Toothache: causes, solutions and when to consult

1. What is a severe toothache?

A severe toothache refers to an intense and sudden dental pain, often described as throbbing, stabbing or burning. It can occur day or night and disrupt sleep, eating and concentration. Unlike simple sensitivity, it usually reflects deep inflammation of the tooth or surrounding tissues.

It is important not to let a severe toothache progress: a dental infection can spread to soft tissues, bone or even to other regions of the body through the lymphatic system.

2. The main causes of toothache

• Deep cavity reaching the pulp (pulpitis): dentine and enamel are destroyed by bacteria; the dental nerve becomes sensitive to cold, heat and pressure. This is the most common cause.
• Dental abscess: acute infection at the root or gum, accompanied by swelling, sometimes fever and an unpleasant smell.
• Erupting or impacted wisdom tooth: pressure on neighbouring teeth, inflammation of the gum flap (pericoronitis).
• Bruxism or teeth grinding: enamel erosion, hypersensitivity and muscle pain.
• Dental fracture: crack or chip exposing the dentine or pulp.
• Acid reflux or acid erosion: thinning of the enamel on back teeth.
• Dental trauma: recent or old impact that damaged the nerve without immediate symptoms.

3. What to do while waiting for the dentist?

These steps do not treat the cause but may temporarily relieve the pain before your appointment:

• Lukewarm salt-water rinse (1 teaspoon of salt in a glass of warm water): helps disinfect locally and reduce inflammation.
• Cold compress on the cheek, 10 to 15 minutes per hour, to limit swelling and inflammation.
• Painkiller: paracetamol or ibuprofen if you are used to it and have no contraindication. Follow the dosage and avoid placing aspirin directly on the gum (risk of chemical burn).
• Avoid very hot, very cold, sugary or acidic foods, and chewing on the painful side.
• If a wisdom tooth is involved, an antiseptic mouthwash can help keep the area clean.

4. Definitive solutions by the dentist

Only a targeted dental treatment will durably end the toothache. Depending on the diagnosis, the practitioner will offer:

• Composite filling for a superficial to moderate cavity, performed in one session under local anaesthesia.
• Endodontic treatment (root canal) when the nerve is infected or inflamed. The canal is cleaned, disinfected and sealed. In most cases, a crown is then placed to protect the tooth.
• Abscess drainage in an emergency, followed by root canal treatment or extraction depending on the tooth's prognosis.
• Dental extraction when the tooth is too damaged or the periodontium severely affected. It can be followed by a dental implant to replace the missing tooth.
• Protective nightguard in case of bruxism, combined with hygiene advice and sometimes treatment for sensitive teeth.
• Wisdom tooth extraction if it is impacted, poorly positioned or the source of recurring infections.

5. When to seek emergency care?

Some situations require immediate care:

• Unbearable pain not relieved by painkillers.
• Visible facial or submandibular swelling.
• Fever above 38 °C accompanied by dental pain.
• Difficulty opening the mouth (trismus) or swallowing.
• Dental fracture with persistent bleeding.
• Tooth completely knocked out (avulsion): emergency within the hour.

The practice handles dental emergencies in Boulogne-Billancourt and strives to arrange prompt appointments for acute pain.

6. Preventing toothache

• Brush twice a day with a soft toothbrush and fluoride toothpaste.
• Daily interdental cleaning (interdental brushes or floss) to remove plaque between teeth.
• Check-up visit every 6 to 12 months to detect cavities early, before they reach the nerve.
• Limit sugary snacks and drink water after meals to neutralise acids.
• Wear a protective nightguard if you grind your teeth at night.
• Treat wisdom teeth before they become symptomatic.

Frequently asked questions