Toothache That Won't Go Away: Causes and What to Do

A toothache that lingers for days or keeps coming back is your body telling you something is wrong. While it can be tempting to keep taking painkillers and hope it resolves on its own, a persistent toothache almost always needs professional treatment.

Here's what might be causing it and what to do about it.

Common Causes of Persistent Toothache

Several dental conditions can cause pain that doesn't go away. Understanding the likely cause helps you know how urgently you need to be seen.

Tooth Decay (Dental Caries)

The most common cause of toothache. When decay is small and limited to the enamel, you may not feel anything at all. But as it progresses deeper into the tooth, reaching the softer dentine and eventually the pulp (nerve), pain can become constant and increasingly severe.

By the time a cavity is causing persistent pain, it has usually progressed significantly and may need more than a simple filling. Learn more about the stages of tooth decay.

Dental Abscess

An abscess is a collection of pus caused by a bacterial infection, typically at the root tip of a tooth or in the gum. It can cause a throbbing, persistent pain that may spread to the jaw, ear, or neck.

You might notice a bad taste in your mouth, facial swelling, or a small bump on the gum near the affected tooth. Dental abscesses do not resolve without treatment and can become serious if the infection spreads.

Cracked or Fractured Tooth

A crack in a tooth can be difficult to spot. It may not be visible to the naked eye and sometimes doesn't even show on an X-ray. Cracked tooth pain is often sharp and intermittent, triggered by biting or chewing, and can be difficult to pinpoint to a specific tooth.

The pain may come and go over weeks or months. If you suspect a cracked tooth, see our guide on broken tooth treatment.

Gum Disease (Periodontal Disease)

Advanced gum disease can cause a dull, aching pain around one or more teeth, along with bleeding gums, recession, and looseness. The pain tends to be less sharp than decay-related toothache but can be persistent and uncomfortable. Gum disease is a leading cause of tooth loss in adults.

Why Toothache Gets Worse at Night

Many people notice their toothache feels worse when they go to bed. This happens for several reasons. Lying down increases blood flow to your head, which raises pressure around the tooth. There are fewer distractions at night, making you more aware of the pain. And if you grind your teeth during sleep (bruxism), this can aggravate an already sensitive tooth.

Try sleeping with your head elevated on an extra pillow to reduce the pressure.

Need to find a dentist who can see you quickly? Search for available appointments near you.

Other Possible Causes

Less commonly, persistent tooth pain may be related to:

• Teeth grinding (bruxism) can cause generalised aching, particularly first thing in the morning. See our bruxism guide
• Sinus infection can make upper back teeth ache when sinuses are inflamed
• Impacted wisdom teeth can cause pain at the back of the jaw. See our wisdom tooth pain guide
• A failed or deteriorating old filling allows bacteria to get underneath worn restorations
• Pain after a recent filling may indicate the filling is too high or there's an issue. See our guide on pain after a filling
• TMJ (jaw joint) problems can sometimes mimic toothache. See our TMJ guide

Red Flags: When to Seek Urgent Help

Most toothaches are not emergencies, but some symptoms require same-day care. Here's when to act urgently.

Managing Pain at Home (Temporarily)

While waiting for your dental appointment, these measures may help manage the pain. These are temporary solutions, not cures.

• Ibuprofen (400mg, up to three times daily with food) is generally the most effective painkiller for dental pain, as it reduces both pain and inflammation. You can alternate with paracetamol for added relief
• Warm salt water rinses using half a teaspoon of salt in a glass of warm water, rinsed gently around the affected area
• Cold compress against the cheek for 15 to 20 minutes if there is swelling
• Sleep propped up on pillows. Lying flat can increase pressure and worsen pain
• Avoid triggers such as very hot, cold, or sweet foods which can make the pain worse
• Clove oil applied to the affected area with a cotton ball can provide temporary numbing relief. It contains eugenol, a natural anaesthetic

What Your Dentist Will Do

When you visit the dentist with a persistent toothache, here's what to expect:

• Clinical examination: Your dentist will look at the tooth and surrounding gum, check for swelling, and test the tooth's response to temperature and pressure
• X-rays: A dental X-ray can reveal decay between or under teeth, infection at the root tip, bone loss from gum disease, or fractures
• Diagnosis: Based on their findings, your dentist will explain what's causing the pain and discuss treatment options with you
• Treatment plan: This may range from a filling for decay, to root canal treatment for an infected pulp, antibiotics for a spreading abscess, or referral for more complex cases

If you're anxious about visiting the dentist, you're not alone. Dental anxiety is very common. Many practices now offer options to help nervous patients feel more comfortable. Read more in our dental anxiety guide.

Don't Wait It Out

It can be tempting to ignore a toothache and hope it goes away, especially if the pain fluctuates. But dental problems do not heal on their own in the way a cut or bruise might.

A toothache that appears to resolve may simply mean the nerve has died. The infection can continue silently, potentially leading to an abscess or more serious complications down the line.

The earlier you seek treatment, the more conservative (and less costly) it tends to be. A tooth that needs only a filling today could require root canal treatment or extraction if left for months.

Frequently Asked Questions

Why won't my toothache go away even with painkillers?

Painkillers manage symptoms but don't treat the cause. If pain persists despite ibuprofen and paracetamol, there is likely an active problem such as deep decay, an abscess, or a crack that needs professional treatment. See a dentist for diagnosis.

How long is too long for a toothache?

Any toothache lasting more than one to two days should be assessed. Persistent or spontaneous pain, especially pain that wakes you at night, suggests a problem that won't resolve on its own. If you have swelling, fever, or a bad taste, seek care urgently.

Can a toothache go away on its own?

Minor sensitivity or gum irritation may settle on its own. But pain from decay, an abscess, or a crack will not. If pain stops suddenly, it may mean the nerve has died. The infection can continue silently and lead to complications.

What is the best painkiller for toothache?

Ibuprofen (400mg, up to three times daily with food) is generally most effective for dental pain as it targets both pain and inflammation. Alternate with paracetamol for added relief. Never place aspirin directly on the gum as it can cause a chemical burn.

Should I go to A&E for a toothache?

A&E departments generally cannot provide dental treatment. Only go to A&E if swelling is affecting your breathing or swallowing, you have uncontrollable bleeding, or signs of a serious spreading infection. Otherwise, call your dentist, NHS 111, or find an emergency dental service.

Why does my toothache get worse at night?

Lying down increases blood flow to your head, raising pressure around the tooth. Fewer distractions make pain more noticeable. Teeth grinding during sleep can also aggravate a sensitive tooth. Try sleeping with your head elevated on an extra pillow.

Can a cracked tooth cause constant pain?

Yes. A cracked tooth can cause sharp, intermittent pain triggered by biting, or constant throbbing if the crack has exposed the nerve. Cracks can be difficult to diagnose as they may not be visible or show on X-rays.

What will the dentist do for a persistent toothache?

Your dentist will examine the tooth, take X-rays, and test its response to temperature and pressure. Treatment may include a filling, root canal, antibiotics if infection is spreading, or extraction if the tooth can't be saved.