Toothache and Gum Problems

Overview

Toothaches and gum problems are common. But you can usually prevent them by taking good care of your teeth and gums. Keeping your teeth, gums, and the bones around your teeth healthy requires regular brushing, flossing, and good nutrition. Brush your teeth twice a day with a fluoride toothpaste that's approved by the American Dental Association (ADA). Clean between teeth daily with floss or an interdental cleaner.

Toothaches

Sometimes you may have tooth pain when you touch a tooth or when you eat or drink foods that are hot, cold, sweet, or sour (a sensitive tooth). Mild sensitivity can be caused by shrunken (receded) gums or a worn-down tooth. Moderate to severe sensitivity can mean that you have a cracked tooth, a dental cavity, or a lost filling. Seeing a dentist for treatment can prevent the tooth from dying.

The most common cause of a toothache is tooth decay. But you might not have a toothache in the early stages of decay. Other reasons for a toothache might include:

  • An infection of or around the tooth (abscess). A red, swollen, painful bump may be found near or on the side of the sore tooth. The tooth may hurt more when you bite down.
  • A tooth that has not broken through the gum (impacted tooth). Gums may be red, swollen, and sore. The area around this tooth can ache, throb, and be quite painful.
  • Problems with or injury to the nerves in the center of the tooth (pulp). These can be caused by an injury to the face or from grinding or gnashing the teeth.

Sometimes a toothache can be caused by another health problem, such as:

Gum problems

Healthy gums are pink and firm and don't bleed easily. Now and then, your gums may bleed if you brush your teeth and gums too hard, use a hard-bristled toothbrush, or snap dental floss hard against your gums. Be gentle with your teeth. Use a soft-bristled toothbrush and floss carefully to help prevent bleeding gums.

Gingivitis is a gum disease that causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people delay treatment. If not treated, gum disease can cause more serious problems with the gum tissue.

Periodontitis is severe gum disease. It's caused by long-term infection of the gums, bone, and other tissues that surround and support the teeth. It can progress until the bones that support the teeth are damaged. In this late stage, teeth may become loose and fall out or need to be removed. Early treatment of gum disease is important to prevent tooth loss.

Other causes of gum bleeding, swelling, and pain include:

  • Pregnancy, blood-thinning medicines, and bleeding disorders. Each of these can cause gums to bleed easily.
  • Lack of vitamins, such as vitamin K or vitamin C, or medical problems, such as anemia, that interfere with how well the body can absorb certain vitamins.
  • Teething in babies and young children.
  • Medicines such as Dilantin or calcium channel blockers.
  • Dentures or a dental appliance that irritates the gums.
  • An infection around the root of the tooth. Swelling and redness, sometimes with pus, may appear at the base of a tooth.

Smoking and using other tobacco products increases your risk for gum disease. Smokers have a higher chance of having gum disease throughout their mouths than nonsmokers. But you might not have symptoms of bleeding or swollen gums. That's because the normal bleeding immune response is affected by tobacco use. Chewing tobacco or using snuff may push back the gums in the area of the mouth where the tobacco is inserted. Constant irritation caused by tobacco products increases your risk of oral cancer.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Actionsets are designed to help people take an active role in managing a health condition.

Check Your Symptoms

Do you have a toothache or a problem with your gums?
Yes
Toothache or gum problem
No
Toothache or gum problem
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female

The medical assessment of symptoms is based on the body parts you have.

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Do you have an injury to your mouth or teeth?
Yes
Injury to mouth or teeth
No
Injury to mouth or teeth
Could you be having symptoms of a heart attack?
In some cases, a heart attack may cause a strange feeling in part of the face, such as the jaw.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Do you have a toothache?
Yes
Toothache
No
Toothache
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Is the toothache disrupting your sleep or other activities?
Yes
Toothache is interfering with sleep or other activities
No
Toothache is interfering with sleep or other activities
Do you have swelling or pain in your face?
Yes
Swelling or pain in face
No
Swelling or pain in face
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Do you have diabetes, a weakened immune system, or any surgical hardware in the area?
"Hardware" in the facial area includes things like cochlear implants or any plates under the skin, such as those used if the bones in the face are broken.
Yes
Diabetes, immune problems, or surgical hardware in affected area
No
Diabetes, immune problems, or surgical hardware in affected area
Do you have problems with your gums?
Yes
Gum problems
No
Gum problems
Do you have a red, swollen, painful bump on your gum next to a sore tooth?
Yes
Red, swollen, painful bump on gum next to a sore tooth
No
Red, swollen, painful bump on gum next to a sore tooth
Do you have new bleeding from your gums?
Yes
New bleeding from gums
No
New bleeding from gums
Do you take a medicine that affects the blood's ability to clot?
This may include blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. These medicines can cause bleeding and can make it harder to control bleeding.
Yes
Takes medicine that affects blood's ability to clot
No
Takes medicine that affects blood's ability to clot
Are any of your teeth sensitive to heat, cold, sweet or sour things, or air?
Yes
Teeth sensitive to heat, cold, sweet or sour things, or air
No
Teeth sensitive to heat, cold, sweet or sour things, or air
Is the sensitivity problem moderate to severe?
Yes
Moderate to severe tooth sensitivity
No
Moderate to severe tooth sensitivity
Has the sensitivity problem lasted more than a week?
Yes
Tooth sensitivity for more than 1 week
No
Tooth sensitivity for more than 1 week
Do you think that a medicine could be causing the problem?
Yes
Medicine may be causing tooth or gum problem
No
Medicine may be causing tooth or gum problem
Are dentures or any other type of dental device (like a crown or filling, for instance) causing pain or discomfort?
Yes
Discomfort from dentures or other dental appliance
No
Discomfort from dentures or other dental appliance
Have you had a toothache or gum problems for more than 2 weeks?
Yes
Toothache or gum problems for more than 2 weeks
No
Toothache or gum problems for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Many prescription and nonprescription medicines can cause mouth problems. A few examples are:

  • Antibiotics.
  • Some seizure medicines.
  • Medicines used to treat cancer (chemotherapy).
  • Steroid medicines.
  • Medicines used after organ transplant.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your dentist today to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your dentist in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your dentist. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your dentist now to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care in the next hour.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Mouth and Dental Injuries

Self-care

Try these tips to help treat a sensitive tooth, toothache, or gum problem.

  • Treat tooth sensitivity.

    You can reduce sensitivity to heat, cold, or brushing.

    • Use a toothpaste specifically designed for sensitive teeth.
    • Brush with it regularly, or rub a small amount of the paste on the sensitive area with your finger 2 or 3 times a day.
    • Floss gently between your teeth.
  • Ease a toothache.
    • Use an ice pack on the outside of your cheek to reduce pain and swelling. Don't use heat.
    • Avoid very hot, cold, or sweet foods and drinks if they make your pain worse.
    • Adults can apply an over-the-counter benzocaine gel to the tooth for short–term relief. Do not use teething gels for children younger than age 2. Ask your doctor before using mouth-numbing medicine for children older than age 2. The U.S. Food and Drug Administration (FDA) warns that some of these can be dangerous. Be safe with medicine. Read and follow all instructions on the label. If your pain lasts longer than a few days or it gets worse, call a doctor.
  • Treat gum problems.
    • Use a tartar-control toothpaste that contains fluoride. And use a mouthwash that contains fluoride if your gums are mildly swollen and red.
    • Make sure to brush after meals and snacks and floss every day.
    • Chew sugar-free gum, use a toothpick, or rinse your mouth with warm salt water if you can't brush after eating. You can make your own salt water by mixing 1 tsp (5 mL) of salt in a medium-sized glass [ 8 fl oz (240 mL)] of warm water.
    • Don't smoke or use other tobacco products. Tobacco can cause many gum problems, decrease your ability to fight infection of your gums, and delay healing.
    • Don't use illegal drugs, such as methamphetamines, that cause tooth and gum problems.

Caring for a loose tooth

Try these tips for caring for a loose tooth.

  • Protect a slightly loose tooth.

    Teeth that are slightly loose but still in their normal position should tighten up in 1 to 2 weeks.

    • Eat a diet of soft foods for 1 to 2 weeks.
    • Be gentle when you brush or floss.
    • Wear a mouth guard or face protection if you play sports.
  • Remove a very loose baby tooth in a child.
    • First, tilt your child's head forward and down so that when the tooth comes out, it doesn't fall to the back of the throat, causing your child to choke or swallow the tooth.
    • Grasp the tooth with gauze or a washcloth, and pull firmly with a twisting motion.

Caring for a knocked-out tooth

Mouth injuries that are forceful enough to knock out a tooth may also damage other teeth or other structures in the mouth or face, such as the roof of the mouth, gums, lips, or cheeks. A permanent tooth can sometimes be put back into its socket (reimplanted). The best results occur if a dentist puts the tooth back in the socket within 30 minutes. Chances of successful reimplantation are unlikely after 2 hours.

  1. Find the tooth.
    • For a baby tooth (primary tooth): Apply clean gauze to the gum and socket for about 15 minutes to control the bleeding. A baby tooth is not reimplanted after it has been knocked out because the reimplantation may cause problems with later development of the permanent tooth. Your child will need to be checked by a dentist even if the tooth was getting ready to fall out soon.
    • For a permanent tooth: Apply clean gauze and continue with the steps listed below.
  2. Rinse the tooth.
    • Rinse the tooth gently with tap water while holding it by the top of the tooth (crown). Do not rub or scrub the tooth or touch the root.
  3. Store the tooth properly for transport to the dentist.
    • The best way to transport a tooth is to put it back into the socket. Gently place it back into its normal position. Do not be concerned if it sticks out slightly. Bite down gently on gauze or a moistened tea bag to help keep the tooth in place. Hold the tooth in the socket with your finger during transport.
    • An adult or older child may be able to keep the tooth in his or her mouth between the gums and the cheek or under the tongue, being careful not to swallow it.
    • A young child should not be expected to do this.
    • If the adult or child is too anxious to put the tooth in the socket or hold it between the gums and the cheek, place the tooth in milk. If milk is not available, use tap water or a nonprescription product, such as Hank's solution or Save-A-Tooth.
    • Do not put the tooth in salt water, alcohol, or mouthwash.
  4. Seek immediate care.
    • Call your dentist immediately to arrange for your care. If you are unable to talk with your dentist right away, go to a hospital emergency room immediately. Be sure to take the tooth with you.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

  • New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
  • New or worse dehydration.
  • Symptoms occur more often or are more severe.

Learn more

Preparing For Your Appointment

Credits

Current as of: June 30, 2021

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine