Toothache with ear pain or a headache: why it spreads and what to do

What’s probably going on

Pain doesn’t always stay where it starts. Cleveland Clinic explains that your ears share nerves with nearby parts of your body, so a problem near the ear can be felt in the ear itself. It lists toothaches, jaw joint problems and sinusitis among the causes. Doctors call this referred pain.

It can run the other way too. MedlinePlus notes that an earache can sometimes cause tooth pain.

Upper teeth versus lower teeth

Feeling in your teeth comes from the trigeminal nerve, a large nerve with separate branches for different parts of the face.

• Upper teeth share a branch with your sinuses, nasal cavity, palate and the middle of your face. That’s one reason a sinus problem and an upper tooth problem can feel alike.
• Lower teeth share a different branch with your tongue and the floor of your mouth. That branch also works your chewing muscles.

So the spot that hurts most may not be where the problem is. That’s one reason a dentist tests teeth one by one and takes an X-ray.

The usual causes, most common first

• A deep cavity or an inflamed nerve. Once decay reaches the pulp in the middle of the tooth, pain can throb and spread. See throbbing tooth pain.
• An abscess. Cleveland Clinic describes abscess pain as shooting or throbbing, and it can feel like it’s radiating to your ear, jaw or neck. Swelling, a bad taste or a fever may come with it. See tooth abscess.
• A wisdom tooth. Cleveland Clinic notes that impacted wisdom teeth are more prone to infection and can cause radiating pain in your jaw, face and head. Swollen gums and trouble opening your mouth all the way can come with it. See wisdom tooth pain.
• Grinding, clenching or a sore jaw joint. Cleveland Clinic lists jaw pain, headaches, earaches and tooth pain among the symptoms of TMJ disorders. See jaw and tooth pain from grinding.
• Your sinuses. MedlinePlus lists sinus infection as a cause of toothache. Because upper teeth and sinuses share a nerve branch, it’s usually upper teeth that ache. See sinus toothache.

When ear or head pain means something else

Sometimes the ear or head is the real problem and the tooth is the bystander.

• An ear problem may come with drainage from the ear, hearing loss or a high fever; Cleveland Clinic lists these as reasons to see a doctor. That needs a doctor, not a dentist.
• Jaw or tooth pain with chest pain or pressure, or trouble breathing can be a heart attack. Call 911. See tooth pain and heart attacks.

What to do tonight

1. Take an over-the-counter pain reliever as the label directs. 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.
2. Hold a cold pack on your cheek or jaw. About 20 minutes at a time. Don’t use heat if your face is swollen.
3. Rinse with warm salt water and floss gently to clear out any trapped food.
4. Go easy on your jaw. Stick to soft food and skip gum.
5. Plan for the night. See how to sleep with a toothache.
6. Notice the pattern. Which side hurts, whether hot or cold sets it off, whether biting hurts, and whether your nose is stuffed. It helps the dentist or doctor narrow it down.

What not to do

• Don’t put aspirin on the tooth or 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 tooth.
• Don’t wait it out if the pain is spreading. Cleveland Clinic warns that an untreated abscess can spread to the bone and other tissues.

Call a dentist today if the tooth pain has lasted more than a day or two, or if it comes with fever, earache or pain when you open wide. If the tooth checks out fine, MedlinePlus notes you may need your regular doctor to find the source.

How a dentist fixes it, and what it costs

The fix depends on the cause.

• A deep cavity or inflamed nerve usually needs a filling, or a root canal and a crown. See root canal cost.
• An abscess needs the infection drained, and the tooth treated with a root canal or taken out.
• A troublesome wisdom tooth is often removed. See wisdom teeth removal cost.
• Grinding or a sore jaw joint is often treated with a custom mouth guard, jaw exercises and habit changes.
• Sinus pain is a job for your doctor. See sinus toothache.

Prices depend on the treatment, the tooth and where you live, so ask for a written estimate first. If you don’t have insurance, a dental savings plan can lower the price at participating dentists. 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.
• Get regular checkups, so cavities are filled while they’re small.
• Ask your dentist to keep an eye on your wisdom teeth.
• If you wake up with a sore jaw or a headache, ask about grinding. A night guard can protect your teeth; see custom vs over-the-counter night guards.