Toothache is one of the most common reasons for an emergency dental visit. This leaflet explains the different types of dental pain, why antibiotics will not cure a toothache, and what you should do.
Most toothaches are caused by a problem with the nerve (pulp) inside the tooth. The pulp is living tissue containing blood vessels and nerve fibres, enclosed within a hard, rigid chamber. When it becomes inflamed — usually from decay, a crack, or a deep filling — it swells, but because it is trapped inside the tooth, the pressure builds and causes pain.
Common causes include:
Tooth decay — bacteria eat through the enamel and reach the sensitive inner layers
A cracked or fractured tooth — allows bacteria to reach the nerve
A deep or failing filling — leakage around an old restoration
Trauma — a blow to the tooth
Gum disease — can cause a deep, dull ache, especially if an abscess forms
Not all dental pain comes from the nerve. Sensitivity to hot and cold, pain when biting, or gum soreness can have different causes — your dentist will examine the tooth and may take X-rays to determine the source.
Two types of nerve inflammation
When the nerve inside a tooth is irritated, the inflammation falls into one of two categories. Recognising the difference helps you understand the urgency and likely treatment.
Reversible pulpitis — the nerve can still recover:
A short, sharp pain triggered by cold, sweet, or air
The pain stops within a few seconds once the trigger is removed
No spontaneous pain — it only hurts when something sets it off
Does not wake you at night
If the cause is treated promptly (for example, a filling to remove decay), the nerve usually recovers fully.
Irreversible pulpitis — the nerve is dying:
Pain that lingers for 30 seconds or more after the trigger is removed
Spontaneous pain that strikes without any trigger
A dull, throbbing ache that may spread across the jaw — you may struggle to identify exactly which tooth hurts
Pain that wakes you at night or is worse when lying down
Over-the-counter painkillers may provide only partial relief
Sometimes heat makes it worse while cold gives temporary relief
Once the nerve reaches this stage, the inflammation will not resolve on its own even if the original cause is removed. The treatment is root canal treatment (to remove the dying nerve) or extraction.
Why antibiotics will not cure your toothache
This is one of the most important things to understand about dental pain: antibiotics do not cure toothache.
Here is why:
Most toothaches are caused by inflammation, not infection. Antibiotics fight bacteria — they do not reduce inflammation.
Antibiotics travel through your bloodstream. When the nerve inside a tooth is inflamed or dying, the blood supply to it is being squeezed shut by the swelling inside the rigid tooth. Antibiotics simply cannot reach the problem.
Once the nerve has died, there is no blood supply at all to the dead tissue inside the tooth. No blood flow means no antibiotic delivery.
The only effective treatment is for a dentist to physically treat the tooth — with a filling, root canal treatment, or extraction.
Antibiotics are only indicated when there is evidence that the infection has spread beyond the tooth — for example, visible facial swelling, fever, or feeling systemically unwell. Even then, antibiotics are a supporting measure alongside dental treatment, not a substitute for it.
Requesting or prescribing repeated courses of antibiotics for the same untreated tooth contributes to antibiotic resistance — making antibiotics less effective for everyone when they are truly needed.
Managing pain while waiting for your appointment
The combination of ibuprofen and paracetamol is more effective for dental pain than any opioid-containing painkiller. These two drugs work through different mechanisms and can be taken together safely.
Ibuprofen 400mg up to three times daily with food — this reduces both pain and inflammation at the site. Only take ibuprofen if it is safe for you (avoid if you have stomach problems, kidney issues, asthma, heart or cardiovascular disease, take blood-thinning medications, or are pregnant — if unsure, check with your dentist or pharmacist).
Paracetamol 1g (two 500mg tablets) up to four times daily — this blocks pain signals in the brain.
You can take both at the same time, or alternate them every 3–4 hours. Do not exceed the maximum daily dose of either drug.
Avoid 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 and avoid chewing on the painful side
Avoid very hot or cold food and drinks
If pain is worse lying flat, sleep propped up with extra pillows
Do not place aspirin directly on the gum — this causes a chemical burn
Do not drink alcohol to numb the pain — it can interact with painkillers and worsen bleeding
The pain stopped — does that mean it is better?
No. This is a common and dangerous misconception.
If a toothache suddenly stops on its own, it often means the nerve inside the tooth has died. You feel relief because there is no longer a living nerve to send pain signals — but the problem has actually become more serious, not less.
The dead tissue inside the tooth becomes a breeding ground for bacteria. Without treatment, this will progress to:
A periapical abscess — an infection at the tip of the root, causing swelling and severe pain
A dental abscess — a collection of pus that can spread into the face
In rare cases, serious spreading infection that requires 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 extraction.
When toothache is an emergency
Most toothaches are not life-threatening, but dental infections can become serious if left untreated. Go to A&E or call 999 if you have:
Difficulty breathing or swallowing — the infection may be affecting your airway
Swelling spreading to your neck, under your tongue, or around your eye
High fever (above 38°C) combined with feeling very unwell, shivering, or confusion
Inability to open your mouth (severe trismus)
See your dentist urgently (or call NHS 111 if out of hours) if you have:
Facial swelling alongside dental pain
Pus discharging from around a tooth
Severe pain not controlled by maximum-dose ibuprofen and paracetamol
A fever alongside dental symptoms
Important: Do not go to your GP for toothache — they are not equipped to examine or treat teeth. Do not go to A&E for routine toothache without the emergency signs listed above.
How to prevent toothache
Most toothaches are preventable:
Brush twice daily with fluoride toothpaste — spit after brushing, do not rinse
Clean between your teeth daily with interdental brushes or floss
Limit sugary foods and drinks — especially between meals
Attend regular dental check-ups — your dentist can detect problems before they cause pain
Do not delay treatment — a small filling is far simpler than a root canal. 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 dentist will discuss your individual circumstances and any risks and treatment specific to you. Treatment outcomes vary between patients depending on individual circumstances.
When to Seek Urgent Help
If you have facial swelling that is spreading, difficulty breathing or swallowing, a high fever with feeling very unwell, or swelling near your eye, go to A&E immediately or call 999. These are signs of a serious spreading infection.
References
Aligned with guidance from: SDCEP, FGDP(UK), NICE, Cochrane, ADA.