Disclaimer

The information contained on this page should only act as a general indication of the causes of dental and facial pain and discomfort and not be used as a diagnostic tool.  You should always consult with your dentist.  You should follow the advice of your dentist and attend for regular dental examinations and oral hygiene visits.

What is the problem?

Broke my tooth/crown/filling

Fractures caused by chewing and biting hard.

Teeth grinding and clenching.

Underlying decay.

Debonded crown, veneer or filling.

Keep area clean from food impacting in the cavity.

Avoid chewing on the problem side.

You need to see a dentist as soon as possible during normal opening hours to stabilise the area and to arrange for a permanent restoration.

Do not be tempted to ignore the issue – this can lead to pain and much more complex and expensive treatment.

Dull toothache

Chronic abscess due to decay or tooth dying.
Current root canal requiring re-treatment.
Root fracture.
Trauma when biting together.

Pain killers if required.

Arrange to see your dentist at your earliest convenience.

Severe toothache

Chronic tooth abscess due to decay, failed root canal teatment or other cause flaring up into an acute stage.

Acute abscess due to tooth fracture, decay, trauma or changes in the way teeth bite together especially after the placement of a new filling.

Anti-inflammatory drugs.

Arrange for an emergency appointment and don’t delay seeing your dentist. Doing so may cause even more problems for you.

Cold sensitivity

Leaking or broken filling or fractured tooth.
New decay setting in.
Secondary decay around a current filling.
Trauma, or after the placement of a new filling.
Vigorous tooth brushing causing sensitive tooth necks.
After seeing a hygienist.

Desensiting toothpastes and mouthwashes.
Anti-inflammatory drugs.
Using a much softer toothbrush.

Routine appointment for a dental examination, depending on severity.

Heat sensitivity

Trauma to a tooth, historic or recent.
Extensive decay.
Deep filling after extensive decay.
Sometimes no obvious cause.
Newly placed crown or overlay

Arrange to see your dentist as soon as possible since heat sensitivity is generally an indication of a tooth in need of a root canal treatment.
Do not ignore heat sensitivity.

Bite sensitivity

Tooth fracturing due to trauma or decay.
Recently placed filling that is now too high.

Anti-inflammatory drugs.

Arrange for an appointment at your earliest convenience to eliminate an escalation of pain.

Loose tooth/teeth

Looseness of teeth is caused by a disease of the periodontium and includes the tissues surrounding the teeth, which are the gums/gingiva, the bone supporting the teeth and the fibres attaching the teeth to the bone.

Gum disease.
Chronic abscess due to decay or tooth dying.
Root fracture.
Trauma when biting together.
Tumour (Rare)

Pain killers if required.

Contact the dentail surgery for a routine appointment at your earliest convenience to diagnose and treat/refer the problem.

Knocked a tooth out

General trauma

The sooner a knocked-out tooth is reimplanted, the more likely it is to embed itself back into the gum. If you don’t want to be left with a gap, make an emergency appointment to see your dentist and follow this advice:

  • Handle the tooth by the white bit at the top (the crown) and avoid touching the root.
  • Do not scrape or brush the tooth.
  • If the tooth is dirty, rinse it with milk or a saline (salt water) solution and try to put the tooth back into its socket in your mouth as soon as possible. Do not rinse the tooth with water or alcohol.
  • When the tooth is back in its socket, bite down onto a clean piece of material (such as a handkerchief) or a wet tea bag to keep it in place.
  • If you cannot reimplant the tooth, hold it between your cheek and gum until you manage to see a dentist, or store the tooth in a clean container and cover it with milk or a small amount of your saliva.

The above advice only applies to adult teeth – children’s milk teeth should not be re-implanted as an adult tooth will soon grow in its place.

Book an appointment with your dentist as soon as possible or report to the closest A&E unit.

Pain one side of the face

Sinusitis: This is caused by infection of the maxillary sinus, usually following an upper respiratory tract infection.

Recent tooth extraction, leading to an oro-antral fistula or a dry/infected socket

The pain tends to be increased on lying down or bending over. There is often a feeling of `fullness’ on the affected side. The pain is usually unilateral, dull, throbbing and continuous. Quite often the patient feels unwell generally and feverish.

Pain originating from the sinus arises mainly from pressure. Decongestants can help sinus drainage. Antibiotics probably have only a minor role in mild cases.

Arrange for a consultation with your dentist at your earliest convenience.

Swelling with/without pain

Chronic/acute abscess related to a tooth/teeth.
Blocked saliva gland/s.
Trauma.
Tumour (rare)

Heat therapy, e.g. hot salt water, coffee, tea held over the area.
Anti-inflammatory drugs

Routine appointment at your earliest convenience to diagnose, treat/refer the cause.

Discomfort after new filling/crown

High filling/crown (teeth not closing down correctly after placement of restoration).
Inflammation (reversible/irreversible) of the nerve of the tooth due to stress the tooth experienced of having the treatment done.

Anti-inflammatory drugs.
Eat softer food in the meantime.

An emergency appointment at your earliest convenience.

Discomfort after new denture

It will probably take some time for you to adjust to the new denture.
Rubbing of the edges of the denture on the gums.
Natural bite may need adjusting.
Hidden root fragment.

Wear your old denture in the meantime.
Heat therapy, e.g. hot salt water, coffee, tea held over the area.
Anti-inflammatory drugs.

Emergency appointment at your earliest convenience for a denture adjustment or the review your bite or to have the root fragment removed, if present.

Pain after root canal treatment

A chronic abscess may flare up to become an acute abscess.
Restoration too high.
Root fracture.
General post-operative sensitivity.

Anti-inflammatory drugs.
Heat therapy, e.g. hot salt water, coffee/tea held over the area.

Emergency appointment if the area swells up and if the pain increases for a review and possible antibiotics.

Mouth ulcer

Mouth ulcers: They are painful round or oval sores that form in the mouth, most often on the inside of the cheeks or lips. They’re usually white, red, yellow or grey in colour and are inflamed (red and swollen) around the edge. Although mouth ulcers can be uncomfortable, especially when you eat, drink or brush your teeth, they are usually harmless. Most mouth ulcers will clear up by themselves within a week or two. You only need to see your GP or dentist if the ulcer gets worse or lasts for longer than three weeks, or if you develop ulcers regularly.

Cold sores: They are small blisters that develop on the lips or around the mouth. They are caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days.

Acute necrotising ulcerative gingivitis (ANUG): This is a rapidly progressive infection of the gingival tissues that causes ulceration of the gums between the teeth. It can lead to extensive destruction. Usually young to middle-aged people with reduced resistance to infection are affected. Males are more likely to be affected than females, with stress, smoking and poor oral hygiene being predisposing factors. Halitosis, spontaneous gingival bleeding, and a `punched-out’ appearance of the gums between the teeth are all important signs.

The patients quite often complain of severe gum tenderness with pain on eating and tooth brushing. The pain is dull, deep-seated and constant. The gums can bleed spontaneously and there is also an unpleasant taste in the mouth.

Cold sores: Antiviral creams are available over the counter from pharmacies without a prescription. If used correctly, these can help ease your symptoms and speed up the healing time.

ANUG: Use Corsodyl mouthwash and take pain killers.

Arrange to see your dentist as soon as possible when you suspect ANUG

Discomfort after hygienist visit

It is a very common misconception that patients feel their mouths have been damaged by the treatment. This is understandable, as you likely went in to the dentist with no pain or noticeable problems and are left with sore teeth for days afterward. So, while we all like to avoid pain, sore gums following a cleaning can actually be an indicator that good things are happening. But the reasons for the pain are;

If you had a lot of tartar build-up, although this can do great harm, it insulates the teeth against the cold/heat etc. So as tartar strips away your gums, it also covers the underlying tooth surface, so you are not aware of any issues. Take this tartar away (as must be done) and the teeth are sensitive for a few days or more. So the sensitivity is not directly due to the scaling, but down to the removal of tartar.

Some people have sensitive teeth and the scaling can upset the trigger the nerve endings, leading to transient pain.

If you have inflamed gums, these may also become painful as a reaction to the cleaning. This should settle down within a few days.

Heat therapy, e.g. hot salt water, coffee/tea held over the are.
Desensiting toothpastes and mouthwashes as recommended by your hygienist.
CONTINUE to clean your teeth and gums thoroughly even when they are sensitive.

Routine appointment at your earliest convenience ONLY if the teeth or gums don’t settle down.

Discomfort after periodontal/gum treatment

Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it’s usually in a deeper region under the gums.
The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.

Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.
Your dentist or hygienist may recommend salt water or chlorhexidine rinses.

Routine appointment ONLY if the discomfort does not settle down.

Pain/bleeding after tooth removal

Disruption of the healing process of the socket.  Either the bloodclot got washed out with a subsequent infection of the bone or an artery opened up and has started bleeding.  A healthy bloodclot is essential for the healing process.  Diabetics will have impaired healing and have to take antibiotics when a tooth is removed.  If you take blood thinning medication, like aspirin, this will also affect the clotting process.

Recovery will be uneventful, providing you follow the instructions:

 

  • Do not rinse mouth out for at least 30 minutes after the extraction.
  • Do not chew on the side of the extraction for the rest of the day.
  • Do not perform any strenuous activities for the rest of the day.
  • Keep your head elevated when you lie down for the next 24 hours.
  • Gently rinse mouth with hot salt water (1 tbs. /glass), three times daily, for five days.
  • Do not try to rinse or clean the socket out. It will disturb the blood clot, which will lead to pain (dry socket).
  • If bleeding persists wet a tea bag in water, squeeze excess water out and place the tea bag over the socket. Close together to apply pressure for at least ten minutes. You can use a linen compression pad as an alternative.
  • If you need to take painkillers, avoid aspirin. Use your regular painkillers or as advised by your dentist.
  • If pain develops three days after the extraction, or if pain persists, contact the Practice.
  • Please note: A minimum charge will be payable for a post-extraction appointment.
  • It is possible for bits of hard tissue (bone) to work its way out of the socket. This is not usually a concern.
  • Remember to take your antibiotics if you were asked to do so, e.g. diabetes sufferers.

A healthy, clean mouth heals quicker.  Smoking and alcohol will delay the healing process and possibly lead to complications.

You have to contact the surgery if pain develops so the socket can be cleaned and re-dressed.  You will likely need antibiotics as well. Uncontrollable bleeding has to be dealth with by your dentist or an A&E department.