Toothache: what to do next

First — is this an emergency?

Go to a hospital emergency department, or call 000, if you have:

A dental infection that is spreading into the face can compromise the airway. That is a hospital presentation, not a dental appointment, and it should not wait until morning.

Outside our hours

We are open Monday to Friday, 8:00am to 5:00pm and do not run an after-hours service. Between 5:00pm and 8:00am, and at weekends:

What you can do right now

Do not hold aspirin — or any tablet — against the gum. It burns the tissue and leaves you with a chemical ulcer on top of the toothache. Pain relief works by being swallowed.

Clove oil is a common home remedy. It may dull the pain briefly; it does nothing to the cause, and it can irritate the gum. It is not a substitute for being seen.

What not to do

Do not Why
Hold aspirin or any tablet against the gum Causes a chemical burn on the gum
Apply heat to a swollen face Heat encourages an infection to spread; use cold
Poke at the tooth with a pin or sharp object Pushes debris deeper and can damage the gum or pulp
Take someone else's antibiotics, or leftovers from a previous course Wrong drug, wrong dose, incomplete course, and it can mask a worsening infection
Keep taking pain relief for days and hope The cause does not resolve; the treatment options narrow as it progresses
Drink alcohol to manage the pain Interacts with pain relief and does not help

What the pain is telling you

Different patterns point to different problems, which is why the detail matters when you call:

Sharp, brief pain to cold or sweet that stops as soon as the stimulus is removed — often sensitivity, a small cavity, exposed root surface, or a crack.

Lingering pain after hot or cold, particularly lasting more than 30 seconds — suggests the nerve is inflamed. This usually changes the treatment from a filling to root canal treatment.

Throbbing pain that wakes you at night, or is worse lying down — commonly an irreversibly inflamed or infected nerve. Needs prompt assessment.

Pain on biting, particularly a sharp jolt on release — often a cracked tooth.

Constant deep ache with a bad taste, or a gum boil — suggests infection. See our dental abscess page.

Dull ache across several teeth or the jaw, worse in the morning — may be grinding or clenching rather than any one tooth. See TMD and jaw treatment.

Pain relieved by cold and made worse by heat — an unusual but recognised pattern, generally pointing to an advanced pulp infection. People with it often arrive holding a cup of ice water. It needs prompt treatment.

Soreness behind the last lower molar, with a bad taste and difficulty opening — often an inflamed gum flap over a partly erupted wisdom tooth. See wisdom teeth.

Pressure across several upper back teeth, worse bending forward, with a blocked nose — may be sinus rather than dental. The upper back tooth roots sit immediately below the sinus floor. A GP is often the right first call if you have cold or sinus symptoms as well.

When you ring us, have these ready

It genuinely changes how we triage the call:

About antibiotics

This is worth saying plainly because it is the most common misunderstanding in emergency dental care.

Antibiotics do not cure toothache. Pain from an inflamed or dying nerve is not an infection an antibiotic can reach — the blood supply into a dying pulp is exactly what has failed. Antibiotics have a role where an infection has spread into the surrounding tissue, where there is swelling or fever, or where a patient is medically compromised. Even then they buy time; they do not fix the tooth.

What resolves the problem is treating the source: removing the decay, opening and cleaning the root canal system, draining an abscess, or removing the tooth. A course of antibiotics without that usually delays treatment and lets the problem come back.

If you have been given antibiotics elsewhere and the pain has settled, book anyway. The tooth still needs treating.

Particular situations

Pregnancy. Toothache in pregnancy should be treated, not endured. Dental treatment with local anaesthetic is generally safe, radiographs are used only where needed and with shielding, and untreated infection carries its own risks. Paracetamol is generally the preferred pain relief; check with your doctor or pharmacist before taking anti-inflammatories, particularly in the third trimester. Tell us you are pregnant when you book.

Children. Dosing is by weight, so follow the packet for your child's weight rather than guessing, and do not exceed the stated frequency. A child who is off their food, waking at night, or has any facial swelling needs to be seen promptly. Facial swelling in a child progresses faster than in an adult.

After recent dental work. Some tenderness for a few days after a filling or a deep clean is normal. Pain that is worsening after three days, that wakes you, or that is triggered by biting on a new filling is worth a call — a high filling takes a minute to adjust and the relief is immediate.

If you take blood thinners, bisphosphonates, or are immunosuppressed, tell us when you ring. It changes how we plan treatment and how quickly you need to be seen.

If the pain stops on its own

This is the most important thing on this page after the emergency criteria.

Severe toothache that suddenly disappears is usually not recovery. It generally means the nerve inside the tooth has died. The relief is real but temporary — the infection is still there, and it will typically return as an abscess, often worse and often at an inconvenient time.

A tooth in that state can frequently still be saved with root canal treatment. Left long enough, it often cannot. If your pain has gone away on its own, book anyway.

What happens at the appointment

We take your dental and medical history, examine the tooth and surrounding tissues, and usually take radiographs where clinically indicated — decay between teeth and infection at the root tip are not visible to the eye. We have an on-site OPG for cases that need it.

Sensitivity testing and tapping the tooth help establish whether the nerve is involved, which determines the treatment.

You will be told what has been found, what the options are, what each involves and what it costs, before treatment starts.

Depending on what is found, we may manage the pain and infection first and bring you back for definitive treatment, or proceed on the day. Common causes are decay, a cracked tooth, a failed or leaking filling, gum infection, an abscess, or a problematic wisdom tooth.

Occasionally the examination does not identify a dental cause. Referred pain from the sinuses, the jaw muscles, the ear, or a nerve condition can all present as toothache, and in those cases the right answer is a referral rather than treating a healthy tooth. We would rather tell you that than drill something on spec.

Cost

Fees depend on what treatment is actually needed, which is not known until the tooth has been examined. You are given the cost before anything begins. HICAPS on-the-spot health fund claiming; Afterpay and Zip accepted. Eligible children aged 0–17 may be able to claim under the Child Dental Benefits Schedule.

Questions we are asked

Can I take paracetamol and ibuprofen together? Many people can, and the combination is often more effective than either alone for dental pain. It is not suitable for everyone — check with your pharmacist, and follow the packet for each.

Will you pull the tooth out today? Only if that is genuinely the best option and you choose it. Most painful teeth can be saved, and an extraction decided in the middle of an emergency appointment is one people frequently regret.

Can I just get a prescription over the phone? No. Prescribing without an examination is not appropriate care, and as above, antibiotics are usually not what a toothache needs.

How quickly can I be seen? We keep capacity for emergencies during opening hours. Ring rather than booking online if you are in pain — it is triaged.

Book

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about dental emergencies, dental abscess or broken and chipped teeth.

This page is general information and does not replace advice from a registered dental practitioner about your own circumstances, and it is not a substitute for being examined. If in doubt, seek care rather than waiting. Please see our Disclaimer.

When is toothache an emergency?

Call 000 or go to a hospital emergency department for difficulty breathing or swallowing, swelling spreading across the face or under the jaw, or fever and shivering with facial swelling — these suggest infection spreading into the tissues of the neck, and they are not something to wait on a dental appointment for. Also call 000 if jaw or tooth pain comes on with exertion, or with chest tightness, breathlessness, sweating, nausea, or pain spreading to the arm, neck or back: pain felt in the jaw can be referred from the heart.

What can I do right now?

Rinse with warm salt water and floss gently either side of the tooth in case food is trapped — that alone relieves a proportion of toothache. Take over-the-counter pain relief as directed on the packet, and ask your pharmacist what is suitable for you. A cold pack on the outside of the cheek helps with swelling. Do not hold aspirin or clove oil against the gum, as both burn the tissue; do not apply heat to the face; and do not take antibiotics left over from a previous course.

What does the type of pain suggest?

A sharp twinge with cold that disappears within seconds is usually sensitivity or a small area of decay. Pain that lingers for minutes after hot or cold, or wakes you at night, suggests the nerve is inflamed and often means root canal treatment or extraction. Sharp pain on biting can indicate a crack or a high filling. Constant throbbing with tenderness to touch, particularly with swelling, suggests an abscess. None of this replaces an examination, but it helps to describe it accurately when you ring.

The pain has stopped — do I still need to be seen?

Yes. Pain that stops of its own accord often means the nerve inside the tooth has died, not that the problem has resolved. The infection usually continues quietly and reappears later as an abscess or facial swelling, by which time the options are narrower. Have the tooth checked even if it no longer hurts.

What causes toothache?

Decay reaching the nerve, a cracked or fractured tooth, a lost or leaking filling, an abscess, gum infection or an exposed root surface, a wisdom tooth pushing through or becoming infected, and sometimes sinus infection, which can make several upper back teeth ache at once. Grinding can also make teeth ache without any decay being present.

Will antibiotics fix it?

No. Antibiotics can settle spreading infection but they do not treat the cause, and the pain returns once the course ends unless the tooth itself is dealt with. They are prescribed only where clinically indicated. The treatment is removing the source — a filling, root canal treatment, draining an abscess, or extraction.

What about a child with toothache?

Treat it the same way: rinse, check for trapped food, and give pain relief appropriate to their age and weight as directed on the packet or by your pharmacist. Do not rub teething gels or alcohol on the gums of a young child. Book them to be seen — pain in a baby tooth still needs treating, and children often underreport how long it has been going on. Fever with facial swelling in a child means the emergency department.

How quickly can I be seen?

Ring the practice rather than booking online, so the problem can be triaged and fitted in appropriately — describe the pain, how long it has lasted, and whether there is any swelling. Victorian Dental Group, 291 Wattletree Road, Malvern East VIC 3145 — (03) 9088 5808, Monday to Friday 8:00am to 5:00pm.

What if it starts outside opening hours?

For pain alone, manage it with the measures above and ring when the practice opens. For any of the emergency signs — spreading swelling, difficulty breathing or swallowing, fever with swelling, or trauma — go to a hospital emergency department or call 000 rather than waiting. The Royal Dental Hospital of Melbourne also provides emergency dental care, with eligibility criteria and waiting times that apply.

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