Toothache and dental abscess explained

Why teeth hurt

A tooth has a hard outer shell, but inside is a soft core full of nerves and tiny blood vessels called the pulp. Pain usually starts when something reaches or irritates this inner part. The most common cause is tooth decay, where bacteria and sugar wear a hole through the hard layers. Other causes include a cracked or broken tooth, a lost or leaking filling, worn enamel, gum disease exposing sensitive roots, and wisdom teeth pushing through. Sensitivity to hot, cold or sweet things is common and often mild. A deeper, constant or throbbing pain suggests the inner pulp is inflamed or infected, which needs a dentist rather than just waiting for it to pass.

What a dental abscess is

A dental abscess is a collection of pus caused by a bacterial infection. It usually forms at the tip of a tooth's root when decay or a crack lets bacteria into the pulp, or in the gum beside a tooth where gum disease is present. As pus builds up, pressure rises, which is why the pain is often severe, throbbing and hard to ignore. You might notice a swollen, tender gum, a bad taste, a raised temperature and swollen glands. Sometimes the abscess bursts and the pain suddenly eases — but the infection is still there and treatment is still needed. An abscess will not clear on its own, so it should always be assessed by a dentist.

When to seek urgent or emergency help

Toothache and a suspected abscess should be seen by a dentist promptly, and NHS 111 can help find urgent dental care out of hours. Some situations are emergencies needing 999 or A&E rather than a routine dental appointment. These include facial swelling that is spreading, especially towards the eye or that begins to close the eye, or swelling reaching the throat or floor of the mouth. Difficulty breathing or swallowing, trouble opening the mouth, a rapidly worsening swelling, or a high fever with feeling very unwell are all emergencies. Infection spreading to the eye or throat can threaten sight or the airway, so do not wait to see if it settles.

How toothache and abscesses are treated

Treatment depends on the cause. For decay, a dentist removes the damaged part and places a filling. If the pulp inside is infected, the tooth may need root canal treatment, where the infection is cleaned out and the tooth sealed, or in some cases the tooth is removed. For an abscess, the essential step is draining the pus and treating the tooth itself. Antibiotics are not a cure on their own and are reserved for spreading infection or when someone is unwell, always alongside dental treatment. For sensitivity and gum problems, dentists may recommend special toothpaste, a scale and polish, or gum treatment. Simple painkillers can ease discomfort while you wait to be seen.

Preventing tooth pain

Most toothache and abscesses can be prevented with good daily care. Brush twice a day with fluoride toothpaste, including last thing at night, and spit rather than rinse so the fluoride keeps working. Clean between your teeth daily with floss or interdental brushes to remove plaque your toothbrush misses. Cut down on how often you have sugary food and drink, as it is the frequency, not just the amount, that fuels decay. Avoid smoking, which worsens gum disease. See a dentist regularly for check-ups so problems are caught early, when they are easier and cheaper to fix. Children benefit from the same habits, and dentists can advise on the right approach for each family.