How to relieve toothache

In the middle of the tooth is a soft tissue called the pulp; it contains the nerve and blood vessels. When decay, a crack or wear approaches or reaches this tissue, the pulp reacts. The shape of that reaction, how long it lasts, what triggers it and when it comes, helps you guess the source even before you see a dentist.

A sharp pain that starts with cold water or something sweet and stops on its own within a few seconds of the trigger going away shows that the pulp is still experiencing irritation that can be reversed. The source is usually decay that has come close to the tooth, or an exposed root surface. This picture is not an emergency; booking an appointment within a few days is enough.

Throbbing pain that carries on for minutes after the trigger has gone, and that wakes you at night, points to something else: the pulp has now entered inflammation that cannot be reversed. This pain does not stop on its own; it only goes quiet between flare-ups. It getting worse when you lie down and at night comes from the pressure inside rising with each heartbeat.

If pain only appears when you bite on that tooth, the problem is usually not the pulp itself. A new filling left high in the bite, an invisible crack in the tooth, or a loose crown all give the same sign. The distinguishing point is that the pain does not come on its own, only when you bite.

If there is swelling in the gum, a bad taste in the mouth or a small blister on the gum, the inflammation at the root tip has found a way out. The pain may ease for a while at this point, but the infection has not stopped, it is simply draining. Waiting this out at home is the wrong call; you need to see a dentist.

What you can safely do at home is limited but real: rinsing with warm salt water, a cold compress held against the painful area from outside, ibuprofen or paracetamol following the patient information leaflet and your pharmacist's advice, not chewing on that side, and avoiding very hot, very cold or sweet foods. Pressing aspirin against the tooth or gum is a common mistake; aspirin is acidic and causes a chemical burn to the tissue. Applying heat from outside can also increase blood flow to the area and make swelling worse; a cold compress should be used instead.

The following signs are not something to wait out at home: swelling spreading towards your eye or neck, a high temperature, being unable to open your mouth even a finger's width, and difficulty swallowing or breathing. These signs show that the infection has gone beyond the tooth and spread into the surrounding tissue, even into spaces that can affect your airway. In this situation the place to go is not the next appointment but A&E; call the emergency number (112 in Turkey and across Europe) if needed.

The two lists below are not a diagnosis, only a guide to urgency. If you recognise yourself on the left, first aid at home and an appointment within a few days is enough. For the items on the right, do not wait.

This sequence is not a treatment; it is a checklist to help you make the right decision in the right order.

1. 1

   Observe the pain first

   Note when it started, what triggers it (cold, sweet things, biting), how long it lasts once the trigger is gone and whether it wakes you from sleep. Telling this to a dentist speeds up the diagnosis.

2. 2

   Apply safe first aid

   Rinse with warm salt water, hold a cold compress against the area from outside, take ibuprofen or paracetamol following the patient information leaflet and your pharmacist's advice, avoid chewing on that side and switch to soft food.

3. 3

   Only ever swallow aspirin

   If you have aspirin, take it by mouth with water only. Pressing it directly against the tooth or gum causes a burn; this should never be done.

4. 4

   Book an appointment within two days

   Even if the pain eases, the source does not go away on its own. Pain lasting more than two days, or that keeps coming back, needs a dentist's appointment.

5. 5

   Check for emergency signs

   If there is swelling in the face or neck, a high temperature, being unable to open your mouth, or difficulty swallowing or breathing, go to A&E without waiting for the next appointment. If you have unbearable pain outside working hours, you can use your local public dental service (oral and dental health centres, or the on-call dentist rota at hospitals, if you are in Turkey); call the emergency number (112 in Turkey and across Europe) without waiting if you have difficulty breathing or swallowing.

There is no single treatment for toothache; what is done depends on the source.

We are not writing this to frighten you, but so you can make the right decision for every day you spend at home.

How long it takes depends on the source. The timeline below is the realistic course for the pictures we see most often.

1. The first 24-48 hours

   Painkillers and home first aid usually reduce the severity, but the pain may not stop completely. Use this time to work out the source and book an appointment.

2. If it is simple decay or a filling

   Pain after a filling or crown goes away completely within a few days; a few days of mild sensitivity is normal.

3. After root canal treatment

   Throbbing pain eases noticeably within the first day; tenderness when biting lasts a few more days and reduces on its own.

4. If it is coming from the gum

   After a scale and clean, the gum firms up within a few weeks, and bleeding and tenderness reduce; regular care determines the outcome.

We do not give a single figure on this page, because until the source is found, the work to be done is not clear either: the same complaint ends with a single-session filling in one patient, root canal treatment in a second and an extraction in a third. These are the items that determine the price:

The source of the pain

A filling, root canal treatment, gum treatment and extraction are completely different procedures; their length and number of sessions also differ.

How much imaging is needed

In some cases a panoramic X-ray is enough. If a crack is suspected, a cone beam CT scan may be needed.

How many teeth are affected

A plan built around a single tooth and a plan covering several teeth are calculated separately.

How far the infection has spread

A spreading infection adds drainage and follow-up appointments; in a picture caught early, this item does not come into it.