Understanding Toothache
Toothache is one of the most common reasons for an emergency dental visit. Find out about the different types of tooth pain, why antibiotics will not cure toothache, and what to do.
Urgent help: who to contact
Call 999 or go to A&E now if you find it hard to breathe, speak, swallow or open your mouth, have a lot of swelling in your mouth or swelling spreading to your neck, have a swollen or painful eye or sudden problems with your eyesight, or feel very unwell with a high temperature. These are signs of a serious infection that is spreading.
If you have toothache or a swollen face without these signs, ask for an urgent dentist appointment or get help from NHS 111.
What causes toothache?
Most toothache is caused by a problem with the nerve (pulp) inside the tooth.
The pulp is living tissue with blood vessels and nerves. It sits inside a hard chamber that cannot stretch. The pulp can get inflamed, usually from decay, a crack or a deep filling. Then it swells. The swelling is trapped inside the tooth, so pressure builds up and causes pain.
Common causes include:
- Tooth decay. Germs eat through the enamel and reach the sensitive inner layers.
- A cracked or broken tooth. This lets germs reach the nerve.
- A deep or failing filling. Germs leak in around an old filling.
- Injury, such as a blow to the tooth.
- Gum disease. This can cause a deep, dull ache, mainly if an abscess forms.
Not all tooth pain comes from the nerve. Pain with hot and cold, pain when biting or sore gums can have other causes. Your dental team will examine the tooth to find the cause. They may take X-rays.
Two types of inflamed nerve
When the nerve inside a tooth is irritated, the inflammation is one of two types. Knowing the difference helps you understand how urgent it is and what treatment you may need.
Reversible pulpitis: the nerve can still recover
- A short, sharp pain set off by cold, sweet things or air
- The pain stops within a few seconds once the trigger is gone
- No pain out of the blue. It only hurts when something sets it off.
- It does not wake you at night
If the cause is treated quickly (for example, with a filling to remove decay), the nerve usually recovers fully.
Irreversible pulpitis: the nerve is dying
- Pain that lasts 30 seconds or more after the trigger is gone
- Pain that comes on by itself, with no trigger
- A dull, throbbing ache that may spread across the jaw. You may find it hard to tell which tooth hurts.
- Pain that wakes you at night or is worse when you lie down
- Painkillers you can buy may only help a little
- Sometimes heat makes it worse, while cold eases it for a short time
Once the nerve reaches this stage, the inflammation will not settle on its own, even if the cause is removed. The treatment is root canal treatment (to remove the dying nerve) or taking the tooth out.
Why antibiotics will not cure your toothache
This is one of the most important things to know about tooth pain: antibiotics do not cure toothache.
Here is why:
- Most toothache is caused by inflammation, not infection. Antibiotics fight germs (bacteria). They do not reduce inflammation.
- Antibiotics travel in your blood. When the nerve inside a tooth is inflamed or dying, the swelling squeezes its blood supply shut. This happens because the tooth is rigid. So antibiotics cannot reach the problem.
- Once the nerve has died, the dead tissue inside the tooth has no blood supply at all. No blood flow means the antibiotic cannot get there.
- The only treatment that works is for a dentist to treat the tooth itself, with a filling, root canal treatment or taking the tooth out.
Antibiotics are only needed when there are signs that the infection has spread beyond the tooth. Examples are swelling you can see in your face, a fever, or feeling unwell all over. Even then, antibiotics only support dental treatment. They do not replace it.
Asking for or giving repeated courses of antibiotics for the same untreated tooth adds to antibiotic resistance. This makes antibiotics work less well for everyone when they are really needed.
Managing pain while you wait for your appointment
Taking ibuprofen and paracetamol together is at least as effective for most dental pain as common codeine-containing painkillers, with fewer side effects. The two medicines work in different ways and are safe to take together.
- Ibuprofen 400mg up to three times a day with food. This reduces both pain and swelling (inflammation) where it hurts.
- Only take ibuprofen if it is safe for you. Do not take it if you have stomach problems, kidney problems, asthma, or heart or blood vessel disease (cardiovascular disease). Do not take it if you take blood thinners or are pregnant. If you are not sure, check with your dental team or pharmacist.
- Paracetamol 1g (two 500mg tablets) up to four times a day. This blocks pain signals in the brain.
- You can take both at the same time, or spread them out through the day.
- Leave at least 4 hours between doses of the same medicine.
- Never take more than the daily maximum of either medicine: 4g of paracetamol (8 × 500mg tablets) or 1,200mg of ibuprofen in 24 hours.
- Do not take aspirin if there is any bleeding.
- Do not give aspirin to anyone under 16.
Other things that may help:
- Rinse with warm salt water (half a teaspoon of salt in a glass of warm water).
- Eat soft foods.
- Do not chew on the painful side.
- Avoid very hot or cold food and drinks.
- If the pain is worse lying flat, sleep propped up on extra pillows.
- Do not put aspirin directly on the gum. It causes a chemical burn.
- Do not drink alcohol to numb the pain. It can interact with painkillers and make bleeding worse.
The pain stopped — does that mean it is better?
No. This is a common and dangerous mistake.
If toothache suddenly stops on its own, it often means the nerve inside the tooth has died. You feel better because there is no living nerve left to send pain signals. But the problem has actually become more serious, not less.
Germs breed in the dead tissue inside the tooth. Without treatment, this will lead to:
- an infection at the tip of the root (periapical abscess), causing swelling and bad pain
- a dental abscess, a pocket of pus that can spread into the face
- rarely, a serious spreading infection that needs hospital treatment
If your toothache stops suddenly, you still need to see a dentist. The tooth will still need treatment, usually root canal treatment or taking the tooth out.
When toothache is an emergency
Most toothache is not life-threatening. But dental infections can become serious if they are not treated. Call 999 or go to A&E if you have:
- Difficulty breathing, speaking or swallowing. The infection may be affecting your airway.
- Swelling spreading to your neck, under your tongue or around your eye
- A swollen or painful eye, or sudden problems with your eyesight
- A high temperature (above 38°C) and you feel very unwell, shivery or confused
- You cannot open your mouth (severe trismus)
See your dental team urgently (or call NHS 111 when they are closed) if you have:
- swelling in your face as well as tooth pain
- pus coming from around a tooth
- bad pain that the highest dose of ibuprofen and paracetamol does not control
- a fever as well as tooth problems
Important: do not go to your GP for toothache. GPs cannot examine or treat teeth. Do not go to A&E for everyday toothache without the emergency signs above.
How to prevent toothache
Most toothache can be prevented:
- Brush twice a day with fluoride toothpaste. Spit after brushing, but do not rinse.
- Clean between your teeth every day with interdental brushes or floss.
- Cut down on sugary foods and drinks, mainly between meals.
- Go for regular dental check-ups. Your dental team can find problems before they cause pain.
- Do not put off treatment. A small filling is much simpler than root canal treatment. Early treatment saves the tooth, reduces pain and costs less.
This leaflet is for general information only and does not replace professional dental advice. Your dental team will discuss your individual circumstances and any risks and treatment specific to you. Treatment outcomes vary between patients depending on individual circumstances.
Sources
- Toothache. NHS website (nhs.uk), reviewed July 2024.
- Management of Acute Dental Problems, 2nd edition. Scottish Dental Clinical Effectiveness Programme (SDCEP), 2026.
- Drug Prescribing for Dentistry, 3rd edition; online version updated for BNF 91. Scottish Dental Clinical Effectiveness Programme (SDCEP), 2016, updated 2026.
Links checked 18 October 2026.
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