These are severe pains in the mouth

What are toothaches?

Toothaches are uncomfortable pains that can occur not only in the teeth themselves but also in the gums, the jaw, or surrounding tissues. They present in different types of pain — from a pulling or stabbing sensation to dull, throbbing pain. Intensity ranges from mild discomfort to severe, persistent pain that can significantly impact daily life.

Toothaches often occur only under certain conditions, e.g. when chewing, brushing teeth, or in contact with hot, cold, sweet or acidic foods. In some cases they develop spontaneously without any obvious external trigger. Accompanying symptoms such as swelling, redness or increased sensitivity are also possible. Depending on the cause, toothaches may be occasional or become chronic over a longer period.

How do toothaches develop?

Toothaches develop when the sensitive nerve fibres inside the tooth are irritated. Normally, the enamel protects the tooth interior from external influences like temperature changes or chemicals. Beneath this hard layer lies the dentin, which contains tiny tubules leading to the pulp, where nerves and blood vessels are located.

If the enamel is damaged or worn away, external stimuli can reach the dentin unimpeded and cause pain. Gum recession can also expose sensitive tooth necks, which react painfully to cold, heat or acidic foods. If bacteria penetrate the tooth interior through weakened protective layers, an inflammation may develop that intensifies pain perception. If left untreated, the infection can spread to the root and permanently damage the tooth nerve.

What can cause toothaches?

Toothaches can have many causes that are not always directly related to the teeth. However, dental diseases are often the reason for the discomfort. The best-known cause is tooth decay (caries), where bacteria convert sugars and carbohydrates into acids that attack the enamel. If decay progresses and reaches the dentin, painful sensations occur, often triggered by hot, cold or sweet foods.

Another common cause is gum disease such as gingivitis and periodontitis. Gingivitis usually causes redness and swelling of the gums rather than pain, and it typically resolves with good oral hygiene. If the inflammation is not treated, it can develop into periodontitis, where the gums recede and tooth necks become exposed, causing pain.

Toothaches caused by an inflammation of the tooth nerve (pulpitis) are severe, throbbing pains often accompanied by a feeling of swelling and sometimes fever. In severe cases, a dental abscess may form, also causing intense pain. Another frequent cause of toothaches is accidents in which teeth are knocked out or injured.

Besides direct dental diseases, toothaches can also be triggered by other health problems. An inflammation of the sinuses can cause dull pain that radiates into the molars. Likewise, dysfunctions of the jaw joint, such as craniomandibular dysfunction (CMD), can lead to toothaches radiating into the jaw and surrounding areas. A trigeminal neuralgia, where the facial nerve is inflamed, can also cause sudden tooth pain.

In rare cases, toothaches may also indicate more serious conditions such as migraine, shingles or heart problems. Therefore, it is important to see a dentist for persistent toothaches to determine the exact cause and start the appropriate treatment.

Toothache with a dead tooth — is that possible?

Tooth pain can occur even with a dead tooth. The term “dead tooth” describes a tooth whose inner tissue, the pulp, has died. This tissue normally contains nerves and blood vessels that nourish the tooth and are responsible for pain perception. When the pulp is dead, that connection is absent and the tooth itself may no longer generate pain.

Toothaches can however occur if, for example, an inflammation develops around the root or in the surrounding tissue. A progressing infection can irritate the affected area and cause severe pain. Another sign of a problem is a sudden disappearance of pain — this may indicate that the tooth has died and there are no nerves left to send pain signals.

In some cases, external factors such as dental trauma that damages the tooth, or decay that has reached deep into the pulp, can lead to a dead tooth. If the tooth is not treated, an infection can spread and lead to further health complications. Therefore, a dentist should examine the tooth and, if necessary, perform a root canal treatment or remove the tooth to avoid long-term health damage.

Are chronic toothaches possible?

Yes, chronic toothaches are possible and particularly unpleasant because they persist over a long period. Unlike acute toothaches, often caused by an inflammation of the tooth nerve or root, chronic toothaches frequently involve hypersensitivity. This can be caused by repeated dental treatments such as fillings or dental corrections.

A common but often not directly recognisable cause of chronic toothaches is craniomandibular dysfunction (CMD), where the jaw muscles are overloaded, leading to persistent pain. Treating chronic toothaches requires an accurate diagnosis of the cause, e.g. through periodontal treatment, root canal therapy or possibly tooth extraction. Antibiotics alone are usually not sufficient, as they only relieve the acute inflammation but do not eliminate the underlying cause.

When should you see a dentist for toothaches?

There are several signs that require an immediate visit to the dentist. A clear warning sign is the onset of severe toothache, especially when accompanied by fever, nausea or swelling. These symptoms indicate a serious infection that requires immediate medical intervention. If a wound from an accident does not stop bleeding, or a tooth has been knocked out by a blow, an immediate dental visit is necessary.

You should also not hesitate if sudden sharp tooth pain occurs that may be accompanied by fever and facial swelling. These symptoms can indicate an inflammation of the pulp or a deeper infection that must be treated quickly to avoid complications. A sharp pain when chewing or biting can also indicate a tooth fracture or a damaged filling. Another sign of an emergency is severe toothache after dental procedures that does not subside over an extended period. Pain associated with wisdom tooth development, especially if they are breaking through the gum or growing at an angle, also warrants a consultation.

What you can do yourself against toothache: practical tips

• Use sage or chamomile tea as a mouthwash or for gargling to relieve pain and inflammation. Both have antibacterial properties and soothe irritated gums.
• Prepare a saline solution for rinsing. Dissolve a teaspoon of salt in a glass of lukewarm water and rinse your mouth with it. This helps reduce bacteria and soothe inflammation.
• Coconut oil is a gentle remedy for oral inflammation. Let it slowly melt in the mouth or apply it directly to the painful areas.
• Try tea tree oil or black seed oil. Apply a few drops with a cotton swab to the affected area to use their antibacterial effect. Be careful not to swallow the oil.
• Place a clove directly on the painful tooth and bite down slightly. The active ingredient eugenol has an anaesthetic effect.
• Apply clove oil to painful spots for an analgesic effect, but do not use too much as it can irritate the oral mucosa.
• Place an ice pack wrapped in a cloth on the painful cheek to reduce pain and inflammation. Only apply cooling externally.
• If cold worsens the pain, you can gently apply a warm cloth to the affected area to promote blood circulation.
• Chop an onion, wrap it in a cloth and place it on the painful cheek to use its anti-inflammatory properties.
• Crush a peeled garlic clove and place it on the painful tooth to benefit from its antibacterial properties.
• Wrap a chilled cabbage leaf in a damp cloth and place it on the affected cheek to reduce swelling.
• Press the points on the wrist or between thumb and forefinger for a few minutes to achieve a calming effect.
• Use an alcohol-free mouthwash with anti-inflammatory agents to ease pain from gingivitis. For a lower-jaw abscess, an antibacterial mouthwash can additionally help protect the periodontal structures. Prompt treatment is important to prevent the infection from spreading to the jaw bone.
• If teeth grinding causes dental problems or headaches, use a night guard. Painkillers provide short-term relief. If the tooth nerve is affected, a root canal treatment may be necessary. Medication can help with severe jaw tension.
• Although home remedies may provide temporary relief, you should have the cause of the pain checked by a professional to avoid serious problems.

Toothaches should always be taken seriously, as they often indicate more significant problems. Early treatment and good oral hygiene help relieve symptoms and prevent long-term damage.