For severe toothache, take paracetamol or ibuprofen at the leaflet dose, rinse with warm salt water, hold a cold compress on your cheek and avoid hot, cold or sweet food. See a dentist the same day. If swelling reaches your eye or neck, or swallowing or breathing becomes hard, go to a hospital emergency department.
What to do in the first hour
The steps below are safe for most adults and can take the edge off the pain while you arrange to see a dentist. They ease the symptoms; they do not treat the cause.
- Rinse your mouth with warm water and brush gently with a soft toothbrush. If food is trapped next to the tooth, remove it carefully with floss.
- Take a painkiller such as paracetamol or ibuprofen, following the dose on the leaflet and never going above the maximum daily dose. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney, liver or heart problems or asthma.
- Rinse with warm salt water: about half a teaspoon of salt in a glass of warm water, swished around the mouth and spat out. Young children should not do this, as they may swallow it.
- Hold a cold compress, such as ice wrapped in a thin cloth, against the outside of your cheek for 15 to 20 minutes at a time. Cold can reduce swelling and dull the pain.
- Eat soft, lukewarm food, chew on the other side, and avoid sugary drinks as well as very hot or very cold food and drinks.
- At night, rest with your head raised on an extra pillow. Lying flat often makes throbbing pain feel stronger.
The NHS advice on toothache recommends similar steps: toothache lasting more than two days, or not settling with painkillers, needs a dentist.
What not to do
- Do not place an aspirin tablet on the gum or tooth: it can burn the gum. Aspirin should not be given to children under 16.
- Do not put heat on your face. A hot compress can make swelling worse when there is an infection.
- Do not take leftover antibiotics or someone else’s prescription. They do not relieve most toothache and can cause side effects and resistance.
- Do not try to burst or drain a swelling yourself with a needle or pin.
- Do not simply wait for the pain to go away. When it disappears suddenly, the nerve may have died while the infection carries on.
Why toothache can be so intense
Inside each tooth is the pulp, a soft tissue containing nerves and blood vessels, enclosed by the hard walls of the dentine and enamel. When the pulp becomes inflamed, the swelling has nowhere to go, so pressure builds up inside the tooth. That is why dental pain can throb and keep you awake.
The most common causes of severe toothache are:
- deep tooth decay (caries) that has reached the pulp and inflamed it, a condition called pulpitis;
- a dental abscess, a pocket of pus at the tip of the root or in the gum, caused by infection;
- a cracked tooth or a broken filling, which often hurts sharply when you bite or release;
- a partly erupted wisdom tooth with inflamed gum around it (pericoronitis);
- gum disease, a gum abscess, or food packed tightly between two teeth;
- exposed roots or worn enamel, which cause short, sharp sensitivity.
Not every jaw pain is dental: a sinus infection, grinding, jaw joint problems or, rarely, heart problems can mimic it. Jaw or chest pain with breathlessness, sweating or arm pain needs emergency medical help immediately.
What the type of pain can tell you
| What you feel | Possible cause | How urgent |
|---|---|---|
| A short, sharp twinge with cold or sweet, gone within seconds | Sensitivity, an exposed root or a small cavity | Book a routine visit |
| Pain with hot or cold that lingers for a minute or more | Inflamed pulp (pulpitis) | See a dentist within a day or two |
| Throbbing pain that starts on its own or wakes you at night | Severe pulpitis or an early abscess | The same day if possible |
| Constant pain on biting, the tooth feels “high”, the gum is swollen | Abscess or infection around the root | The same day |
| Facial swelling, fever, difficulty opening the mouth | Spreading infection | Urgent: today, or the emergency department if it spreads |
Brief twinges are a different problem; our article on tooth sensitivity to cold and heat explains its causes and treatment.
Warning signs: when to go to the emergency department
A few signs suggest that an infection may be spreading beyond the tooth, which can become dangerous. Go to a hospital emergency department straight away, and do not drive yourself, if you have:
- swelling that spreads towards the eye, under the jaw or down the neck;
- difficulty swallowing, breathing or speaking, or you cannot swallow your own saliva;
- a high temperature with chills, or you feel generally very unwell;
- increasing difficulty opening your mouth;
- heavy bleeding that does not stop with firm pressure, or a serious injury to the face or jaw.
Our guide on facial swelling from a tooth and when to go to the emergency room explains these signs in more detail. If an adult tooth has been knocked out, hold it by the crown rather than the root, put it back in its socket if you can or keep it in milk, and see a dentist immediately: the sooner, the better the chance of saving it. A knocked-out baby tooth should not be put back.
What happens at an emergency dental visit in Tripoli
The aim is to find the cause and relieve the pain safely. Most visits take 30 to 60 minutes.
- Questions and examination, about 10 to 15 minutes. The dentist asks when the pain started, what triggers it, whether you have swelling or fever, and about your general health and medicines. Simple tests, such as gently tapping the tooth or touching it with something cold, help locate the problem.
- X-ray. A small dental X-ray usually shows decay, an abscess at the tip of the root or bone loss that cannot be seen in the mouth.
- Diagnosis and options. The dentist explains what is causing the pain and the realistic choices, including whether the tooth can be saved, and you decide together.
- Treatment to relieve the pain, usually under local anaesthesia.
Depending on the cause, that first treatment may be:
- opening the tooth to remove the inflamed or infected pulp and placing a soothing dressing, which is the first stage of root canal treatment;
- draining an abscess so that the pus and pressure can escape;
- removing a tooth that cannot be saved (extraction);
- cleaning around an inflamed wisdom tooth, or protecting a cracked or broken tooth with a temporary filling.
Antibiotics are not a substitute for this treatment. They are reserved for spreading infection, with swelling or fever, or for particular medical conditions, and are given alongside treatment of the tooth.
Will it hurt? Pain and anaesthesia
Treatment is done under local anaesthesia, an injection that numbs the tooth and the area around it while you stay fully awake. For most patients, the moment the anaesthetic takes effect is the moment of real relief, because the pain they arrived with stops.
To be honest, a very inflamed tooth can be harder to numb than a healthy one, especially a lower back tooth. The dentist can give additional anaesthetic or use a different technique, and waits until the tooth is properly numb before continuing. Raise your hand at any time if you feel pain, and the dentist will pause.
If you are anxious, say so when you call. Agreeing on a stop signal and taking short breaks help many people stay calm.
After the emergency visit: recovery and next steps
Once the cause has been treated, the pain usually settles noticeably within one to three days. Some tenderness when biting is common for a few days and usually responds to a simple painkiller.
- Avoid chewing hard food on a tooth with a temporary filling until the treatment is finished.
- After an extraction, do not rinse vigorously, smoke or drink through a straw for the first day, so that the blood clot can protect the socket.
- Contact the clinic if the pain gets worse after two or three days, if swelling increases or if you develop a fever.
A tooth that has been opened needs its root canal treatment completed and, in many cases, a crown to protect it, because a back tooth weakened by a large cavity can crack. If a tooth has to be removed, it can later be replaced with a bridge, an implant or a removable denture if you wish.
How long the result lasts
A tooth that is properly treated and restored can usually last for many years. Pain often returns when treatment is left unfinished or new decay develops. Regular check-ups and scaling, the professional removal of tartar, reduce the risk of another emergency.
What determines the cost of emergency treatment
We do not quote prices online, because the cost depends on what the examination finds. The main factors are:
- the cause of the pain and the type of treatment needed: a dressing, drainage, an extraction or root canal treatment;
- which tooth is involved, since molars have more roots and canals than front teeth;
- whether X-rays are needed;
- whether an extraction is simple or surgical, as with an impacted wisdom tooth;
- the treatment needed afterwards to restore the tooth, such as a filling or a crown.
A consultation is the only way to get an accurate estimate; ask for the options and their cost to be explained before treatment starts.
Toothache care at Ajam Dental Clinic in Tripoli
Ajam Dental Clinic is a dental practice run by Dr. Abdel Rahman Ajam and Dr. Soumaya Ajam at Fouad Chehab Boulevard, Al-Makateb Building, 1st Floor. The treatments offered include extractions and oral surgery, including wisdom teeth. Root canal treatment and re-treatment are carried out at the clinic by a visiting specialist endodontist. All dental care for children, including a child’s toothache, is handled by Dr. Soumaya Ajam.
If you have a toothache, call or send a WhatsApp message to one of our dentists describing your symptoms (Dr. Abdel Rahman Ajam on +961 76 593 093, or Dr. Soumaya Ajam on +961 76 619 659 for children), so that we can advise you on the next step. You can read more about our emergency dental care. If you have any of the warning signs listed above, go to a hospital emergency department first.
Patients come to our clinic on Fouad Chehab Boulevard from across Tripoli — Zahriyeh, Al-Tall, Dam wa Farez, Azmi Street, Bahsas and Beddawi — as well as from the rest of North Lebanon. To arrange a consultation, please get in touch through our contact page.
Frequently asked questions
How can I sleep with a severe toothache?
Take a painkiller such as paracetamol or ibuprofen about an hour before bed, following the leaflet, so that it is already working when you lie down. Sleep with your head raised on an extra pillow, because lying flat often makes throbbing pain feel worse. Avoid anything sweet, very hot or very cold in the evening, and keep a cold compress nearby for the outside of your cheek. If the pain still wakes you despite these steps, it is a sign that the tooth needs treatment soon, so contact a dentist first thing in the morning.
Should I take antibiotics for toothache?
In most cases, no. The pain of an inflamed nerve, called pulpitis, is not something antibiotics can relieve, and even an abscess needs its source removed by draining it, cleaning out the tooth or extracting it. Antibiotics are useful when an infection is spreading, for example with facial swelling or fever, or for people with certain medical conditions, and they are prescribed by a dentist or doctor alongside treatment. Taking leftover tablets or someone else's prescription can cause side effects, hide warning signs and contribute to antibiotic resistance.
The pain suddenly stopped. Do I still need to see a dentist?
Yes. When severe toothache disappears on its own, it sometimes means the nerve inside the tooth has died rather than healed. The infection can then continue quietly and spread to the bone around the root, forming an abscess that may cause swelling weeks or months later. A dentist can check the tooth with simple tests and an X-ray. Treating it at this stage, usually with root canal treatment, is often simpler and more comfortable than waiting for the next flare-up, and it gives the tooth a better chance of being saved.
Can a tooth be treated or extracted while it is infected and swollen?
Often yes, and removing the cause is usually the fastest way to bring an infection under control. The dentist may drain the abscess, open the tooth to release the pressure or, if the tooth cannot be saved, extract it. In some situations, for example when the swelling is large or the mouth does not open well, the dentist may first control the infection and plan the definitive treatment a few days later. Local anaesthesia can work less well in very inflamed areas, so the technique is adapted. Swelling that spreads to the eye or neck needs hospital care first.
What can I do about toothache during pregnancy?
Contact a dentist and mention that you are pregnant. Dental treatment, including local anaesthesia and, when really necessary, a small dental X-ray, is generally considered safe during pregnancy, and leaving an infection untreated is not good for you or your baby. Paracetamol is usually the first-choice painkiller in pregnancy, at the recommended dose. Ibuprofen and other anti-inflammatory medicines are generally avoided, particularly in later pregnancy, unless a doctor advises otherwise. Check with your doctor, midwife or pharmacist before taking any medicine, and never take antibiotics without a prescription.
My child has a toothache. What should I do?
Give a children's painkiller such as paracetamol or ibuprofen at the dose for your child's age and weight, as shown on the pack or advised by a pharmacist. Never give aspirin to a child under 16, and do not use salt-water rinses with young children who may swallow them. Offer soft, lukewarm food and check gently for food trapped between the teeth. Children's teeth can decay quickly, and swelling of the face, fever or a child who refuses to eat or drink needs to be seen urgently. At Ajam Dental Clinic, dental care for children is handled by Dr. Soumaya Ajam.
Have a question about your teeth?
Send a WhatsApp message to Dr. Abdel Rahman Ajam or Dr. Soumaya Ajam, or call the clinic to book a consultation.
This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.