Description, causes, prevention, treatment and medicines

Toothache is any pain in and around a tooth. The pain of toothache can be a dull ache or a sharp pain. Without treatment most toothache gets worse, so if you have toothache you should visit a dentist to have it diagnosed and treated.

What causes toothache?

Toothache has numerous causes. Most commonly, acid-producing bacteria in the mouth cause dental decay by breaking down fermentable sugars such as glucose, fructose and lactose. The resultant acids then corrode the tooth enamel. The pain of toothache is caused by the exposure of tooth nerve endings.

The tooth will not mend itself. If pain does eventually lessen, the nerve ending may have ‘died’. However the tooth decay will still be present and the tooth will continue decaying unless a dentist treats the tooth. Pain intensifies when there is infection in the surrounding tissues.

Pain may also come from gum disease, cracked teeth and problems with past dental work.


You can help prevent toothache by regular brushing and flossing. Fluoride can help prevent tooth decay. In Australia sufficient fluoride is obtained from fluoride-containing toothpaste and fluoride in the water supply.

Dental floss will help reduce tooth decay by removing food and plaque from the spaces between teeth. It also improves gum health, which is essential to maintaining good teeth. Mouthwashes (antiseptics) temporarily lower the number of bacteria in the saliva, but offer only short-term protection.

The role of saliva in tooth decay

Although good oral hygiene is important, other reasons such as hereditary factors and lack of saliva can also cause tooth decay. Saliva helps prevent tooth decay because it neutralises the acids produced by carbohydrate food breakdown, and its enzymes help clear carbohydrates and bacteria from the mouth. Sugar-free gum stimulates saliva production. Dehydration reduces saliva production.

Sensitive teeth

‘Sensitive teeth’ tends to be a term used for teeth that are painful when exposed to extremes of temperature. The reason is unknown. People with sensitive teeth often have different responses to special toothpastes for sensitive teeth and may have to try a variety of products before they find one that suits them.

Relief from toothache

Temporary pain relief, such as paracetamol or paracetamol plus codeine, may be used until you can see a dentist. However, codeine-containing products may cause constipation and should be used cautiously in people prone to constipation, especially the elderly.

It is preferable not to use aspirin because of the risk of bleeding during dental treatment. However, an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen may be suitable as it has less risk of bleeding than aspirin. NSAIDs should be avoided if you have asthma or a history of stomach problems because they may worsen these problems.

Topical analgesics

Topical analgesics containing benzocaine can be applied to the affected cavity with a cotton wool swab. However, they should not be applied to large areas of damaged gum tissue.

Oil of cloves applied with a cotton wool swab may numb the tooth and ease the pain.

When should you seek immediate dental advice?

You should seek an immediate dental appointment if you have:

  • obvious inflammation, abscess or fever;
  • generally feel unwell;
  • a swollen jaw or face; or
  • injury caused by trauma, such as a blow to the mouth.
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