Health Library Toothache and Gum ProblemsFrom Healthwise

Toothaches and gum problems are common but usually can be prevented 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 an ADA-accepted fluoride toothpaste. Clean between teeth daily with floss or an interdental cleaner. For more information on proper brushing and flossing techniques, see the topic Basic Dental Care.

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 a tooth has cracked, a dental cavity is present, or a filling has been lost. Seeing a dentist for treatment can prevent the tooth from dying.

The most common cause of a toothache is tooth decay, although toothache may not be present 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 especially hurt when you bite down.
• An 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), which can be caused by an injury to the face or from grinding or gnashing the teeth.

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

• A heart attack, cluster headache, or sinus infection, which can cause referred pain into the teeth or jaw.
• Viral infections, such as shingles.
• Diseases such as diabetes.
• Nerve-related disease, such as trigeminal neuralgia.
• Alcohol or drug abuse, especially methamphetamines.
• Vitamin deficiencies, such as too little vitamin B12.

Gum problems

Healthy gums are pink and firm and do not bleed easily. Occasionally 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 tooth brush and floss carefully to help prevent this problem.

Early-stage gum disease (gingivitis) 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.

As gum disease gets worse, the gums pull away from the teeth, leaving deep pockets where plaque can hide and cause further damage. This stage of gum disease is called periodontitis or periodontal disease and is 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. As gum disease gets more severe (periodontitis), it becomes harder to treat.

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

• Pregnancy, blood-thinning medicines, or bleeding disorders; each 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 the body's ability to absorb certain vitamins.
• Teething in babies and young children. For more information, see the topic Teething.
• 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. You may not have symptoms of bleeding or swollen gums because the normal bleeding immune response is affected by tobacco use. Chewing tobacco or using snuff may push the gums back in the area of the mouth where the tobacco is inserted. Constant irritation caused by tobacco products increases your risk of oral cancer.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

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.
	Dental care: Brushing and flossing your teeth

• Lower teeth or jaw pain with unexplained chest pain, or that occurs with any other symptoms of a heart attack

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have the following, evaluate those symptoms first.

• A mouth or dental problem that was caused by an injury: Go to the topic Mouth and Dental Injuries.
• A lip, mouth, or tongue problem: Go to the topic Mouth Problems, Noninjury.

	Yes	Do you have a toothache?
When to See a Doctor See significance of a toothache if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a severe toothache that has not improved after 2 hours of home treatment? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have swelling or pain in your face? Yes Do you have red, swollen, painful gums or a bump near the sore tooth? Yes Is your toothache interfering with your sleep or other activities? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Do you have a moderate toothache that has not gotten better after 24 hours of home treatment? Yes Do you have a mild toothache that has not gotten better after 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had a toothache off and on for 2 weeks or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a toothache and a fever?
When to See a Doctor See significance of a toothache and a fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take a medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to the following question. Yes Do you have a toothache and know or think you may have a fever? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have gum problems?
When to See a Doctor See significance of gum problems if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes and a red, swollen, painful bump on your gum next to a sore tooth? Yes Do you have a disease or take a medicine that causes problems with your immune system and a red, swollen, painful bump on your gum next to a sore tooth? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a red, swollen, painful bump on your gum next to a sore tooth? Yes Do you have new bleeding of the gums and you are taking medicine that thins your blood, such as aspirin, enoxaparin (such as Lovenox), heparin, or warfarin (such as Coumadin)? Yes Do you have new bleeding of the gums and you have a known bleeding disorder, such as hemophilia or idiopathic thrombocytopenic purpura (ITP)? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Do you have swollen gums that bleed easily despite 2 weeks of home treatment? Yes Do you have sore or swollen gums despite 2 weeks of home treatment? Yes Do you have irritation of the gums from poorly fitting dentures or a dental appliance? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a sensitive tooth?
When to See a Doctor See significance of a sensitive tooth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have moderate to severe sensitivity in a tooth when you eat or drink a hot or cold food or beverage? Yes Do you have moderate to severe sensitivity in a tooth when you eat or drink sweet, sour, or acidic foods or liquids? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a mildly sensitive tooth for 72 hours or longer after using home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your gum or tooth problem is caused by a medicine?
When to See a Doctor See significance of problems caused by a medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think a medicine may be the cause of your gum or tooth problem? Note: Call the health professional who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are your dentures or other dental appliance causing discomfort?
When to See a Doctor See significance of uncomfortable dentures or dental appliance if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Are your dentures or dental appliance causing discomfort? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptom?

• Symptoms of teething: Go to the topic Teething.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Toothache

To reduce pain and swelling of a toothache, use an ice pack on the outside of your cheek; do not use heat. Avoid very hot, cold, or sweet foods and drinks if they increase your pain.

Tooth sensitivity

To reduce sensitivity to heat, cold, or brushing, consider using 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 a 2 to 3 times a day. Floss gently between your teeth.

Gum problems

If your gums are mildly swollen and red, use a tartar-control toothpaste that contains fluoride and an antiseptic mouthwash, such as Listerine, or a mouthwash that contains fluoride. Make sure you brush after meals and snacks and floss every day. If you cannot brush after eating, chew sugar-free gum, use a tooth pick, or rinse your mouth with warm salt water. You can make your own salt water by mixing 1 tsp (5 g) of salt in a medium-sized glass [8 fl oz (240 mL)] of warm water.

Tobacco can cause many gum problems, decreases your ability to fight infection of your gums, and delays healing. Do not smoke or use other tobacco products. For more information, see the topic Quitting Tobacco Use.

Do not use illegal drugs, such as methamphetamines, which cause tooth and gum problems.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• New symptoms develop.
• Signs of infection develop.
• Home treatment is not helping relieve discomfort.
• Gum symptoms continue despite home treatment.
• Symptoms persist or become more severe or frequent.

Keeping your teeth and gums healthy requires good nutrition and regular brushing and flossing. To avoid a tooth or gum problem:

• Brush your teeth twice a day, in the morning and before bedtime. Floss once a day. For more information, see:

  Dental care: Brushing and flossing your teeth.

• Use a toothpaste that contains fluoride.
• Avoid foods that contain a lot of sugar. Sugar helps plaque grow.
• Ask your dentist or dental hygienist about tongue cleaning. You can use a tongue cleaner or a soft-bristled toothbrush, stroking in a front-to-back direction. Tongue cleaning is particularly important for people who smoke or whose tongues are coated or deeply grooved.
• Ask your dentist or hygienist whether he or she recommends using a mouthwash that contains fluoride and ingredients to reduce plaque.
• Schedule regular trips to the dentist. Most dentists recommend exams and cleaning 2 times a year. Some experts believe those who are at low risk for dental problems need only a yearly exam.
• Get regular checkups or recommended blood tests ordered by your health professional if you are on a blood-thinning medicine or you have a bleeding disorder.
• Do not smoke or use other tobacco products because it decreases your ability to fight gum infection and delays healing. For more information, see the topic Quitting Tobacco Use.
• Do not use illegal drugs, such as methamphetamines, which cause tooth and gum problems.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• Do you have tooth pain?
  • When did the pain start?
  • Does the pain come from a tooth? Which tooth?
  • Has the pain been constant or does it come and go?
  • Does anything make the pain better or worse?
  • Does the pain awaken you from sleep or interfere with any other activities?
• Do your gums bleed?
  • When did the bleeding start?
  • What makes your gums bleed?
• How often do you brush and floss your teeth?
• When was your last dental examination? Do you visit a dentist regularly?
• Have you had a dental or gum problem in the past?
• What prescription and nonprescription medicines do you take?
• Do you have any health risks?

• Abscessed Tooth
• Basic Dental Care
• Facial Problems, Noninjury
• Gum Disease
• Mouth and Dental Injuries
• Mouth Problems, Noninjury
• Quitting Tobacco Use
• Shingles
• Sinusitis
• Teething
• Tooth Decay

Author:	Susan Van Houten, RN, BSN, MBA	Last Updated: December 1, 2006
Medical Review:	Martin Gabica, MD - Family Medicine William M. Green, MD - Emergency Medicine Steven K. Patterson, BSc, DDS, MPH - Dentist
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