Toothache: what is causing it, and what actually helps.

Most toothache comes from the tooth itself or the gum around it. Pain can be sharp and brief, a dull constant ache, or a throb that worsens when you lie down — and each pattern hints at a different cause. The important point is that teeth do not heal themselves: a cavity, a crack or an infection stays until it is treated. Relief at home is for managing the pain until you can be seen, not for fixing what is behind it.

The usual culprits are tooth decay that has reached the sensitive inner layers, a cracked or fractured tooth, a lost or failing filling, an exposed root from gum recession, or an infection (an abscess) at the root. Pain when biting often points to a crack or a high filling; lingering pain to hot and cold suggests the nerve is involved; a constant throb with swelling points to infection. Pain that radiates along the jaw or into several upper teeth at once can even be sinus-related rather than dental.

• Over-the-counter pain relief taken as directed — an anti-inflammatory such as ibuprofen, if it suits you, often works well for dental pain;
• A gentle warm salt-water rinse to clean the area and soothe the gum;
• A cold compress on the cheek for 15–20 minutes to dull the ache;
• Keeping your head raised, including propped up at night, since lying flat can make throbbing worse;
• Avoiding very hot, cold or sweet foods on that side until you are seen.

Do not hold an aspirin tablet against the gum — it burns the tissue rather than helping.

See someone promptly — not in a few days — if the pain comes with facial or gum swelling, a fever, or a bad taste of pus, as these suggest a spreading infection. Swelling that affects your eye, neck, or your ability to breathe or swallow is an emergency and needs urgent medical care, not a routine appointment. A toothache that stops a few days after being severe is not necessarily good news either — it can mean the nerve has died while infection continues quietly, so it is still worth checking.

Treatment depends on what is found, usually with a quick examination and a small X-ray: a filling for decay caught early, a root canal to remove infected pulp and save a badly affected tooth, a crown to protect a cracked one, treatment of the gum where recession or infection is the source, or removal only where a tooth genuinely cannot be saved. The aim is always to treat the cause and keep your own tooth wherever possible — not to reach for the most invasive option.