Throbbing tooth pain: what it means and what to do

What’s probably going on

Throbbing pain comes in waves, often in time with your pulse. In a tooth, it usually means pressure is building in the pulp, the nerves and blood vessels in the middle of the tooth. The pulp sits inside a hard shell that can’t stretch, so when it swells, it hurts. Common causes, most likely first:

• An inflamed nerve that can’t recover. Dentists call this irreversible pulpitis. Pain from heat, cold or sweets lingers more than a few seconds, and the tooth may hurt when tapped. It often starts from a deep cavity, a crack, or recent dental work. Left alone, it can turn into an infection.
• An abscess. A pocket of pus at the root or in the gum beside the tooth. The pain is often severe and can feel like it spreads to your ear, jaw or neck. Swollen gums, a bad taste, a loose tooth or a fever can come with it. See tooth abscess.
• A cracked tooth. At first it may hurt only when you chew, or with hot and cold. Over time the pulp can get too damaged to heal, and the tooth may start to hurt all by itself. See cracked tooth.
• Your sinuses. Sinus pressure commonly causes pain in the upper back teeth, often during a cold, allergies or a sinus infection. It can feel a lot like a tooth problem. See sinus toothache.
• Grinding or clenching. Often a sore jaw, headaches or teeth sensitive to hot, cold or sweets, especially in the morning, rather than one tooth that throbs. It can still wear teeth down and irritate the nerve over time. See grinding.

A rough guide, not a rule: one tooth that throbs on its own, or aches long after hot or cold, is more likely the tooth itself. An ache in the upper back teeth with a stuffy nose and pressure in your face may be your sinuses. The two can overlap, so only an exam and an X-ray can say for sure.

Pain that suddenly stops after days of throbbing isn’t necessarily good news. The nerve may have died, and an infection can keep going without much pain.

What to do tonight

Pain relief buys time; it doesn’t treat the cause. The full list is in what to do for a toothache right now. The short version:

1. 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.
2. Hold a cold pack on your cheek. About 20 minutes at a time, wrapped in a thin towel. Never use heat on a swollen face.
3. Rinse and floss gently. Warm water or warm salt water, then gentle floss to clear anything stuck.
4. Keep hot, cold and sweet things away from the tooth, and chew on the other side.
5. Sleep with your head raised. Lying flat can make an inflamed tooth throb more. See how to sleep with a toothache.
6. Call a dentist in the morning, even if the pain has eased.

What not to do

• Don’t put aspirin on the tooth or gum. It burns the tissue.
• Don’t take more pain reliever than the label allows. If it isn’t enough, that’s a reason to call a dentist, not to take more.
• Don’t take leftover antibiotics. Only a dentist or doctor should decide if you need them, and they don’t fix the tooth.

When it can’t wait

Go to an emergency room if throbbing comes with swelling in your face or neck, a fever, trouble swallowing or breathing, or pain nothing touches. An infection from a tooth can spread to the jaw, head and neck.

How a dentist fixes it, and what it costs

A dentist tests how the tooth reacts to cold and to gentle tapping, and takes an X-ray. The fix depends on what they find.

• Irreversible pulpitis needs the inflamed pulp removed. That’s a root canal: the dentist cleans out the inside of the tooth and seals it, often followed by a crown. The other option is taking the tooth out.
• An abscess needs the infection drained. That can mean a small cut in the gum, a root canal, or pulling the tooth. Antibiotics may help fight the bacteria, but they don’t remove the cause.
• A cracked tooth may need a crown, a root canal, or, if the crack runs down the root, an extraction.
• A sinus problem is treated by a doctor, not a dentist, once the dentist has ruled out the tooth.

A root canal keeps your tooth; an extraction usually costs less up front, but the gap may need an implant or bridge later. Ask about both, with a written estimate for each, before any work starts. The price depends on the tooth, who does the work, where you live and your coverage.

If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can cut the price at participating dentists. The dental cost estimator gives a rough idea of what to budget.

How to keep it from coming back

A tooth rarely goes from fine to throbbing overnight. It usually starts as a small cavity or crack that could have been fixed simply.

• Brush twice a day with a fluoride toothpaste, and clean between your teeth once a day.
• Get regular checkups, so cavities are filled while they’re small.
• Tell your dentist about a zing from cold or sweets that’s new. See tooth sensitive to cold.
• If you grind or clench, ask about a night guard.

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