Some Basics...

• The main cause of toothache is tooth decay (cavities). Problems from tooth decay can also cause pain. For example, a pus pocket can grow around a tooth with a cavity.
• Pain from other parts of the body can sometimes cause toothaches. For example, some earaches can cause people to feel tooth pain.
• A toothache that lasts longer than 24 hours means that something is wrong. Often it is a cavity, a cracked tooth, or an infected tooth.

Dental Causes of Toothache

• Dental cavity (tooth decay): pulpitis, periapical abscess
• Food stuck between teeth
• Lost crown
• Lost filling
• Gum disease: gingivitis, periodontal abscess, pericoronitis
• Tooth fracture: broken or cracked tooth

Other Causes of Toothache

• Canker sore (aphthous ulcer)
• Heart attack
• Ludwig's angina
• Sinusitis
• TMJ Syndrome
• Trigeminal Neuralgia

Pain Scale

• None: No pain. Pain score is 0 on a scale of 0 to 10.
• Mild: The pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
• Moderate: The pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
• Severe: The pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

Complications of Tooth Decay

• Cellulitis of the cheek
• Periapical dental abscess
• Ludwig's Angina: This is an infection of the floor of the mouth. It is serious. It is most often a complication from a dental abscess or tooth extraction. Symptoms are fever, a swollen/tender tongue, and trouble swallowing.
• Submandibular lymphadenitis

Caution: People may have a toothache or jaw pain as the only symptom of a heart attack. Most often, there will be other symptoms of a heart problem. These include chest pain, shortness of breath, nausea, and sweating.

1. What You Should Know:
   • Most toothaches are due to a sensitive tooth.
   • The pain will go away after a short time. If your pain gets worse or does not get better in 24 hours, it could be from a small cavity.
   • You can treat mild toothaches at home.
   • Here is some care advice that should help.
2. Floss: Floss on either side of the painful tooth to remove any wedged food.
3. Pain Medicines:
   • You can take one of the drugs listed below if you have pain.
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   Acetaminophen (Tylenol):
   • Regular Strength Tylenol: Take 2 pills (650 mg) every 4-6 hours. Each pill has 325 mg of acetaminophen.
   • Extra Strength Tylenol: Take 2 pills (1,000 mg) every 8 hours. Each pill has 500 mg of acetaminophen.
   • Do not take more than (3,000 mg) of this drug per day.
   Ibuprofen (Motrin, Advil):
   • Motrin and Advil: Take 2 pills (400 mg) every 6 hours. Each pill has 200 mg of ibuprofen.
   • A second choice is to take 3 pills (600 mg) every 8 hours.
   Naproxen (Aleve):
   • Aleve: Take 1 pill (220 mg) every 8 hours. Each pill has 220 mg of naproxen.
   • A second choice is to take 2 pills (440 mg) every 12 hours.
   Extra Notes:
   • Use the lowest amount of a drug that makes your pain feel better.
   • Your doctor might tell you to take more than what is shown above. That is because your doctor knows you and your health problems.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription drugs. It might be in more than one drug you are taking. Be careful how much you take. Too much of this drug can hurt the liver.
   • Caution- Acetaminophen: Do not take it if you have liver disease.
   • Caution- Ibuprofen and Naproxen:
     • Do not take ibuprofen or naproxen if you are pregnant.
     • Do not take these drugs if you have stomach problems or kidney disease.
     • Do not take these drugs for more than 7 days without checking with your doctor.
   • Read all package instructions.
4. Cold: Put an ice pack on the painful jaw for 20 minutes.
5. What to Expect: Most minor causes of toothache get better in less than a day.
6. Call Your Dentist If:
   • Toothache lasts more than 24 hours
   • The toothache gets worse