The type of pain tells you a great deal about what is happening. Brief sharp pain to cold that stops as soon as the cold is removed usually means sensitivity or early decay. Pain that lingers for minutes afterwards, or that wakes you at night, usually means the nerve inside the tooth is inflamed or dying, and that does not recover on its own.
Below is how to read it. None of it replaces an examination, but it will tell you how urgently you need one.
Reading the pain
Sharp, brief, triggered by cold or sweet — stops immediately
Typically exposed dentine: a small cavity, a worn or cracked filling, gum recession exposing root surface, or general sensitivity. Not an emergency, but it will not improve without treatment — see tooth sensitivity: causes and treatment.
Pain to cold or heat that lingers for minutes
This is the important distinction. Lingering pain suggests the pulp — the nerve inside the tooth — is significantly inflamed. At this stage the inflammation usually does not settle by itself, and the tooth generally needs root canal treatment. Book promptly rather than waiting to see whether it passes.
Pain to heat, relieved by cold
Often a sign of an irreversibly inflamed or dying pulp. People sometimes arrive holding a cup of cold water because it is the only thing that helps. It needs attention.
Spontaneous throbbing that wakes you at night
Classic pulpitis. It needs an appointment, not painkillers alone.
Sharp pain on biting, or on releasing a bite
Suggests a crack in the tooth, a high filling, or a problem at the root tip. Pain specifically when you release pressure is particularly associated with cracked teeth — see a broken or chipped tooth.
Constant, severe, well-localised pain and the tooth feels raised
Usually infection at the root tip. The tooth may feel taller than its neighbours. Needs urgent treatment.
Dull ache over several teeth, worse in the morning
Often clenching or grinding rather than decay, particularly if the jaw muscles are tender too — see teeth grinding and jaw clenching.
Aching in the upper back teeth on both sides, with a blocked nose
Can be sinus rather than dental. Usually worse bending forward and affects several teeth at once rather than one.
Pain around a partly erupted wisdom tooth, with swollen gum
Inflammation of the gum flap over the tooth. See wisdom teeth.
When to seek help immediately
Contact a dentist or attend an emergency service without delay if you have:
- Facial swelling, particularly if it is spreading, involves the eye, or extends under the jaw or into the neck.
- Difficulty swallowing or breathing.
- Fever with dental pain.
- Difficulty opening your mouth.
- Pain not controlled by ordinary pain relief.
A dental infection that is spreading is a medical emergency, not a dental inconvenience. Do not wait overnight with a swelling that is getting worse.
What helps until you are seen
- Take ordinary pain relief at the recommended dose — and do not exceed it. Follow the guidance on the packet and any advice specific to you.
- Keep the area clean; continue brushing gently even if it is tender.
- Rinse with warm salt water.
- Avoid very hot, very cold and very sweet things.
- Chew on the other side.
- Sleep with your head slightly raised, which often reduces night-time throbbing.
- A cold compress on the outside of the face for swelling.
What not to do
Do not put aspirin against the gum. It burns the tissue and does nothing for the tooth.
Do not apply heat to a swelling on the outside of the face.
Do not rely on antibiotics from a previous course or from someone else. Antibiotics do not treat a toothache. They may temporarily reduce swelling from an infection, but the source is inside the tooth and has to be dealt with mechanically — the pain almost always returns.
Do not ignore pain that stops. A tooth that hurt badly and then went quiet has often had the nerve die. The pain stops; the infection does not.
What happens at the appointment
An examination, radiographs, and tests to identify which tooth is responsible — which is less obvious than it sounds, since pain from one tooth is frequently felt in another or in the opposite jaw. Tests may include cold applied to individual teeth, tapping them gently, and checking how you bite.
Treatment depends on the cause: a filling, root canal treatment, treatment of the gum, drainage of an infection, adjustment of a high contact, or extraction where the tooth cannot be saved.
Why the pain is often in the wrong place
Patients routinely point confidently at a tooth that turns out to be healthy, and this is not carelessness — it is how the nerve supply works.
The pulp inside a tooth has no proprioceptive nerve fibres, meaning it cannot tell the brain where it is. Early pulp pain is therefore genuinely diffuse: you know the side, often not the tooth, and sometimes not even the jaw. Upper and lower teeth on the same side share nerve pathways closely enough that pain from an upper molar is frequently felt in the lower jaw, and occasionally the reverse.
Two useful consequences. First, do not be surprised if testing identifies a different tooth from the one you expected. Second, pain that becomes sharply localised, with the tooth tender to tap and feeling raised, usually means the inflammation has reached the ligament around the root — which can localise. That change is diagnostically useful and worth reporting.
What to tell us on the phone
These details determine how urgently you are seen and often shorten the appointment considerably:
- How long it has been going on.
- What triggers it — cold, heat, sweet, biting, or nothing at all.
- How long it lasts after the trigger goes: seconds, or minutes.
- Whether it wakes you at night.
- Whether anything relieves it, including cold water.
- Whether there is any swelling, in the gum or the face.
- Whether you have a fever or feel unwell.
- What pain relief you have taken, how much, and whether it worked.
- Any recent dental work on that side.
The two that change the urgency most are swelling and whether pain is controlled by ordinary analgesia.
Pain after recent dental treatment
A common and separate situation. Some discomfort after a deep filling, a crown preparation or a deep clean is expected and settles over days to a couple of weeks. What is not expected:
- Pain on biting after a new filling or crown. Usually the restoration is fractionally high. It is adjusted in a minute or two and should never be endured — a high contact can inflame the nerve.
- Sensitivity that worsens over the days after treatment rather than easing.
- Pain that starts spontaneously where there was none before.
- Severe pain three to five days after an extraction, often with a bad taste — likely dry socket, which is quickly relieved once dressed.
None of these mean something has been done badly. All of them mean call rather than wait.
Frequently asked questions
The pain went away. Do I still need to go?
Yes. Pain stopping often means the nerve has died, and infection follows.
Can a toothache be nothing?
Brief sensitivity after a filling, or after whitening, can settle. Pain lasting days, or waking you, does not.
Which painkiller is best?
Take what you would normally take for pain, at the recommended dose, and tell us what you have taken. If it is not controlling the pain, that is itself a reason to be seen.
Will I lose the tooth?
Most painful teeth are saved. The chance is better the earlier it is seen.
Why does it hurt more at night?
Lying flat increases blood pressure in the head, which increases pressure in an inflamed pulp. Raising your head helps.
Get seen rather than waiting it out
Toothache is one of the few dental problems that reliably gets worse and more expensive with delay. See our general dentistry page and dental emergencies.
To reach our clinic on Abbas El-Akkad in Nasr City, call +20 101 969 7597 or message us on WhatsApp.
