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First aid

Toothache

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Does this describe your symptoms?

Definition
  • Pain or discomfort in a tooth

The main cause of toothache is tooth decay (cavities). Complications of tooth decay can also cause pain. For example, a periapical abscess (pus pocket) can develop around the base of tooth with a cavity.

Dental Causes of Toothache

  • Dental caries (tooth decay): pulpitis, periapical abscess
  • Food stuck between teeth
  • Periodontal disease (gum disease): gingivitis, periodontal abscess, pericoronitis
  • Tooth fracture (broken or cracked tooth)

Other Causes of Toothache

  • Canker sore (aphthous ulcer)
  • Heart attack
  • Ludwig's angina
  • Sinusitis
  • TMJ Syndrome
  • Trigeminal Neuralgia

Complications of Tooth Decay

  • Cellulitis of the cheek
  • Periapical dental abscess
  • Ludwig's Angina: This serious infection is a rapidly progressive cellulitis of the floor of the mouth that usually is a complication of a dental abscess or tooth extraction. The presenting symptoms are fever, a swollen/tender tongue and difficulty swallowing.
  • Submandibular lymphadenitis

Caution: Rarely individuals may have a toothache or jaw pain as the sole symptom of a heart attack. Usually there will be other accompanying symptoms of a heart problem, such as: chest pain, shortness of breath, nausea and/or sweating.


If not, see these topics

When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Very weak (can't stand)
Call Your Dentist or Doctor Now (night or day) If
  • You feel weak or very sick
  • Severe pain and not improved after taking pain medication
  • Fever is present
  • Face is swollen
  • Tongue is very swollen and tender
Call Your Dentist Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • Toothache present longer than 24 hours
  • Brown cavity visible in the painful tooth
  • Red or yellow lump (pus pocket) present at the gum line of the painful tooth
Call Your Dentist During Weekday Office Hours If
  • You have other questions or concerns
Self Care at Home If
  • Mild toothache present less than 24 hours and you don't think you need to be seen
HOME CARE ADVICE FOR MILD TOOTHACHE

  1. Reassurance: Most toothaches are temporary and due to a sensitive tooth. If the pain becomes worse or does not resolve in 24 hours, it could be due to a small cavity.
  2. Floss: Floss on either side of the painful tooth to remove any wedged food.
  3. Pain Medication:
    • For pain relief, take acetaminophen or ibuprofen.
    • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
    • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
    • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • CAUTION: Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  4. Local Cold: Apply an ice pack to the painful jaw for 20 minutes.
  5. Expected Course: Most minor causes of toothache resolve in less than a day.
  6. Call Your Dentist If:
    • Toothache persists longer than 24 hours
    • The toothache becomes worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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