Severe toothache: what to do while you get an appointment

What a very intense toothache can indicate

Not all toothaches are the same. Mild discomfort when eating something cold or sweet usually points to a superficial cavity or sensitivity, but intense, throbbing pain that does not let up — the classic "pain that keeps you awake at night" — almost always has a more specific cause: the pulp of the tooth (where the nerve and blood vessels are) has become inflamed or infected.

The most common causes of this type of pain are a deep cavity that has reached the nerve (pulpitis), an infection around the root (abscess), or a fracture of the tooth that leaves the inner part exposed. In all three cases the pain tends to worsen with heat, sometimes improves momentarily with cold, and can increase on lying down because of the change in blood pressure in the area.

It can also be a tooth that was treated before (a filling or a root canal) and has become infected again, or a wisdom tooth that is partially erupting and has inflamed the surrounding gum.

What to do while you wait for your appointment

While you get an appointment, there are several measures that help control the pain, though none of them ever replaces dental treatment:

• Scheduled pain relief: take your usual painkiller (such as ibuprofen or paracetamol) following the stated dose and timing, without waiting until the pain becomes unbearable before taking the next dose.
• Cold on the cheek: applying local cold on the outside (never directly on the tooth or gum) helps reduce swelling and pain in many cases.
• Avoid the affected side: chew on the other side and avoid very hot, very cold or very hard food that could increase the pain.
• Warm salt water rinse: can help if there is inflammation of the gum around the tooth.
• Gentle hygiene of the area: keep brushing carefully, without forcing over the painful tooth, so as not to help the infection progress.

None of these measures resolves the cause: if there is an infection or the nerve is damaged, the pain will come back as soon as the painkiller wears off, and only dental treatment (a root canal, draining an abscess, or extraction, depending on the case) solves the underlying problem.

Signs that it cannot wait

There is a group of symptoms that turn a toothache into a real emergency, not just an intense discomfort. When they appear, it is best not to wait for the clinic's normal opening hours:

These signs can mean that a dental infection is spreading beyond the tooth, into the bone or the soft tissue of the face and neck. This situation requires emergency care, because an uncontrolled dental infection can become complicated in a short time.

Why pain that suddenly disappears is not always a good sign

It is common to think that if the pain suddenly stops, the problem has sorted itself out. In many cases the opposite happens: when pulpitis progresses to the point where the nerve of the tooth dies, it stops transmitting the pain signal, but the infection can still be active around the root without it being noticeable.

That's why, even if the pain has gone away, if it was very intense for several days it is still worth going for a check-up: an X-ray can show whether infection remains at the root and help prevent it reappearing later, usually as an abscess or greater swelling.