What should I do right now for a severe toothache?
“If I can just get through tonight, will it be okay?” The order is to take steps to ease the pain and book an appointment at the earliest time possible.
- Take an over-the-counter painkiller as directed on the label.
- Rinse your mouth with lukewarm water and carefully remove only food that's stuck.
- Don't chew on the painful side, and avoid hard, very hot or cold, or sweet foods.
- Book a dental appointment at the earliest time possible.
Dissolving half a teaspoon of salt in a cup of lukewarm water, holding it in your mouth, and spitting it out can help briefly, but it is not a treatment that removes the cause of the inflammation.
Which painkiller should I take for a toothache?
Take an over-the-counter painkiller from the pharmacy (acetaminophen-type, or an anti-inflammatory such as ibuprofen) at the dose on the label. Taking more than the set dose does not cure the cause.
If you are pregnant, have a stomach ulcer, kidney, liver, or heart disease, or take blood thinners, you may need to avoid certain medications, so check your current medications with a pharmacist first.
What should I not do when I have a toothache?
| Action | Why not |
|---|---|
| Crushing a pill and putting it on the gum | The gum tissue gets sore and burned |
| Popping swollen gums with a needle | The infection can spread |
| Taking leftover antibiotics on your own | It leaves the decayed nerve or pus in place and only masks the symptoms |
| Leaving it because the pain stopped | When the nerve dies, it only hurts less for a while; the inflammation progresses outside the root |
Why does it throb even when I'm still?
Because the nerve inside the tooth (the pulp) is inflamed and the pressure can't escape. The pulp contains nerves and blood vessels, and when the vessels swell from inflammation, they are blocked by hard walls, so it throbs like a pulse and gets worse at night. At this stage, removing the cavity alone is often not enough, and depending on the examination it often leads to root canal treatment.
The Korea Disease Control and Prevention Agency also explains that if pain continues after the stimulus is gone, or hurts spontaneously enough to wake you at night, the damage to the pulp may be hard to reverse.
Can the type of pain tell me the cause?
| Type of pain | Suspected cause |
|---|---|
| Pain lingers after something cold or hot | Pulpitis |
| Hurts even when still, worse at night | Advanced pulpitis |
| Hurts when chewing or tapping | Inflammation at the root tip, a cracked tooth |
| Swollen gum with pus or a strange taste | Periapical abscess, periodontal abscess |
| Swollen gum at the very back, mouth hard to open | Inflammation around a wisdom tooth |
| Sharp pain when releasing a bite | Cracked tooth |
I don't confirm a diagnosis from the type of pain alone. I look at the depth of the cavity, cracks, gums, existing restorations, and the nerve's response, and take X-rays if needed. If it's in a molar, also see When a molar throbs.
How we do it at Wonjin Dental
On days when your face is swollen, you have a fever, or you can't open your mouth well, I don't leave it for a few days — I see you the same day. If the swelling reaches around the eyes or the neck, the swelling inside the mouth grows quickly, and breathing, speaking, or swallowing becomes difficult, it is an emergency. Don't wait for a dental appointment; go to the emergency room.
Pain stopping is not treatment. I often see a tooth that could have been treated relatively simply end up needing root canal treatment or extraction after someone held out on painkillers for a few days. What matters with a toothache is not how well you can endure it, but when you get the cause checked.
Frequently asked questions
Does a cold compress help with a toothache?
A cold compress wrapped in a towel on the outside of the cheek for 15–20 minutes at a time can reduce swelling and pain a little. Don't put ice directly on the painful tooth.
Why is a toothache worse at night?
When you lie down, more blood flows toward your head, increasing the pressure in the inflamed area. Sleeping with your head raised slightly on a higher pillow can sometimes help.
Where do I go if a toothache starts at night or on the weekend?
Use a dental clinic that's open or an emergency room. If you call 119 (Korea's emergency number), you can be directed to a hospital that can see you now. If there is swelling, fever, or difficulty breathing, the emergency room comes first.
Can I drink alcohol when I have a toothache?
Avoid it. Alcohol widens blood vessels and makes the throbbing worse, and drinking with painkillers puts a strain on the liver and stomach. It's better to take a break from alcohol and smoking until treatment.