Ouch! The pain of a toothache is never fun, but sometimes the biggest concern is whether or not it could be something serious. Before going into panic mode, let’s go over some reasons your tooth could be hurting, and when it’s necessary to contact a dentist. 

Most Common Tooth Pain Causes

When people complain of a toothache, it is often because of:

Trauma. After being hit in the mouth, tooth pain can show up right away or days later. Not only do swelling and inflammation cause pain around an injured tooth, but if it’s cracked, chipped, or loose, patients are likely to experience severe pain as bacteria makes its way into the tooth. A dentist should examine the teeth after oral trauma to determine if treatment is needed. 

Gingivitis (early gum disease). When plaque and bacteria are left on teeth, they make their way into the gums, causing inflammation. As gum disease progresses, the gums start to pull away from the teeth, exposing nerves that can cause sensitivity and pain. Gingivitis is reversible with proper oral hygiene, particularly focusing on brushing along the gum line to reduce harmful buildup. However, if tooth pain and sensitivity persist, it’s time to see a dentist.

Teeth grinding. People who grind their teeth at night often wake up with tooth pain and a sore jaw because grinding puts pressure on these areas. If grinding or clenching is severe enough, it can cause small chips in the teeth that expose the nerves, causing more pain. Some patients find relief from using a mouth guard that prevents grinding, or by taking muscle relaxers temporarily to stop jaw muscles from clenching. Severe cases may lead to problems with the temporamandibular joints (TMJ) in the jaw, which can limit range of motion while chewing, so it’s worth it to see a dentist if conservative efforts don’t help. 

A cracked, loose, or missing filling. Grinding the teeth or biting down on something hard can cause a filling to crack or fall out. This can be very painful as food particles get stuck in the crack or vacant hole. It can even cause sensitivity to hot or cold beverages as the liquid passes over exposed nerves. Some patients can actually see a hole where the filling was or a dark spot on the filling where it’s cracked or chipped, but it often requires a dentist’s trained eye to determine the cause of pain.  

A damaged crown. While crowns made of resin and porcelain are strong, they’re not indestructible. It’s not uncommon for a crown to chip, crack, or become loose from biting down on something hard, and sometimes they can simply weaken and erode with age. If a crown is damaged, it’s not able to protect the tooth as it should and will become very painful if bacteria makes its way in. 

Sinus infection. Because the sinuses are just above the back teeth in the upper jaw, sinusitis is one of the most common tooth pain causes. When sinus tissue becomes inflamed, it pushes into the roots of those teeth, which feels like painful pressure. If patients have other symptoms of a sinus infection such as a stuffy nose, nasal drainage, and pressure in the face, treatment for sinusitis may take away the tooth pain, too.  

What Does a Cavity Feel Like?

A cavity can definitely cause tooth pain, but it depends on how advanced the decay is. In its early stage as the enamel begins to weaken, a cavity may cause mild sensitivity when eating or drinking hot or cold things.  

As decay progresses, it penetrates through the enamel deeper into the softer dentin layer. This is when patients are likely to experience moderate sensitivity to temperature, and even a painful zing when eating sugary foods. 

Left untreated even longer, a cavity allows bacteria into the pulp or innermost layer of the tooth, which contains nerves and blood vessels. This is when patients are likely to feel extreme pain when biting or chewing. Redness and swelling in the gums are likely to form around your tooth as infection settles in.

Once the pulp is infected or abscessed, it causes tooth pain that is severe, as well as pain in the jaw or face. A pocket of pus forms near the tooth root which can send toxic material throughout the bloodstream — leading to a general feeling of unwellness as infection settles in. 

At this point, patients often ask “Do I need a root canal?” In many cases, that is the best option to save the tooth and relieve pain. During a root canal, the dentist removes the infected pulp from inside the tooth and seals the tooth with a cap or crown to prevent further damage

When to See a Dentist for Tooth Pain

For some tooth pain, conservative treatments at home such as ibuprofen can work, since it reduces the inflammation that causes tooth pain. Swishing with saltwater might also help by drawing out debris that’s stuck in teeth, and dissolving bacteria in the mouth. 

But if you are experiencing any of the following symptoms, it’s time to call a dentist:

Sharp, throbbing pain that doesn’t go away. If a tooth hurts for more than a day or two and isn’t relieved by ibuprofen, there is likely something irritating the nerve inside your tooth. This could be a cavity, an infection, or inflammation.   

Pain when chewing. Chewing can put pressure on a cracked tooth. It could also mean a filling or crown has become loose. Without treatment, a cracked tooth can split, which is even more painful, and a displaced filling or crown could allow bacteria into the tooth — leading to an infection. 

Persistent sensitivity to hot or cold. Mild temperature sensitivity sometimes goes away, but if that “zing” feeling lingers long after eating or drinking, it could signify tooth decay, gum disease, or that the tooth’s protective enamel is worn down.

A pimple-like blister on the gums. This indicates a dental abscess, which means the pulp of the tooth is infected. Without prompt treatment, the infection can make its way into the bloodstream and eventually affect other organs.

Swelling in the jaw, gums, or face. If a dental abscess goes untreated, it can lead to throbbing pain, a fever, and a swollen cheek or jaw. Because an abscess is potentially life-threatening, it’s important to see a dentist immediately.