What to do for a toothache right now

What’s probably going on

A toothache usually means something in or around the tooth is irritated or infected. The most common causes, roughly in order:

• A cavity that has gone deep. Once decay reaches the softer layer under the enamel, cold, sweets and chewing can start to hurt. When it reaches the nerve, the pain can turn constant or throbbing. See toothache at night.
• A cracked tooth. Sharp pain when you bite down or let go, often hard to pin to one tooth. See cracked tooth.
• An infection at the root (abscess). Deep, throbbing pain, sometimes with swelling or a bad taste. See tooth abscess.
• Something stuck, or sore gums. A popcorn hull or seed wedged under the gum can ache like a bad tooth.
• Grinding or clenching. Sore teeth and jaw, worst in the morning. See grinding.
• Your sinuses. Upper back teeth can ache during a cold or sinus infection, often several teeth at once.

Pain that comes and goes with cold is usually less urgent than pain that throbs on its own. Pain that suddenly stops after days of throbbing isn’t necessarily good news; the nerve inside may have died, and the infection can keep going.

What to do tonight

These steps often calm a toothache enough to get some sleep.

1. Rinse with warm water. Swish and spit to clear out food. Warm salt water (about half a teaspoon in a cup) is fine too.
2. Floss gently around the tooth. Something stuck between teeth is a surprisingly common cause, and removing it can end the pain on the spot.
3. Cold pack on the cheek. About 20 minutes at a time, a few times a day. It can dull pain and keep swelling down. Never use heat on a swollen face.
4. Take an over-the-counter pain reliever as the label directs. For adults and teens 12 and up, the American Dental Association’s guideline puts anti-inflammatories such as ibuprofen or naproxen first, alone or combined with acetaminophen. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
5. Sleep with your head raised. An extra pillow may ease the pressure that makes tooth pain worse lying down.
6. Try a numbing gel for short-term relief. A little benzocaine gel on a cotton swab can numb the area for a while. Use it as the label directs, and never on children under 2.
7. Cover a lost filling. A temporary filling from the pharmacy can protect the hole overnight. It isn’t made for a broken tooth, or for one that throbs or is swollen. See lost a filling.

If you’d like a dentist’s advice before your own office opens, The TeleDentists offer video visits at any hour.

What not to do

• Don’t put aspirin on the tooth or gum. It burns the tissue and doesn’t help the tooth.
• Don’t take more pain reliever than the label allows, even if the pain is bad. Call a dentist instead.
• Don’t take leftover antibiotics. Antibiotics don’t fix the tooth, and only a dentist or doctor should decide whether you need them.
• Don’t wait it out for weeks. Relief isn’t a cure; the cause is still there.

How a dentist fixes it, and what it costs

The fix depends on the cause, and a dentist usually needs an exam and an X-ray to know which it is.

• A cavity gets a filling.
• A deep cavity or an infected nerve needs a root canal and usually a crown, or the tooth is taken out.
• A cracked tooth often needs a crown.
• An abscess needs the infection drained, by root canal or extraction. Antibiotics usually help only when the infection is spreading.

The price depends on the treatment, the tooth, where you live and your coverage, so ask for a written estimate before any work starts. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can cut the price at participating dentists, and it can usually be used within days of signing up.

How to keep it from coming back

Many toothaches start months before they hurt, as a small cavity or a crack nobody saw.

• Brush twice a day with a fluoride toothpaste, for two minutes.
• Clean between your teeth once a day with floss or a water flosser.
• Cut back on sipping sugary or acidic drinks through the day.
• See a dentist for a checkup, so small problems get fixed before they turn into a night like this one.
• If you wake up with a sore jaw, ask about a night guard.

A good electric toothbrush makes the first habit easier. See the best electric toothbrush.