Toothache usually means a problem with a tooth, the nerve inside it or the gum around it. If you have toothache, here is what to do until your appointment: painkillers and simple home measures can ease the pain, but finding and treating the cause needs a dentist.
Severe toothache: what to do straight away
Advice from the UK’s NHS and the American Dental Association (ADA):
- Take a painkiller. Ibuprofen or paracetamol, exactly as directed on the packet (see below).
- Rinse with warm salt water. Dissolve half a teaspoon of salt in a glass of warm water, then rinse and spit. Not suitable for children.
- Stick to soft food. Try yoghurt or scrambled eggs. Chew on the other side and avoid sweet, very hot or very cold food and drinks.
- Brush gently. Use a soft toothbrush. Do not floss around the sore tooth, except to gently remove trapped food.
- If there is swelling, do not wait. Ask to be seen the same day.
A pain-relieving gum gel from a pharmacy may also help, if the pharmacist says it suits you.
What not to do
- Do not put aspirin on the tooth or gum. It can damage the gum.
- Do not take more than the dose on the packet. Taking more does not work better and can be very dangerous (NHS).
- Do not self-medicate with antibiotics. They usually do not help and can cause side effects.
- Do not smoke. Smoking can make some dental problems worse.
Ibuprofen or paracetamol for toothache?
Painkillers can provide toothache relief but do not treat the cause.
- Ibuprofen reduces pain and inflammation. Do not take it with similar medicines, such as aspirin or naproxen.
- Paracetamol is an option if ibuprofen does not suit you, for example in pregnancy.
- Both together. Adults can take both at the same time if needed, following each packet’s directions.
- Aspirin must not be given to children or young people under 16.
According to the NHS, ibuprofen may not be suitable if you:
- have had an allergic reaction to ibuprofen, aspirin or a similar medicine
- have, or have had, a stomach ulcer
- have asthma or allergies
- have chickenpox
- have heart, liver or kidney disease
- have a blood clotting problem or have had a stroke
- are pregnant, trying to get pregnant or breastfeeding
If any of these apply, or you regularly take other medicines such as blood thinners, ask a pharmacist which painkiller suits you.
Tooth pain: why it hurts and what it might mean
Toothache can be caused by (NHS):
- tooth decay
- an abscess (a pus-filled infection) at the root of the tooth or in the gum
- a cracked or damaged tooth
- a loose or broken filling
- an infection around a wisdom tooth that has partly come through
- a problem with braces
- gum disease
- clenching or grinding your teeth
- sensitive teeth
The type of pain can give a clue to the cause (Oral Health Foundation).
| What the pain is like | What it might mean |
|---|---|
| A short, sharp pain from something cold | Receding gums, a worn or lost filling, or a cracked or broken tooth |
| Pain when you bite | A cracked tooth, decay or a loose filling |
| A dull ache that lingers, or comes and goes | The nerve in the tooth is irritated, damaged or dying |
| Severe, throbbing pain that wakes you at night | Possible infection or abscess, especially with swelling |
If your only symptom is brief sensitivity to cold, try a toothpaste for sensitive teeth twice a day. If it has not improved after two weeks, book an appointment.
Toothache with swelling: when is it an emergency?
A dental infection can sometimes spread quickly and become dangerous.
Call 194 (ambulance) or 112 (European emergency number), or go to hospital straight away if you:
- find it hard to breathe, swallow or speak
- have swelling around your eye or in your neck
- have a swollen or painful eye, or notice your eyesight suddenly getting worse
- have a lot of swelling inside your mouth, or find it hard to open your mouth
- have swelling with a high temperature and severe pain
- have had a blow to your face or head with a serious injury, bleeding from your mouth that will not stop, loss of consciousness, vomiting or double vision
Do not drive yourself: ask someone to take you or call an ambulance. Have a list of your medicines with you (NHS). Outside North Macedonia, call your local emergency number.
Without these signs, see a dentist the same day for swelling of the gum or face, swelling that is growing, or severe pain (Oral Health Foundation). Swelling can mean an abscess, which will not go away without dental treatment (NHS).
When to see a dentist
Based on NHS and Oral Health Foundation advice:
| If you have… | When to see a dentist |
|---|---|
| Swelling of the gum, cheek or jaw | The same day |
| Severe pain that wakes you at night or is not eased by painkillers | The same day |
| A knocked-out adult tooth | Immediately |
| A broken or cracked tooth, or pain when you bite | As soon as possible |
| Toothache for more than 2 days, or pain with a high temperature, red gums or a bad taste | As soon as possible |
| A small chip that does not hurt | At a routine appointment |
Pain that stops does not mean the problem has gone: pain can come and go, and a crack in a tooth does not heal.
Knocked-out adult tooth: time matters
Get to a dentist as soon as you can, even if you cannot find the tooth (NHS). In the meantime:
- Hold the tooth by the crown (the white part), not the root.
- If it is dirty, rinse it gently in milk, saline or saliva.
- Try to put it back into its socket, then bite gently on a clean cloth. If it will not go back in, keep it in milk or saliva.
- Do not put a baby tooth back in: it can damage the adult tooth underneath.
Same-day appointments in Skopje’s Aerodrom district
During opening hours, Monday to Friday 11:00–19:00, we try to see patients with toothache or a broken tooth the same day, when an appointment is available. Call +389 78 218 457 and describe your symptoms. For advice on a broken tooth, see Toothache or broken tooth: same-day appointments.
What happens at a toothache appointment
The dentist first asks where it hurts and for how long, which medicines you take, whether you have allergies and whether you are pregnant. They then examine the tooth; an X-ray is usually needed too.
Once the cause is clear, the dentist explains it and talks you through your options. Many problems can be dealt with at the first visit, for example with a filling. If the nerve is too inflamed to recover, or is infected, saving the tooth usually means root canal treatment, often followed by a crown (cap).
The alternative is extraction, but the gap then often needs a bridge, implant or denture. ‘Save the tooth’ is our practice’s motto, but the decision is always yours. Read more in Save the tooth.
Local anaesthetic aims to stop you feeling pain during treatment. A badly inflamed tooth can sometimes be harder to numb. If you still feel something, say so: more anaesthetic can be given. Afterwards, the tooth may be tender for a few days.
How to prevent toothache in future
Many causes of toothache, such as decay and gum disease, can be prevented or picked up early, before they start to hurt.
- Brush your teeth twice a day with fluoride toothpaste.
- Clean between your teeth every day with floss or interdental brushes.
- Cut down on sugary food and drinks.
- Have regular check-ups and a scale and polish (teeth cleaning) to remove tartar.
- Wear a mouthguard for contact sports.
- If you clench or grind your teeth, ask your dentist about a night guard.
More tips: how to brush and clean between your teeth properly.
Toothache: your questions answered
Do antibiotics help with toothache?
Usually not. For adults without a severely weakened immune system, the American Dental Association (ADA) advises against antibiotics for most cases of toothache and for a localised abscess: a dentist needs to remove the cause (ADA, 2019). Antibiotics may be needed if an infection spreads, causing a high temperature or making you feel generally unwell, but even then the tooth still needs treatment.
What can I take for toothache when pregnant?
Paracetamol is usually the first choice of painkiller. Avoid ibuprofen unless a doctor or pharmacist recommends it (NHS).
Do not put off seeing a dentist: dental check-ups, local anaesthetic and dental X-rays are considered safe in pregnancy (ADA MouthHealthy). In a high-risk pregnancy, some treatments may be postponed. Read more in Dental care in pregnancy.
What should I do if my child has toothache?
Give paracetamol or ibuprofen made for children, at the dose on the leaflet for your child’s age. If your child has asthma, chickenpox or another illness, ask a pharmacist first. Do not give aspirin to children under 16 or use salt-water rinses. A child with a swollen face or a high temperature should be seen the same day.
What should I do if my face is swollen from toothache?
Swelling of the gum, cheek or jaw should be checked by a dentist the same day, as it can mean a spreading infection. If it moves towards your eye or neck, or you find it hard to breathe or swallow, call 194 (ambulance) or 112 (European emergency number), or go to hospital straight away.
Where can I find an out-of-hours dentist in Skopje?
The Dr. Milanovski practice is not an out-of-hours or on-call service. During opening hours, Monday to Friday 11:00–19:00, call us on +389 78 218 457. Outside these hours and at weekends, contact the public out-of-hours dental service.
During our annual leave, which we announce on Facebook and Instagram, we refer patients with acute pain to the dentist who covers for us (our registered substitute).
If the pain can wait a few days, request an appointment using our booking form. If you are in pain now or have swelling, it is better to phone us.
Sources
- NHS – Toothache
- NHS – Dental abscess
- NHS – Ibuprofen for adults (who can take it; with paracetamol; pregnancy)
- NHS – Knocked-out tooth
- NHS – How to find an emergency or urgent dentist (urgent dental problems; when to go to A&E)
- Oral Health Foundation – Toothache
- ADA – Antibiotics for Dental Pain and Swelling Guideline (2019)
- ADA MouthHealthy – Dental emergencies
- ADA MouthHealthy – Pregnancy dental concerns