Toothache: what you can do at home and when it's an emergency

The most common causes of toothache, what really helps until you see a dentist, what not to do and the warning signs that can't wait.

Why a tooth hurts

Pain is a signal that something has reached the nerve of the tooth or the tissues around it. The way it hurts already tells you a lot about the cause:

• Brief pain with cold or sweet things that goes away within seconds once the trigger is removed: usually a cavity, or a tooth neck left exposed after the gum has receded.
• Throbbing pain that comes on by itself and wakes you at night, or that lasts for minutes after a cold drink: the nerve is inflamed (pulpitis). Without treatment, it won't go away on its own.
• Pain when biting, a tooth that feels “too high”, swelling of the gum or cheek: an infection at the tip of the root, in other words an abscess.
• Sharp pain only when you bite on a particular spot, which goes away when you release your bite: a crack in the tooth.
• Pain and swelling behind the last tooth, with a bad taste and difficulty opening your mouth: infected gum around a wisdom tooth.
• Diffuse pain in several upper back teeth that gets worse when you bend forward: sometimes it isn't the tooth but your sinus.

Toothache can spread to the ear, the temple or the opposite jaw, and sometimes it is hard to tell which tooth hurts. Don't worry: an X-ray and a few simple tests will show the source.

What helps until you get to the dentist

• Take an ordinary anti-inflammatory such as ibuprofen, if you have no contraindications, or paracetamol. Stick to the doses on the leaflet and don't exceed them, even if the pain doesn't go away completely.
• Rinse with warm salt water, one teaspoon to a glass, several times a day.
• Gently clean the area with dental floss: sometimes the pain comes from a bit of food stuck between the teeth.
• If there is swelling, hold a cold compress against your cheek, 15 minutes at a time with breaks in between.
• Sleep with your head raised; throbbing pain gets worse when you lie flat.
• Avoid very cold, hot or sweet foods and chew on the other side.
• If a filling has fallen out or a piece of tooth has broken off, cover the area with temporary filling material from the pharmacy, so food can't get in.

What not to do

• Don't put aspirin or other tablets directly on the gum: they cause chemical burns to the lining of the mouth without easing the tooth.
• Don't apply heat to your cheek: a warm compress can make the infection spread faster.
• Don't hold alcohol on the tooth, and don't try internet “remedies” with garlic or cloves placed directly on the gum; they can irritate or burn the lining of your mouth.
• Don't take antibiotics without a prescription. They don't treat the cause, they can mask the symptoms for a few days, and then the infection comes back.
• Don't try to “open” an abscess yourself.
• Don't wait for it to pass. When the nerve of a tooth dies, the pain may disappear, but the infection carries on in the bone and comes back later as an abscess, usually at the worst possible moment.

Pain after recent treatment

Mild sensitivity to cold or to biting in the first few days after a large filling, root canal treatment or an extraction is normal and eases from one day to the next. If, after a filling, you feel that the tooth touches first when you close your mouth, the filling is slightly too high: it can be adjusted in a few minutes, without anaesthetic. Call us if the pain gets worse instead of better, if swelling appears or if, after an extraction, strong pain comes back on the third or fourth day.

When it's an emergency

Call us the same day if you have: swelling of the face, the gum or under the jaw, a fever, difficulty opening your mouth, bleeding that doesn't stop after 30 minutes of pressure with a gauze pad, a tooth that has been knocked, is loose or has come out of its socket, or severe pain that painkillers don't help.

If the swelling grows quickly or spreads towards your eye or neck, or if you have difficulty swallowing or breathing, don't wait for a dental appointment: call 112 or go straight to the nearest hospital emergency department. Dental infections that spread can become dangerous.

A permanent tooth knocked out by a blow can sometimes be put back: hold it by the crown, don't rub it, put it in milk and come in as quickly as you can, ideally within the first hour.

What happens at an emergency visit

The first priority is to stop the pain. The dentist examines the tooth, takes an X-ray and decides what needs to be done there and then: opening the tooth and treating the nerve, draining the abscess, temporarily rebuilding a broken tooth or re-cementing a crown that has come off. The laser helps us sterilise the infected area and work with less anaesthetic. Emergency dental treatment costs 350 lei, or 450 lei for more complex cases.

Once the pain has stopped, we draw up a full plan with written prices, so the problem doesn't come back: completing the root canal treatment, a permanent filling or a crown, as needed.

How to avoid the next emergency

Most emergencies are old cavities that have been neglected for months or years. A check-up with a professional cleaning every 6 months catches the problem while it still needs only a small filling, not a root canal treatment and a crown, which cost several times as much. If a tooth “makes itself felt” now and then with cold or sweet things, book an appointment now, not when it really starts to hurt. If you grind your teeth at night, a night guard prevents cracks, and for contact sports a sports mouthguard protects your front teeth.

Frequently asked questions