Short answer: A toothache usually occurs when decay reaches the tooth nerve, or because of inflammation or an abscess at the root, gum disease, a cracked tooth, an impacted wisdom tooth or teeth clenching. Sinusitis or jaw joint problems can also cause referred pain that is felt in the teeth. Measures taken at home bring temporary relief; for the pain to go away for good, the cause has to be treated by a dentist.
A toothache is one of the pains that affects daily life most quickly. It can make eating, sleeping and working difficult, and sometimes it is felt not only in the tooth but also in the ear, the temple or the whole head. A toothache is not the name of a single disease; it is a shared symptom of many different causes, from cavities and gum inflammation to cracked teeth and sinusitis. How the pain goes away also depends on that cause.
In this article we cover the common causes of toothache, pain that radiates to the ear and head, referred pain that is felt in a tooth but comes from somewhere else, temporary measures you can take at home, situations that need urgent care, and the treatment options.
What causes a toothache?
The most common cause of a toothache is decay reaching the pulp, the tissue inside the tooth that contains nerves and blood vessels, and causing inflammation. Beyond that, many conditions involving the gum, the root, the jawbone and surrounding structures can also cause pain.
- Tooth decay: Brief sensitivity to sweets and cold at first can turn into longer-lasting pain that starts on its own as the decay progresses.
- Pulp inflammation (pulpitis): Throbbing pain that increases especially with heat and becomes more intense at night may point to this condition.
- Abscess: A collection of pus at the root tip or within the gum; it may come with swelling, pain that worsens on touch and sometimes fever.
- Cracked tooth: Sharp, brief pain when biting down or releasing the bite
- Gum disease: Gum inflammation, a periodontal abscess or root surfaces exposed by gum recession
- Impacted wisdom tooth: Inflammation of the gum covering it can cause pain, swelling and difficulty opening the mouth.
- Clenching and grinding: Widespread sensitivity in the teeth and fatigue in the jaw muscles
- A new filling or treatment: Temporary sensitivity may occur; a filling that sits too high can cause pain when biting.
- Orthodontic treatment: A feeling of pressure may be felt for a few days after braces are adjusted or after switching to a new set of clear aligners.
Why does pain radiate to the ear and head?
A toothache radiates to the ear, temple or head because sensation from the face and teeth is carried by the same main nerve, the trigeminal nerve. The brain cannot always locate pain signals from the branches of this nerve precisely, so the pain feels as if it has spread over a wider area.
Some observations about this kind of spreading pain:
- Inflammation in the lower back teeth often causes pain that radiates to the ear and the area in front of it.
- Problems in the upper back teeth can spread to the temple, around the eye and to the cheek.
- Pain in an inflamed tooth is sometimes felt so diffusely that the person cannot point exactly to which tooth hurts.
- Pain that gets worse when lying down at night is associated with increased blood flow to the head and may suggest nerve inflammation.
It is also worth remembering that ear pain does not always come from a tooth. Because an ear infection or jaw joint problems can cause similar complaints, a differential evaluation is made during the examination.
What is referred tooth pain?
Referred tooth pain is pain that is felt in a tooth but whose source lies outside the teeth. In this case, a person may think they have a toothache even though their teeth are healthy. Finding the source is important for the right treatment.
- Sinusitis: The roots of the upper back teeth are very close to the sinus cavity. Sinus inflammation can cause widespread pain in several upper molars that increases when bending the head forward.
- Jaw joint and muscle-related pain: With clenching or jaw joint disorders, pain can spread to the teeth and face.
- Nerve-related pain: In conditions such as trigeminal neuralgia, brief, severe, electric-shock-like pain may occur in the face and teeth.
- Heart-related pain: Although rare, a heart attack or angina can be felt as pain in the lower left jaw and teeth. If it is accompanied by pressure in the chest, shortness of breath, sweating or pain spreading to the arm, this is an emergency and 112 (the emergency number in Türkiye) should be called without delay.
The dentist evaluates whether the pain comes from a tooth through an examination, cold and heat tests, a percussion test and X-rays. If the source is thought to be outside the teeth, you are referred to the relevant specialty.
What can you do at home for temporary relief?
Measures taken at home can temporarily ease a toothache, but they do not remove the cause of the pain and should not delay a visit to the dentist. Pain that eases can sometimes mean that the nerve has lost its vitality, and the problem may keep progressing silently.
- Gently clean around the painful area with a soft brush; a piece of food stuck between the teeth may be causing the pain.
- You can gently rinse your mouth with warm salt water.
- If there is swelling, you can apply cold to the outside of the cheek at intervals; heat is not recommended because it can spread the inflammation.
- Avoid very hot, very cold and sugary foods and drinks; do not chew on the painful side.
- Keeping your head slightly elevated when lying down can bring relief from pain that gets worse at night.
- If you use a pain reliever, follow the package leaflet and the advice of your doctor or pharmacist; be sure to consult them if you have a chronic illness or take other medications.
Placing tablets such as aspirin on the painful tooth or the gum can burn the tissue; this should be avoided. Taking antibiotics without a doctor's recommendation is not right either.
When is it an emergency?
If there is rapidly increasing swelling in the face, fever, difficulty swallowing or breathing, inability to open the mouth, or swelling spreading toward the eye, the situation should be considered an emergency and you should go to a healthcare facility without delay. These symptoms may be signs of a spreading infection.
You should also see a dentist as soon as possible in the following situations:
- Severe pain that does not go away despite pain relievers or wakes you from sleep
- A pus-filled bump on the gum or a bad taste in the mouth
- A tooth that has broken, loosened or been knocked out after a blow; for a knocked-out permanent tooth, the first hours are critical
- Severe pain that increases within 2–4 days after a tooth extraction
- Sensitivity or pain lasting longer than a few days
How is a toothache treated?
A toothache can go away for good only with the right treatment aimed at its cause. That is why the first step of treatment is identifying the source through an examination and, when needed, X-rays.
- Filling: If the decay is caught before it reaches the nerve, it is removed and a filling is placed.
- Root canal treatment: If the pulp is inflamed or infected, the nerve tissue is removed and the canals are filled.
- Abscess drainage and infection treatment: When necessary, the pus is drained; if the dentist considers it necessary, medication is planned.
- Gum treatment: Tartar removal and cleaning below the gumline are performed.
- Extraction: Considered for teeth that cannot be saved or impacted wisdom teeth that cause problems.
- Night guard: Can be used to protect the teeth in pain caused by clenching.
For details about the pressure felt during clear aligner treatment and unusual situations, you can read our article on clear aligner problems and solutions. Mild pressure lasting a few days when switching to a new set of aligners is generally expected; sharp, constant pain, however, should be reported to your orthodontist.
Toothache examination in Ankara
If your toothache lasts longer than a few days, gets worse at night or comes with swelling, it is advisable to have an examination to find the cause rather than waiting it out with pain relievers. At our clinic in Park Oran Ofis, next to Panora Mall in Çankaya, the source of the pain is evaluated through examination and imaging, and the suitable treatment options are explained to you clearly.
Frequently asked questions
Does a toothache go away on its own?
Some sensitivity can be temporary, but a toothache caused by decay or inflammation usually does not go away permanently on its own. Pain that suddenly stops can sometimes mean that the nerve has lost its vitality, and the infection may progress silently. That is why a dental examination is recommended.
Why does a toothache get worse at night?
When lying down, blood flow to the head increases and the pressure in an inflamed tooth nerve can rise. In addition, with fewer distractions at night, the pain is felt more clearly. Pain that gets worse at night and wakes you up can be a sign of nerve inflammation.
Can sinusitis cause a toothache?
Yes. Because the roots of the upper back teeth are close to the sinus cavity, sinusitis can cause widespread pain in these teeth. The pain is often felt in more than one tooth and can increase when bending the head forward. During the examination, it is evaluated whether the pain comes from the tooth or the sinus.
Can I apply heat if there is swelling?
No, heat is not recommended for tooth-related swelling; it can make it easier for the inflammation to spread. Cold can be applied to the outside of the cheek at intervals. If the swelling is growing quickly or comes with fever, go to a healthcare facility without delay.
