Tooth pain that comes and goes: what it usually means

What’s probably going on

Pain that shows up, fades, then comes back usually has a trigger: cold, sweets, chewing, a cold in your head, or a night of clenching. The cause is still there between the bad moments. Cleveland Clinic puts it plainly: with a cavity or an abscess, the pain may come and go, but it won’t go away completely.

The usual causes, roughly most common first:

• A cavity. ADA MouthHealthy lists decay among the causes of sensitive teeth. Early on, it can show up as a quick zing with sweets or cold that fades in a moment.
• An irritated nerve that can still recover. Dentists call this reversible pulpitis. Cleveland Clinic describes it as sensitivity to cold or sweets that goes away quickly. Fixing the cause, often with a filling, usually lets the nerve settle.
• A cracked tooth. The American Association of Endodontists describes erratic pain when chewing that may come and go, plus pain with very hot or cold food. It can be hard to tell which tooth it is, even for a dentist. See cracked tooth.
• Grinding or clenching. Cleveland Clinic lists grinding and clenching among the causes of toothache. See jaw and tooth pain from grinding.
• Gum problems. Gum disease is one of the causes of toothache Cleveland Clinic lists. Sore, puffy or bleeding gums, or food wedged under the gum, can make the area ache. See gum pain around one tooth.
• Your sinuses. MedlinePlus lists sinus infection as a cause of toothache. If the ache comes with a cold or a stuffy nose, your sinuses may be part of it. See sinus toothache.

When on-and-off pain turns into something more

The pattern matters more than how bad any one moment is.

• Short zings that fade within a second or two are the milder end.
• Pain from hot, cold or sweets that lingers more than a few seconds is one of the signs Cleveland Clinic gives for irreversible pulpitis, a nerve that is unlikely to recover.
• Pain that starts on its own or throbs can mean the nerve is badly inflamed or infected. Cleveland Clinic says irreversible pulpitis pain can throb, and the AAE notes a cracked tooth may begin to hurt all by itself once the nerve can’t heal. See throbbing tooth pain.

Why “it stopped hurting” isn’t always good news

Sometimes pain stops because the problem settled. Sometimes it stops because the nerve inside the tooth has died. Cleveland Clinic explains that when an infection kills the pulp, the pain can stop because those nerves no longer work, while the infection keeps spreading.

A dead nerve may no longer react to hot or cold, but the tooth may still hurt when a dentist taps it. So if a tooth throbbed for days and then went quiet, get it checked, especially if you notice swelling, a bad taste or a bump on the gum.

What to do tonight

1. Figure out the trigger. Cold, sweets, biting, lying down, or a stuffy nose. Note which tooth or side, and how long each episode lasts. This helps the dentist a lot.
2. Avoid what sets it off. Skip very cold or sweet things, and chew on the other side.
3. Rinse with warm salt water and floss gently around the sore area, in case food is stuck under the gum.
4. Take an over-the-counter pain reliever as the label directs if you need it. The ADA’s toothache guideline names ibuprofen or naproxen, alone or with acetaminophen, as first choices for adults and teens 12 and older. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
5. Try a toothpaste for sensitive teeth if the pain is quick zings with cold. ADA MouthHealthy notes it usually takes several uses to help. It won’t fix a cavity or a crack, so still book the dentist. See best toothpaste for sensitive teeth.

What not to do

• Don’t chew hard things on a tooth you think is cracked. The AAE explains that chewing can move the cracked pieces and irritate the nerve.
• Don’t put aspirin on the tooth or gum. It burns the tissue.
• Don’t treat the quiet days as a cure. Cleveland Clinic advises calling a dentist for a toothache that lasts longer than two days, and notes that cavity or abscess pain may come and go without going away.

How a dentist fixes it, and what it costs

A dentist will usually look, tap, test with cold, have you bite on something, and take an X-ray. The fix depends on what they find.

• A cavity or a nerve that can still recover often needs only a filling. See filling cost.
• A crack often needs a crown, and a root canal too if the crack reaches the nerve. The AAE warns that an untreated crack tends to get worse and can end in losing the tooth. See cracked tooth repair cost.
• A nerve that won’t recover, or one that has died, needs a root canal or the tooth taken out. See root canal cost.
• Grinding is often treated with a night guard.
• Gum problems start with a professional cleaning.

Catching it while it still comes and goes usually means a smaller, cheaper fix. Ask for a written estimate before work starts. If you don’t have insurance, a dental savings plan can lower the price, and the dental cost estimator gives rough ranges.

How to keep it from coming back

• Brush twice a day with fluoride toothpaste and clean between your teeth daily.
• Cut back on sipping sugary or acidic drinks through the day.
• Don’t chew ice, unpopped popcorn kernels or pens, as the AAE advises.
• Get regular checkups, so small cavities and early cracks are found before they hurt.
• If you clench or grind, ask your dentist about a night guard; the AAE suggests one to protect your teeth. See custom vs over-the-counter night guards.