My tooth hurts tonight: how urgent is it, and what should I tell the dentist?

What your dentist is trying to work out

A toothache is a symptom, not a diagnosis. When you call, the team is trying to answer two questions quickly: what is probably causing the pain, and how far has it gone. Decay that has reached the inner part of the tooth, a cracked tooth or filling, an abscess at the root, gum disease and an exposed root surface can all hurt, and sometimes sinus pressure or an ear or jaw problem feels like a toothache. Pain you can describe clearly, plus the presence or absence of swelling and fever, usually tells us how soon you need to be seen.

Early decay confined to enamel generally causes nothing at all, which is why a tooth that hurts has often been developing a problem for a while. Pain tends to begin once decay or a crack reaches the dentin and the nerve, and the pattern of that pain is the most useful thing you can observe tonight.

What sets the pain off, and how long it lasts

• A quick twinge with cold, sweet or cold air that stops within seconds. This usually means dentin is exposed by a small cavity, a worn or receded area, a chipped filling or a bare root. It is uncomfortable but rarely urgent; avoid the trigger and book a routine appointment, sooner if the pain changes, lasts more than a day or two, or starts on its own.
• Pain that lingers after hot or cold, starts on its own, or wakes you from sleep. This pattern often points to an inflamed nerve inside the tooth. It is not usually dangerous overnight, but it usually needs treatment rather than time, so aim to be seen within a day or two.
• Throbbing pain, a tooth that is tender to bite on, or a bad taste in the mouth. These suggest the nerve has become infected and the infection is reaching the bone around the root. Contact a dentist the same day.
• Sharp pain when you bite down or let go. A cracked tooth or a failing filling can behave this way, especially after biting something hard. Chew on the other side, save any pieces of tooth, and arrange an appointment within days.
• Aching across several upper back teeth with a stuffy nose or facial pressure. A sinus infection can feel like a toothache. It still deserves a look, because an examination can tell the difference.

Swelling and fever

Swelling changes the picture because it means infection has moved beyond the tooth itself. A small, soft swelling or "pimple" on the gum beside one tooth, without fever, needs same-day dental contact but is not a reason to go to a hospital. Swelling of the cheek or jaw without a fever, swollen glands in the neck or feeling generally unwell mean the infection is spreading and needs dental attention today. Facial swelling together with a fever is emergency care now. If the swelling is moving toward the eye or down the neck, or you have any difficulty swallowing or breathing, that is emergency care now (see below). The companion guide on facial swelling with tooth pain covers these decisions in more detail.

Injury and bleeding

• An adult tooth knocked out. Time matters. Hold the tooth by the crown, not the root, rinse it gently with water without scrubbing if it is dirty, and try to place it back in the socket. If that is not possible, keep it in a small container of milk, and get to a dentist or emergency department right away.
• A broken or cracked tooth. Rinse with warm water, use a cold compress on the cheek, keep any pieces, and see a dentist promptly.
• Bleeding that does not stop with steady pressure, or a possible broken jaw. Go to the emergency department.

When tooth pain is an emergency tonight

Go to the nearest emergency department or call 911, rather than waiting for an appointment, if you have any of the following:

• Difficulty breathing or swallowing, drooling because you cannot swallow, or a muffled voice.
• Facial swelling together with a fever, or swelling that is spreading toward the eye, under the jaw or down the neck, or getting worse by the hour.
• You cannot open your mouth normally and your jaw or face is also swollen, or you have a fever.
• Bleeding that will not stop, or a serious injury to the face or jaw.
• Tooth or jaw pain together with chest pressure, shortness of breath, sweating or pain spreading into the arm, which can be a heart attack rather than a dental problem.

Dental infections that spread into the floor of the mouth and neck can block the airway. Emergency departments can protect the airway, give antibiotics and drain infection; the tooth that started the problem still needs dental treatment afterward, so let the dental office know. These situations are uncommon, but they are the reason swelling and fever are taken more seriously than pain alone.

What usually helps overnight, and what does not

• Over-the-counter pain relievers, taken exactly as directed on the label. Pain relief is reasonable while you wait to be seen. If you take other medicines, have kidney, liver, stomach or heart conditions, are pregnant, or are unsure what is safe for you, ask a pharmacist before choosing one. Never take more than the label allows because the pain is severe.
• Rinse with warm water and floss gently. Food trapped between teeth or under the gum can cause surprising pain, and removing it sometimes helps.
• A cold compress for swelling or a broken tooth. A cold pack wrapped in a cloth and held against the cheek can ease discomfort and limit swelling.
• Avoid the triggers. Skip very hot, cold or sweet foods and drinks, and chew on the other side.
• Do not put aspirin or any other tablet against the gum. It can burn the tissue and does not treat the tooth.
• Do not take leftover antibiotics. Most toothaches do not need antibiotics at all; they are not a substitute for treating the tooth and can delay proper care. When antibiotics are needed, for spreading infection or fever, a dentist decides that after an examination.
• Do not try to drain a swelling yourself.

What to tell the office in the morning

Clear information lets the team decide whether you need a same-day visit or a scheduled one, how much time to set aside and whether X-rays are likely. Have these ready when you call:

1. Which tooth or area hurts, and whether the pain is sharp, dull or throbbing.
2. When it started and whether it is getting better, worse or staying the same.
3. What sets it off: hot, cold, sweet, biting, lying down, or nothing at all.
4. How long it lasts after the trigger: seconds, minutes, or constant.
5. Whether it wakes you at night.
6. Any swelling, where it is, and whether it has changed since you first noticed it; a phone photo helps.
7. Your temperature if you have measured it, and whether you feel generally unwell.
8. Any recent injury, a lost filling or crown, or recent dental work on that tooth.
9. What you have taken for the pain, how much and when.
10. Your medical conditions and medicines, especially blood thinners, diabetes, heart valve problems, a joint replacement, a weakened immune system, pregnancy and any allergies. Do not stop a blood thinner on your own; if a change is ever needed, the dentist and the physician who prescribes it decide together.

Bring any recent X-rays from another office; recent images often do not need to be repeated.

How to reach Loul Dental Studio

The office is open Monday to Thursday, 8:00 am to 5:00 pm, with select Fridays by appointment, at (805) 565-5111. For pain, call rather than using the online form: an appointment request is not a confirmed appointment, and the team follows up during office hours. Ask the office how it prefers to hear about urgent problems, so you know what to do if this happens again. If the emergency signs above appear at any hour, go to the emergency department first and tell the office afterward. The practice lists emergency dental care among its services; reach it by calling during office hours.

The next step

A toothache that settles by morning still needs an examination. Pain that fades on its own does not always mean the problem is gone; untreated decay can keep progressing toward the nerve and lead to infection without constant pain, which is one reason a cavity can exist without pain. An examination and, when needed, an X-ray show whether the tooth is settling or whether treatment is needed now, when it is usually simpler. Write down what you noticed tonight and bring the notes with you.