In brief
For a severe toothache, rinse gently with warm salt water, floss carefully to remove trapped food, take over-the-counter pain relief exactly as the package directs, use a cold compress on the cheek if there is swelling, and contact a dental office promptly. Severe tooth pain usually signals deep decay, infection or a crack that home care can soothe but not fix. Go to hospital or call 911 if you have trouble breathing or swallowing, or swelling spreading toward the eye or neck.
Key takeaways
- Salt-water rinses, careful flossing and package-directed pain relief are safe first steps.
- Never place aspirin against the gum; it chemically burns the tissue.
- Pain that suddenly disappears can mean the nerve has died — the problem remains.
- Swelling, fever or trouble swallowing changes a toothache into an emergency.
- Trouble breathing, trouble swallowing or swelling spreading to the eye or neck needs hospital care or 911.
A severe toothache usually means something inside or around the tooth needs treatment, and the most useful thing you can do is ease the pain safely and contact a dental office promptly. Rinse with warm salt water, floss gently, take over-the-counter pain relief as directed, and use a cold compress if your face is swollen. If you have trouble breathing or swallowing, or swelling spreading toward your eye or neck, go to hospital or call 911.
This guide walks through what to do right now, what to avoid, what different kinds of tooth pain can mean, when a toothache becomes a medical emergency, and what happens when you see a dentist.
What should you do right now for a severe toothache?
These steps are safe for most people and can make the wait for an appointment more bearable. None of them fixes the cause, but they can reduce pain and keep the area clean.
1. Rinse with warm salt water
Stir half a teaspoon of salt into a cup of warm (not hot) water, swish gently for 30 seconds, and spit. Repeat after meals and before bed. A salt-water rinse helps clear debris and can soothe irritated gum tissue.
2. Floss gently around the painful tooth
A popcorn hull, seed or fragment of food wedged between teeth can press on the gum and cause surprisingly sharp pain. Slide floss carefully down both sides of the tooth. If the pain eases noticeably afterward, trapped food may have been part of the problem, though it is still worth having the area checked.
3. Use over-the-counter pain relief as directed
Follow the package directions for whichever product you normally use. Check with a pharmacist before taking anything new, especially if you take other medications, are pregnant or breastfeeding, or have stomach, kidney, liver or heart conditions. For children, use a children’s product and dose it as the package or pharmacist directs. Pain relief is a bridge to care, not a substitute for it.
4. Apply a cold compress if there is swelling
Hold a cold pack wrapped in a cloth against the outside of your cheek for 15 to 20 minutes at a time, with breaks in between. Cold can reduce swelling and dull pain, especially after an injury.
5. Keep your head raised
Lying flat tends to increase throbbing. Sleeping with an extra pillow can make the night more comfortable.
6. Chew on the other side and choose soft foods
Avoid biting on the sore tooth. Lukewarm, soft foods such as eggs, yogurt, soup that has cooled a little, and mashed vegetables are less likely to trigger pain.
7. Call a dental office
Describe your symptoms clearly: where the pain is, how long it has lasted, whether it is constant or comes and goes, whether heat, cold or biting sets it off, and whether you have swelling or fever. That information helps the team decide how soon you should be seen.
What should you avoid doing with a bad toothache?
Some common remedies do more harm than good.
- Do not put aspirin or any tablet on the gum or tooth. This old remedy causes a chemical burn on the gum and does nothing for the pain inside the tooth.
- Do not apply heat to the outside of your face. If there is an infection, warmth may encourage swelling to spread.
- Do not take more pain medication than the package allows, or combine products without advice from a pharmacist. Exceeding the daily limit can cause serious harm.
- Do not use undiluted essential oils, alcohol or other strong liquids held against the gum. They can irritate or burn the tissue.
- Do not try to pop or drain a gum bump yourself. A pimple-like bump on the gum is often a sign of infection that needs professional treatment.
- Do not rely on leftover antibiotics. Antibiotics may be prescribed in some situations, but they do not remove the source of the problem, and the wrong medication or dose can cause other issues.
- Do not assume the problem is over if the pain suddenly stops. More on this below.
What causes a severe toothache?
Mild sensitivity is common, but pain severe enough to keep you awake usually involves the nerve of the tooth (the pulp) or an infection. The most common causes include:
- Deep decay. A cavity that reaches the inner layers of the tooth can inflame the nerve.
- Pulpitis. This is inflammation of the nerve itself. It may start as lingering sensitivity to cold or heat and progress to constant throbbing.
- Tooth abscess. An infection at the tip of the root or in the gum can cause intense, throbbing pain, tenderness to biting, swelling and sometimes a bad taste.
- A cracked tooth. Cracks often cause sharp pain when biting or when releasing a bite. Our post on why a tooth hurts when biting covers this in more detail.
- A lost or failing filling or crown. Exposed inner tooth structure can be very sensitive.
- Gum problems. A gum abscess, food packed under the gum or advanced gum disease can cause localized pain.
- An erupting wisdom tooth. The gum over a partially erupted wisdom tooth can become inflamed and painful.
- Referred pain. Sinus congestion can make upper back teeth ache, and clenching or grinding can make several teeth feel sore.
The exact cause cannot be confirmed without an examination, and usually X-rays. Two toothaches that feel the same can have very different causes and treatments.
What does the type of tooth pain tell you?
The pattern of your pain gives useful clues, although it is not a diagnosis. This table shows what different symptoms are often associated with.
| What you notice | What it may point to | How soon to call |
|---|---|---|
| Brief sharp twinge with cold that fades in seconds | Sensitivity, early decay or exposed root surface | Book a regular visit |
| Pain with cold or heat that lingers after the trigger is gone | Inflamed nerve (pulpitis) | Within a few days |
| Constant throbbing that wakes you at night | Inflamed or infected nerve | Within a day or two |
| Pain when biting or releasing a bite | Cracked tooth, loose filling or root infection | Within a few days |
| Throbbing pain with gum swelling or a bad taste | Abscess or infection | Same day if possible |
| Pain with facial swelling or fever | Spreading infection | Same day; hospital if swelling is severe or spreading |
| Severe pain that suddenly stops | Nerve may have died; infection may continue | Within a few days |
If your symptoms do not fit neatly into one row, that is common. Call and describe what you are feeling, and the team can help you decide.
Why is a toothache worse at night?
When you lie down, blood flow to the head increases, which raises pressure inside an inflamed tooth. The nerve sits in a closed chamber with no room to swell, so extra pressure is felt as throbbing pain. At night there are also fewer distractions, so the pain seems louder. Raising your head on an extra pillow and taking pain relief as directed before bed may help. Pain that regularly wakes you is a sign the nerve is significantly inflamed and should be assessed soon.
What if the toothache suddenly goes away?
It is tempting to cancel the appointment when days of severe pain vanish overnight. Sometimes the pain eases because trapped food was removed or inflammation settled. But when intense, throbbing pain disappears abruptly, it can mean the nerve inside the tooth has died. The infection can continue without pain and may later flare up as swelling or an abscess. Our post on signs you may need root canal treatment explains this pattern. Keep your appointment so the tooth can be checked.
Is a toothache an emergency, or should you go to the hospital?
Most toothaches belong at a dental office, because dentists can diagnose and treat the tooth itself. Hospitals are equipped for medical emergencies, and they can help with a spreading infection or serious injury, but they generally cannot repair a tooth. Our guide to choosing between an emergency dentist or the hospital explains the difference in more detail.
Call 911 or go to the nearest emergency department if you have:
- trouble breathing or swallowing,
- swelling that is spreading quickly, closing the eye, or moving down into the neck or under the jaw,
- a high fever and feeling very unwell,
- confusion, severe drowsiness or a rapid heartbeat alongside a dental infection,
- a serious facial injury, a possible broken jaw, or a head injury with loss of consciousness,
- bleeding that will not stop with firm pressure.
These can be signs of a serious infection or injury that needs medical care right away.
Contact a dental office the same day if you have:
- a toothache with facial or gum swelling,
- a fever along with tooth pain,
- a bad taste or pus, suggesting a draining abscess,
- pain after an injury to the mouth,
- pain that is severe and not controlled by pain relief taken as directed.
The link between swelling and tooth pain is covered in facial swelling and tooth pain, and our guide to what counts as a dental emergency helps you judge other situations.
What happens at an urgent dental appointment for a toothache?
Knowing what to expect can make the visit easier.
- Health history and symptoms. The dentist asks about your pain, medications and any medical conditions.
- Examination. The dentist looks at the tooth and gums, and may gently tap the tooth, test it with cold, or check your bite to find which tooth is involved.
- X-rays. Images show decay, infection at the root tip and bone changes that cannot be seen by looking, which is often the key to identifying the source of the pain.
- Diagnosis and options. The dentist explains what is causing the pain, the treatment options and alternatives, and the estimated fees before treatment begins.
- Relief. Depending on the problem and the time available, the first step may be the full treatment or an initial procedure to relieve pain, with the rest completed at a follow-up visit.
What treatments fix a severe toothache?
The treatment depends entirely on the cause.
- A filling may be enough when decay has not reached the nerve. See our dental fillings page.
- Root canal treatment is often recommended when the nerve is inflamed beyond recovery or infected. It removes the damaged pulp, cleans the inside of the tooth and seals it, allowing you to keep the tooth. Learn more about root canal treatment, and if you are anxious, read is root canal treatment painful?
- Extraction may be recommended when a tooth cannot be restored, or if you prefer not to save it after discussing the options.
- A crown may be needed afterward to protect a tooth weakened by a large cavity, a crack or root canal treatment.
- Draining an abscess and, in some cases, antibiotics may be part of managing an infection, alongside treatment of the tooth itself.
- Gum treatment or a cleaning may be needed if the pain comes from the gums or trapped debris.
Early treatment is usually simpler and saves more of the tooth. A tooth that could be fixed with a filling this month may need root canal treatment or extraction if it is left for months.
What if your child has a severe toothache?
Children cannot always describe pain clearly. Watch for rubbing the face, refusing to eat on one side, waking at night, or a bump or swelling on the gum. Rinse with warm water if your child can do so safely, check for trapped food, and use a children’s pain reliever dosed exactly as the package or pharmacist directs. Never place tablets against a child’s gum.
Baby teeth can become infected just like adult teeth, and an infection can affect the permanent tooth developing underneath, so a painful baby tooth should be checked promptly. The same hospital warning signs apply to children: trouble breathing or swallowing, swelling spreading toward the eye, or a high fever with your child seeming very unwell need emergency care.
How can you prevent another severe toothache?
Most severe toothaches build slowly from problems that were small and painless at first.
- Keep regular checkups. Exams and X-rays can find decay and cracks before they reach the nerve.
- Do not ignore early warning signs. Lingering sensitivity, a rough edge on a filling or mild pain when biting are worth mentioning early.
- Brush twice a day with fluoride toothpaste and clean between your teeth daily.
- Limit how often you have sugary drinks and snacks, especially sipping throughout the day.
- Ask about a nightguard if you clench or grind, since grinding can crack teeth and cause soreness.
- Wear a mouthguard for contact sports to reduce the risk of injury.
Getting help for a toothache in Cornwall
York Street Dental Centre is a family dental office at 118 York Street in Cornwall, Ontario, open Monday to Friday. If you are in pain, call and describe your symptoms, and our team will advise you on how soon you should be seen and what to do in the meantime. You do not need a referral, and we are accepting new patients, so you can call even if you have not visited us before.
We see patients from across the city, including downtown, Riverdale and Eamer’s Corners, as well as nearby Cornwall Island (Akwesasne) and Glen Walter. Before treatment, we explain what is causing the pain, your options and the estimated fees. We offer direct insurance billing for many plans and welcome eligible Canadian Dental Care Plan (CDCP) patients.
If your toothache comes with trouble breathing, trouble swallowing or rapidly spreading swelling, do not wait to call us: go to the nearest emergency department or call 911.
Book an urgent toothache visit
If you have a severe or lingering toothache, call York Street Dental Centre at (613) 932-1620 or request an appointment online. You can also read more about how we handle urgent problems on our emergency dentistry page.
Frequently asked questions
Why is my toothache worse at night?
Lying down increases blood pressure in the head, intensifying pressure inside an inflamed tooth. Fewer daytime distractions also make pain more noticeable. Night-time throbbing is a classic sign of nerve inflammation.
Can antibiotics cure a toothache?
Antibiotics may control a spreading infection temporarily, but they cannot remove the source inside the tooth. Without dental treatment — a filling, root canal or extraction — the problem returns.
Do clove oil or other home remedies work?
Clove oil has mild numbing properties and may take the edge off briefly. Like all home measures, it manages symptoms without treating the cause, and undiluted oil can irritate tissue. Use sparingly, if at all.
How quickly should a severe toothache be seen?
Ideally within a day or two, and the same day if there is swelling, fever or the pain is unbearable. Contact the clinic, describe your symptoms, and the team can advise the appropriate urgency.
Should I go to the hospital for a toothache?
Go to hospital or call 911 if tooth pain comes with trouble breathing or swallowing, swelling spreading toward your eye or neck, a high fever with feeling very unwell, or a serious facial injury. For tooth pain without those signs, a dental office is the right place, because hospitals generally cannot repair the tooth itself.
Can a toothache go away on its own?
Mild sensitivity sometimes settles, but a severe toothache rarely resolves for good without treatment. When intense pain fades suddenly, it may mean the nerve has died while infection continues. An examination is the only way to know whether the cause has actually gone.
Sources
- Cleveland Clinic — Toothache
- Mayo Clinic — Toothache
- Canadian Dental Association — Dental Emergencies
About the author
This article was written by the York Street Dental Centre Team and reviewed for clinical accuracy by the York Street Dental Centre dental team. York Street Dental Centre is a family dental office at 118 York Street, Cornwall, Ontario K6J 3Y8, providing general, preventive, restorative, and cosmetic dental care for patients of all ages.
Our articles explain common dental questions in plain language, cite reputable health and government sources where relevant, and are updated when guidance changes. Read our editorial policy or learn more about our practice.
This content is intended for general educational purposes and does not replace an examination, diagnosis or personalized treatment recommendation from a dental professional.