Toothache

Is this your child's symptom?

  • Pain or discomfort in a tooth
  • Not caused by an injury

Causes of a Toothache

  • Tooth Decay. If the pain persists more than a day, this is the most common cause. A yellow-brown defect in the enamel may be seen. The most common site is the surface of one of the molars. The pain is dull.
  • Dental Abscess. If the pain is severe and throbbing, the decay has become a tooth abscess. That means a pus pocket has formed within the root of the tooth. Tapping on the tooth causes increased pain. If not treated, the abscess will erode through the bone. A "gum boil" or pimple will be seen below the gum line. The patient needs to see a dentist for a root canal.
  • Cracked Enamel. Biting on a hard object by mistake can crack a tooth. The tooth becomes sensitive to hot and cold liquids. The tooth may look normal. The fracture line may be below the gum line or just hard to see.
  • Gum Disease. Gingivitis is a medical name for irritated gums. They are red and tender. If tooth brushing and flossing are ignored, the gums may even bleed. Can be very painful. Responds to getting the teeth cleaned and daily flossing.
  • Stuck Food. Hard food may become wedged between 2 teeth. Proper flossing will remove the food and stop the pain.

Tooth Abscess and Severe Pain

  • A tooth abscess can cause severe pain not controlled by normal pain medicines.
  • Root canal therapy by an endodontist is needed to cure this problem.
  • In the meantime, call your dentist's office. If you can't reach your dentist, call your doctor for advice. They can often bring the pain under control by calling in a prescription. Most often, this is for an antibiotic such as penicillin.

When to Call for Toothache

When to Call for Toothache

Call Your Dentist or Doctor Now

  • Your child looks or acts very sick
  • Fever is present
  • Face is swollen
  • Severe pain and not better 2 hours after taking pain medicine
  • You think your child needs to be seen, and the problem is urgent

Contact Your Dentist Within 24 Hours

  • You think your child needs to be seen, but the problem is not urgent
  • Toothache lasts more than 24 hours
  • Brown or dark spot in the painful tooth
  • Red or yellow lump at the gumline of the painful tooth

Contact Your Dentist During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild toothache present less than 24 hours

Call Your Dentist or Doctor Now

  • Your child looks or acts very sick
  • Fever is present
  • Face is swollen
  • Severe pain and not better 2 hours after taking pain medicine
  • You think your child needs to be seen, and the problem is urgent

Contact Your Dentist Within 24 Hours

  • You think your child needs to be seen, but the problem is not urgent
  • Toothache lasts more than 24 hours
  • Brown or dark spot in the painful tooth
  • Red or yellow lump at the gumline of the painful tooth

Contact Your Dentist During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild toothache present less than 24 hours

Care Advice for Mild Toothache

What You Should Know About Toothaches:

  • Most toothaches don't last too long. They are due to a sensitive tooth.
  • If the pain becomes worse or doesn't go away in 24 hours, call your dentist. The pain could be due to a small cavity.
  • Here is some care advice that should help.

Floss:

  • Floss on either side of the painful tooth to remove any wedged food.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Cold Pack for Pain:

  • Put a cold pack or ice in a wet washcloth on the painful jaw. Do this for 20 minutes.

What to Expect:

  • Most minor causes of toothache go away in less than a day.

Call Your Dentist If:

  • Toothache lasts more than 24 hours
  • The toothache gets worse
  • You think your child needs to be seen

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC. Date Updated: Mar 31 2025 13:44 Version 0.1

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starfish
February 12, 2026
There are cases of measles in NC, and we are aware of exposures in Chapel Hill, Durham, and Wake County. We can give the MMR dose early to families who want it. This applies to infants 6-12 months who have not gotten a dose yet or kids under 4-5 years who have not gotten their second MMR dose. At this time, the NC DHHS and health departments are not recommending this unless traveling or living in an area with sustained transmission. 2 doses of the MMR vaccine are highly effective (97%) at preventing measles infections. At CHCAC, children receive their first dose at 12 months of age and a second dose at 4 years of age, ensuring they are fully protected as soon as possible, in accordance with the most up-to-date AAP recommendations. Some infants aged 6 months to 11 months who travel internationally or in high-prevalence areas may need a dose to protect them; however, they still require the 1-year and 4-year-old doses as well. If you are ever concerned about a possible exposure to measles, please CALL before entering our office. DO NOT ENTER the office. NC DHHS keeps a list of areas with measles exposures here . This is a highly contagious illness, and special precautions must be taken to prevent spread. The virus can be present in the air for 2 hours after an infected person is in the room, and 90% of susceptible patients can be infected. As always, if you have questions, we are here to help make sense of it all!
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