Community Health Network

Toothache
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Symptom
Description

Should I
Call?

Care at
Home

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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

Toothache followed TOOTH INJURY

Should I
Call?

Care at
Home

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

Symptom
Description

Care at
Home

HOME CARE ADVICE FOR MILD TOOTHACHE

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.
Floss: Floss on either side of the painful tooth to remove any wedged food.
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.
Local Cold: Apply an ice pack to the painful jaw for 20 minutes.
Expected Course: Most minor causes of toothache resolve in less than a day.
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.

Symptom
Description

Should I
Call?

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