Gum pain around one tooth: causes and what to do

What’s probably going on

When the gum around just one tooth hurts, the cause is usually right there, in that spot. The most common reasons, roughly in order:

• Food stuck under the gum. A popcorn hull, a seed or a shred of meat can wedge between the tooth and gum. The gum gets sore and puffy, and it can ache like a bad tooth. This one often clears up once the food is out.
• Brushing too hard, or a small injury. Scrubbing with firm bristles, a sharp chip or a poke from a fork can bruise the gum. It’s usually tender to the touch but settles within days.
• A gum abscess. This is a pocket of pus in the gum beside the tooth. It often looks like a swollen, darker bump, and it can come with a bad taste, bad breath or pain when you chew. Gum disease is the most common reason one forms.
• An infection inside the tooth. An abscess at the root can make the nearby gum swell too. The pain is often deep and throbbing. See tooth abscess.
• A partly erupted wisdom tooth. A flap of gum over a back tooth can trap food and bacteria and get infected. This is called pericoronitis. It’s most common around lower wisdom teeth. See wisdom tooth pain.
• A crack that runs down to the root. A cracked tooth can make the gum beside it sore or swollen, often with sharp pain when you bite. See cracked tooth.

Gum disease itself is usually painless in its early stage. Red, puffy gums that bleed when you brush often mean gingivitis. Soreness in one spot is more often one of the causes above, sometimes on top of gum disease.

What to do tonight

These steps often ease a sore spot, and they may fix it if food is the cause.

1. Floss gently on both sides of the tooth. Slide the floss down and curve it around the tooth, just under the gumline. Don’t snap it into the gum. A water flosser can help rinse out what floss misses.
2. Rinse with warm salt water. Stir a pinch of salt into a cup of warm water, swish and spit. Repeat a few times a day.
3. Brush the area softly with a soft-bristled brush. Keep the gum clean even though it’s sore.
4. Cold pack on the cheek if the area is swollen, a few times during the day. Don’t use heat on a swollen face.
5. Take an over-the-counter pain reliever as the label directs. For adults and teens 12 and older, the ADA’s first choice is an anti-inflammatory such as ibuprofen or naproxen, alone or with acetaminophen. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.

If the soreness was from trapped food or rough brushing, it often feels better within a day or two. Swollen gums that last more than two weeks, or that get worse, need a dentist. So does any bump on the gum.

What not to do

• Don’t pick at the gum with a pin, toothpick or knife. You can push food deeper or cut the gum.
• Don’t try to pop or drain a bump yourself. A gum abscess can’t be treated at home.
• Don’t put aspirin on the gum. It burns the tissue.
• Don’t take leftover antibiotics. Only a dentist or doctor should decide whether you need them, and they don’t fix the cause on their own.

If the pain is more in the tooth than the gum, what to do for a toothache right now covers the rest.

How a dentist fixes it, and what it costs

A dentist will look at the gum, measure the pocket around the tooth, and usually take an X-ray. That shows whether the problem is in the gum, the tooth, or both.

• Trapped food or a minor injury may need only a cleaning, or nothing at all.
• A gum abscess is usually drained, then the root surface is cleaned below the gumline (scaling and root planing). Antibiotics are sometimes added.
• An infection that has reached the tooth may need a root canal. If the tooth can’t be saved, it’s taken out.
• Pericoronitis is often treated with a cleaning and a prescription rinse, sometimes antibiotics. If it keeps coming back, the flap or the wisdom tooth may be removed.
• Gum disease starts with a professional cleaning. Early gingivitis can usually be reversed with that and good daily care.

The price depends on which of these you need, how many teeth are involved, and where you live. Ask for a written estimate before treatment starts. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can lower the price at participating dentists. The dental cost estimator can give you a rough idea first.

How to keep it from coming back

• Brush twice a day for two minutes with fluoride toothpaste and a soft brush. Gentle is enough.
• Clean between your teeth once a day, with floss or a water flosser.
• Floss after meals that tend to get stuck, like popcorn or stringy meat.
• If you smoke or chew tobacco, quitting lowers your risk of gum disease.
• See a dentist for regular checkups and cleanings. Gum disease often doesn’t hurt until it’s advanced.
• If you grind your teeth, ask about a night guard. Grinding is one of the things that can lead to a gum abscess. See custom vs over-the-counter night guards.

A good electric toothbrush can make gentle, thorough brushing easier. See the best electric toothbrush.