Toothache: what to do while you wait for the dentist

A toothache rarely shows up at a convenient time. It wakes you at night, ruins a meal, settles in on a Friday evening. While you wait to see the dentist, a few simple steps can bring relief — and a few common mistakes can make things worse. Here's what you need to know.

Where does the pain come from?

A tooth hurts when its nerve is irritated or infected. The most common causes are deep decay, a crack, an old filling that has given way, an abscess, or an infected gum around a wisdom tooth. Brief sensitivity to cold is often harmless. Pain that throbs, wakes you at night or lingers long after eating usually means the nerve is involved and you should be seen.

Sometimes "tooth" pain comes from somewhere else: a sinus infection can make the upper molars ache, and a clenched jaw makes several teeth hurt at once. The dentist will be able to tell the difference.

What you can do right now — and what to avoid

• Rinse with warm, lightly salted water (half a teaspoon of salt in a glass of water) to clean the area and soothe the gum.
• Gently floss around the tooth: a trapped piece of food can cause surprising pain.
• Take an over-the-counter pain reliever such as acetaminophen or ibuprofen, following the label and your own health restrictions. When in doubt, ask the pharmacist.
• Hold a cold compress against your cheek, 15 minutes at a time, if the area is swollen.
• Chew on the other side and avoid very hot, very cold or sugary foods.
• Sleep with your head slightly raised: lying flat increases the pressure inside the tooth, and often the pain.

There are also things not to do. Never place an aspirin tablet, or any other painkiller, directly on the gum or tooth: it doesn't help, and the acid burns the tissues of the mouth. Avoid heat on the cheek, which can help an infection spread. Don't try to drain an abscess yourself, and don't take leftover antibiotics from an old prescription. Finally, don't let a lull reassure you: when a nerve dies, the pain sometimes fades for a few days before the infection comes back stronger.

When it's urgent

Some signs call for a same-day visit, or a trip to the hospital emergency department if no dentist is available: swelling of the face or neck, fever, difficulty opening your mouth or swallowing, or intense pain that no pain reliever touches. Swelling that makes it hard to breathe is a medical emergency: call 911.

In every other case, a toothache is still a signal not to ignore. The dentist can find the cause, often treat it in one or two visits, and above all end the pain. The sooner it's looked at, the better the odds of keeping the tooth.