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Toothache and Gum Problems

Toothache and Gum Problems

Topic Overview

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 American Dental Association (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 a 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.
  • A 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 another health problem, such as:

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 toothbrush and floss carefully to help prevent bleeding gums.

Gingivitis is a gum disease that 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.

Periodontitis is severe gum 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.

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

  • Pregnancy, blood-thinning medicines, or bleeding disorders. Each of these 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 .

Check your symptoms to decide if and when you should see a doctor.

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  Dental Care: Brushing and Flossing Your Teeth

Check Your Symptoms

Do you have a toothache or a problem with your gums?
Yes
Toothache or gum problem
No
Toothache or gum problem
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you have an injury to your mouth or teeth?
Yes
Injury to mouth or teeth
No
Injury to mouth or teeth
Could you be having symptoms of a heart attack?
In some cases, a heart attack may cause a strange feeling in part of the face, such as the jaw.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Do you have a toothache?
Yes
Toothache
No
Toothache
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Has the pain lasted for more than 2 days?
Yes
Pain for more than 2 days
No
Pain for more than 2 days
Is the toothache disrupting your sleep or other activities?
Yes
Toothache is interfering with sleep or other activities
No
Toothache is interfering with sleep or other activities
Do you have swelling or pain in your face?
Yes
Swelling or pain in face
No
Swelling or pain in face
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Do you have diabetes, a weakened immune system, or any surgical hardware in the area?
"Hardware" in the facial area includes things like cochlear implants or any plates under the skin, such as those used if the bones in the face are broken.
Yes
Diabetes, immune problems, or surgical hardware in affected area
No
Diabetes, immune problems, or surgical hardware in affected area
Do you have problems with your gums?
Yes
Gum problems
No
Gum problems
Do you have a red, swollen, painful bump on your gum next to a sore tooth?
Yes
Red, swollen, painful bump on gum next to a sore tooth
No
Red, swollen, painful bump on gum next to a sore tooth
Do you have new bleeding from your gums?
Yes
New bleeding from gums
No
New bleeding from gums
Do you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix)?
These medicines can cause bleeding and can make it harder to control bleeding.
Yes
Takes medicine that affects blood's ability to clot
No
Takes medicine that affects blood's ability to clot
Are any of your teeth sensitive to heat, cold, sweet or sour things, or air?
Yes
Teeth sensitive to heat, cold, sweet or sour things, or air
No
Teeth sensitive to heat, cold, sweet or sour things, or air
Is the sensitivity problem moderate to severe?
Yes
Moderate to severe tooth sensitivity
No
Moderate to severe tooth sensitivity
Has the sensitivity problem lasted more than a week?
Yes
Tooth sensitivity for more than 1 week
No
Tooth sensitivity for more than 1 week
Do you think that a medicine could be causing the problem?
Yes
Medicine may be causing tooth or gum problem
No
Medicine may be causing tooth or gum problem
Are dentures or any other type of dental device (like a crown or filling, for instance) causing pain or discomfort?
Yes
Discomfort from dentures or other dental appliance
No
Discomfort from dentures or other dental appliance
Have you had a toothache or gum problems for more than 2 weeks?
Yes
Toothache or gum problems for more than 2 weeks
No
Toothache or gum problems for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your dentist now to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care in the next hour.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your dentist in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your dentist. You may need care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your dentist today to discuss the symptoms and arrange for care.
  • If you cannot reach your dentist or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Many prescription and nonprescription medicines can cause mouth problems. A few examples are:

  • Antibiotics.
  • Some seizure medicines.
  • Medicines used to treat cancer (chemotherapy).
  • Steroid medicines.
  • Medicines used after organ transplant.
Mouth and Dental Injuries

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness, tingling, or a strange feeling in your chest or other areas.

Home Treatment

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 2 or 3 times a day. Floss gently between your teeth.

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.

For short-term relief, adults can apply an over-the-counter benzocaine gel to the tooth. Be safe with medicine. Read and follow all instructions on the label . If your pain lasts longer than a few days or it gets worse, call a doctor.

Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.

Gum problems

If your gums are mildly swollen and red, use a tartar-control toothpaste that contains fluoride and also use 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 Smoking.

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

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Signs of infection develop.
  • Gum or tooth problems last for more than 2 weeks.
  • Symptoms persist or become more severe or frequent.

Prevention

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.
    Click here to view an Actionset. 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 back-to-front 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 doctor 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 Smoking.
  • Do not use illegal drugs, such as methamphetamines, which cause tooth and gum problems.

Preparing For Your Appointment

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

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

  • Do you have tooth pain?
    • When did the pain start?
    • 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 home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you tried? Did they help?
  • What prescription and nonprescription medicines do you take?
  • Do you have any health risks?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Current as of June 4, 2014

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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