A toothache may feel like a sharp pain or a dull ache. The tooth may be sensitive to pressure, heat, cold, or sweets. In cases of severe pain, identifying the problem tooth is often difficult. Any patient with a toothache should see a dentist at once for diagnosis and treatment. Most toothaches get worse if not treated.

Toothaches may result from any of a number of causes:

• tooth decay (dental caries)
• inflammation of the tooth pulp (pulpitis)
• abscesses
• gum disease, including periodontitis
• loose or broken filling
• cracked or impacted tooth
• exposed tooth root
• food wedged between teeth or trapped below the gum line
• tooth nerve irritated by clenching or grinding of teeth (bruxism)
• pressure from congested sinuses
• traumatic injury

Diagnosis includes identifying the location of the toothache, as well as the cause. The dentist begins by asking the patient specific questions about the toothache, including the types of foods that make the pain worse, whether the tooth is sensitive to temperature or biting, and whether the pain is worse at night. The dentist then examines the patient's mouth for signs of swelling, redness, and obvious tooth damage. The presence of pus indicates an abscess or gum disease. The dentist may flush the sore area with warm water to dislodge any food particles and to test for sensitivity to heat. The dentist may then dry the area with gauze to determine sensitivity to touch and pressure. The dentist may probe tooth crevices and the edges of fillings with a sharp instrument, looking for areas of tooth decay. Finally, the dentist may take x rays, looking for evidence of decay between teeth, a cracked or impacted tooth, or a disorder of the underlying bone.

Toothaches should always be professionally treated by a dentist. Some methods of self-treatment, however, may help manage the pain until professional care is available:

• rinsing with warm salt water
• using dental floss to remove any food particles
• taking aspirin or acetaminophen (Tylenol) to relieve pain; the drug should be swallowed--never placed directly on the aching tooth or gum
• applying a cold compress against the outside of the cheek; do not use heat, because it will tend to spread infection.
• using clove oil (Syzygium aromaticum) to numb the gums; the oil may be rubbed directly on the sore area or used to soak a small piece of cotton and applied to the sore tooth

Treatment will depend on the underlying cause of the toothache. If the pain is due to tooth decay, the dentist will remove the decayed area and restore the tooth with a filling of silver amalgam or composite resin. Loose or broken fillings are removed, new decay cleaned out, and a new filling is placed. If the pulp of the tooth is damaged, root canal therapy is needed. The dentist or a specialist called an endodontist removes the decayed pulp, fills the space left behind with a soothing paste, and covers the tooth with a crown to protect and seal it. If the damage cannot be treated by these methods, or if the tooth is impacted, the tooth must be extracted.

Toothaches caused by infection or tooth decay must be treated by a dentist. Several alternative therapies may be helpful for pain relief until dental treatment is available. Clove oil (Syzygium aromaticum) may be rubbed on sensitive gums to numb them or added to a small cotton pellet that is then placed into or over a hole in the tooth. The herb corydalis (Corydalis yanhusuo) may also help relieve toothache pain. Pain also may be reduced using acupressure, acupuncture, or reiki. Acupuncture should be done only by a licensed practitioner.

Prompt dental treatment provides a positive outcome for toothache. In the absence of active infection, fillings, root canal treatments, or extractions may be performed with minimal discomfort to the patient. When a toothache is left untreated, a severe infection may develop and spread to the sinuses or jawbone, and eventually cause blood poisoning.

Maintaining proper oral hygiene is the key to preventing toothaches. The best way to prevent tooth decay is to brush at least twice a day, preferably after every meal and snack. Flossing once a day also helps prevent gum disease by removing food particles and bacteria at and below the gum line, as well as between teeth. People should visit their dentist at least every six months for oral examinations and professional cleaning.