When is a toothache an emergency? It is an emergency when the pain comes with swelling that makes it hard to breathe. Go to the emergency room or call 911 right away. Swelling in the face or a fever with a toothache can point to an infection and needs a dentist as soon as possible. A toothache without any of those signs is still worth a call to a dentist.
Why does a tooth hurt, and why can an infection spread?
A tooth has hard outer layers, and inside them sits the pulp. The American Dental Association (ADA) describes the pulp as the soft tissue of a tooth that contains nerves, blood vessels and connective tissue. The American Association of Endodontists (AAE) says the source of tooth pain may be dental decay, a cracked tooth or an infection.
Decay
Early tooth decay usually has no symptoms, according to the National Institute of Dental and Craniofacial Research (NIDCR). As it advances, it can cause a toothache or sensitivity to sweets, hot or cold. That is how a cavity can be there before anything hurts.
A crack
The AAE says that in a cracked tooth, chewing can move the pieces, and the pulp can become irritated. The AAE also lists sharp pain when biting down as a sign of decay, a loose filling, a crack or damage to the pulp.
An infection and an abscess
When decay or a crack lets bacteria into the pulp, the pulp can die. The ADA says pus can then build up at the root tip in the jawbone and form a pocket called an abscess. The AAE adds that an infection around the root may or may not be painful, so pain alone does not show whether one is there.
Why an infection spreads
The ADA says pus builds up at the root tip in the jawbone. The AAE describes where an infection can go in a cracked tooth. Extensive cracks can lead to infection of the pulp tissue. That infection can spread to the bone and gum around the tooth.
The ADA says an untreated abscess can lead to a serious infection in the jawbone, teeth and surrounding tissues. The NIDCR says an infected tooth can form an abscess that causes pain, facial swelling and fever. A fever matters because, in the ADA's words, an infection may have spread beyond its original source.
How a dentist treats an abscess
Treatment depends on the cause. The ADA lists a root canal among the options a dentist may consider when decay or a cracked tooth caused the abscess. Our root canals page explains what that treatment does.
When is a toothache an emergency, and when is it urgent?
To tell how serious a toothache is, start with the ADA's triage chart for dentists, written during COVID-19 and last updated in March 2021. It tells dentists to use their professional judgment, so treat it as a guide, not a diagnosis. It sorts problems into three groups: emergencies, urgent care and routine care. The groups below follow that list, with the AAE's tooth pain page filling in the detail. Our emergency dentistry page gives the practice's own, broader view of what counts as an emergency.
When should you go to the ER for a toothache?
The ADA calls its emergency group potentially life threatening. Two items in it apply to a toothache:
- Uncontrolled bleeding
- A soft tissue infection with swelling inside or outside the mouth that could compromise the airway
MedlinePlus, from the U.S. National Library of Medicine, describes Ludwig angina, an infection that often develops after an infection of the tooth roots, such as an abscess. It says breathing difficulty is an emergency. Go to the emergency room or contact the local emergency number, such as 911, right away.
Bitten tongue or lip
For a bitten tongue or lip, the ADA says to see your dentist or go to the emergency room. It says to do so if there is excessive bleeding, the bleeding will not stop or you are in a lot of pain. If an accident happens when your dental office is not open, it says to visit your local emergency room.
Which signs need a dentist as soon as possible?
The ADA describes its urgent group as conditions that need immediate attention to relieve severe pain or the risk of infection. The group includes:
- Severe pain from an inflamed pulp
- A localized infection with pain and swelling
- A fractured tooth that hurts or injures the soft tissue
- A knocked-out or displaced tooth
What the AAE adds
The AAE adds two patterns. Lingering pain after hot or cold food, typically more than 30 seconds, means the pulp is likely irreversibly damaged, the AAE says. It names deep decay or physical trauma as the cause. For constant and severe pain and pressure, with a swollen gum and a tooth that hurts to touch, it says the tooth may be abscessed.
What to do with a knocked-out adult tooth
For a knocked-out adult tooth, the ADA says to keep it moist at all times and get to your dentist's office right away. If you can, place it back in the socket without touching the root. If that is not possible, hold it between your cheek and gums or put it in milk. The AAE says it is best to see a dentist within 30 minutes of the injury. It adds that saving a tooth is possible even after an hour or more outside the mouth.
What can wait for a regular visit?
The ADA's routine group includes exams, cleanings, removing teeth that cause no symptoms, and treating cavities that cause no symptoms.
Problems that cause no symptoms
The NIDCR says a dentist can find decay at a regular check-up by examining the teeth and taking an X-ray. A cavity found that way belongs in the ADA's routine group.
Sensitivity that comes and goes
The AAE says momentary sensitivity to hot or cold food generally does not signal a serious problem. The exception is sensitivity that lasts for an extended period of time. For sensitivity to hot or cold foods after dental treatment, the AAE says to wait two to four weeks. If the pain persists or worsens, it says to have your dentist check for a more serious problem.
What to do in the meantime
For a toothache, the ADA says to rinse your mouth with warm water and gently floss out any food caught between your teeth. It says not to put aspirin on the tooth or gums, because it may burn the gum tissue. If the pain persists, contact your dentist.
What should you say when you call a dentist?
A one-page Assessment of a True Emergency on the AAE's site, dated March 2020, lists the questions to ask. They cover pain and when it began, swollen gums or face, fever, trouble swallowing, trouble opening the mouth and any injury.
Call Hanover Dental Care in Montpelier at (804) 544-2499. If your question is not about pain or swelling, you can send a message through our contact page.