Toothache: what to do and when to get urgent help

Toothache can happen for many reasons. Symptoms can overlap, so the list below should be treated as possibilities rather than a diagnosis.

• Tooth decay, where damage to the tooth allows irritation or infection to develop.
• A dental abscess or infection around a tooth or gum.
• A cracked, broken or worn tooth.
• A loose, broken or high filling, crown, bridge, veneer or denture.
• Gum inflammation or gum disease.
• A wisdom tooth or other tooth partly coming through the gum.
• Grinding or clenching, which can make teeth, jaw muscles and the bite feel sore.
• Sensitive teeth, which may react to cold, heat, sweet foods or brushing.

Pain severity does not always match the seriousness of the underlying problem. A small-looking tooth problem can be very painful, and some infections can become more serious if they are not assessed.

NHS guidance advises seeing a dentist if toothache lasts more than two days. You should also seek dental assessment if the pain does not go away when you take pain relief that is suitable for you, or if you have a high temperature, pain when biting, red gums, swelling of the cheek or jaw, or a bad taste in your mouth.

You may need to be seen sooner if symptoms are getting worse, if you cannot sleep or carry on with normal activities, or if you have a dental injury. Do not wait for the two-day mark if the situation is severe or deteriorating.

Urgent dental care may be needed when tooth or mouth pain is severe, affects sleep or daily activities, is not helped by suitable pain relief, or is not going away. It may also be needed for swelling or a lump inside the mouth that is getting bigger or not settling.

• A knocked-out tooth or another injury to the teeth.
• Severe tooth or mouth pain affecting sleep or daily life.
• Tooth or mouth pain that improves with pain relief but keeps returning or does not go away.
• Swelling, a lump or a patch inside the mouth that is getting bigger or not settling.
• Bleeding or severe pain after a tooth has recently been removed.
• A broken or loose filling, crown, bridge, veneer or denture causing pain or concern.

If you cannot access your own dentist and need urgent help, use NHS 111 or 111 online. NHS 111 can advise the next step but does not guarantee an appointment.

• Severe swelling of the mouth, lips, throat or neck with difficulty breathing, swallowing or speaking.
• Severe swelling affecting the area around the eye or the ability to open one or both eyes.
• Serious injury to the face or jaw.
• Heavy bleeding from the mouth that will not stop.
• Head or facial injury with symptoms such as loss of consciousness, vomiting or double vision.

If you are not sure whether symptoms need A&E, call NHS 111 or use 111 online for urgent advice. Do not drive yourself to A&E if you may be seriously unwell.

While waiting for dental care, focus on measures that reduce irritation and help you stay safe. These steps do not treat the underlying cause.

1. 1Use pain relief only if it is suitable for you. Follow the packet instructions and ask a pharmacist or appropriate healthcare professional if you are pregnant, breastfeeding, treating a child, taking other medication, allergic to medicines, on blood thinners, or have a medical condition.
2. 2Ask a pharmacist about suitable pain-relieving mouth gels or other over-the-counter options if you are unsure.
3. 3Choose soft foods and try not to chew on the sore tooth.
4. 4Avoid very hot, very cold or very sweet foods and drinks if they trigger pain.
5. 5Brush gently with a soft toothbrush and keep the mouth clean without forcing floss or brushes into a very painful area.
6. 6Adults may rinse gently with warm salty water if they can do so safely. Children should not try this if there is a risk they may swallow it.

• Do not place aspirin or any other medicine directly against the tooth or gum.
• Do not take someone else's antibiotics or leftover antibiotics.
• Do not assume antibiotics will cure toothache. Dental infections often need dental treatment of the source, and antibiotics are not routinely the answer.
• Do not ignore swelling, fever, worsening pain, a bad taste, difficulty opening the mouth, or symptoms spreading beyond the tooth area.
• Do not use the NHS waiting-list pathway for a dental emergency. It is for routine waiting-list interest, not urgent pain, swelling, infection or trauma.
• Do not delay assessment because pain briefly improves if it keeps returning or the wider symptoms are getting worse.

A dentist may ask about when the pain started, what triggers it, whether it wakes you at night, whether there is swelling, and whether you have had recent dental treatment or injury. They may examine the tooth, gums, bite, jaw and nearby tissues.

Depending on the findings, the dentist may discuss options to treat the cause, relieve pain, protect the tooth, drain infection, repair a restoration, or arrange further care. The right treatment depends on assessment, diagnosis, consent, clinical suitability and fees explained by the dental practice.