 2, 3, 4
• Persistent pain after dental treatment warrants reassessment for non-dental causes, not more dental procedures 6, 9
• Psychological comorbidities (depression, anxiety) significantly increase chronicity risk and must be addressed 1, 2, 4