Toothache is one of the most common presentation for dental emergencies.
If your toothache involves facial and/or neck swelling; fever; shortness of breath; or limited mouth opening, please go to the Emergency Department immediately as this constitutes a real emergency that could potentially be life threatening.
Pain related to toothache varies in its severity. The most common presentations are
Sensitivity to cold food/drinks
Non-lingering sharp pain to cold (& sometimes hot) food/drinks
Sharp pain to cold & hot food/drinks that lingers
Spontaneous throbbing pain that affects your sleep
Dull ache that comes and goes
Common causes include exposed root surfaces inducing hypersensitivity, tooth decay, and/or inflammation/infection involving the nerve of the tooth. Treatment varies depending on the diagnosis but you can expect a simple topical fluoride to root canal treatment.
Gum infection and/or inflammation
Pain related to infection/inflammation of the gum can closely mimic that of toothache. It is important to distinguish between the two as the treatment for each is completely different. Your dentist is the best person to assess it and recommend an appropriate management.
The most important assessment in this presentation is the extent of the break, depending on which, treatment can be as simple as restoring the tooth back to shape and function through to extracting the tooth.
Knocked tooth but not out of socket
Your dentist needs to assess if the tooth is mobile and/or partially displaced from its socket. There is a risk of root resorption and the tooth may need a root canal treatment.
Knocked tooth that is completely out of socket (avulsed tooth)
If you still have the tooth, store it in milk and see your dentist immediately. DO NOT store it in water. You may put it back in if you feel comfortable.
There is a risk of root resorption and the tooth may need a root canal treatment if you wish to save it.
Sometimes dental trauma may involve gum trauma, such as laceration of the surrounding gum. You may need stitches on the torn gum to let it heal, as well as addressing the tooth involved in the trauma.
Child dental emergency
Most dental emergencies related to children are due to trauma, such as falls. It is important to see your dentist immediately as they need to assess if there is a risk to the underlying adult tooth.
If a baby tooth is avulsed (knocked out completely), it is important that you DO NOT put it back into the socket.
The most likely sequel to dental trauma in a baby tooth is tooth necrosis (non-vital) leading to infection. Pay attention to darkening of the tooth following trauma and the presence of 'gum pimple' above the affected tooth. Bring your child to your dentist immediately if this happens.