What Are the 6 Common Causes of a Toothache?

Woman with Toothache

Unsurprisingly, toothaches are among the most common reasons people call the dentist. Over 40% of Americans experience tooth pain each year. Tooth pain can be debilitating, causing pain and sensitivity when eating, drinking, or even talking. They also have various causes, from the deep, unrelenting pain of an abscess to an injury to a tooth or crown. Here are some of the most common causes of toothaches.




Tooth decay

Tooth decay is painless when it’s superficial. It’s only when it enters the deeper tissues of the teeth that it causes pain, which can take years. Tooth decay is a process that occurs when your tooth enamel erodes and the protective layer of the tooth wears away, allowing bacteria easier access.

As the decay deepens, bacteria can enter the middle layer of the tooth, called the dentin, and then the soft tissue inside the tooth, called the pulp, where the nerves and blood vessels are. This leads to inflammation of the pulp or pulpitis. Once the decay enters the pulp, you will need a root canal to save the tooth. That’s why preventing cavities is so important.

Tooth decay can affect any person at any age. However, certain factors increase an individual’s risk of developing cavities:

  • Age — Children are at higher risk because their natural tooth enamel is not fully developed. Additionally, young children often have less control over what they eat than older individuals. This makes them more likely to eat food with sugar (which increases bacterial activity).
  • Genetics — Your genes determine how quickly you develop cavities. If both parents had many cavities as children/adults, it may be likely that you will as well
  • Diet — Eating sugary foods regularly accelerates dental decay while consuming fewer sweets improves oral health.
  • Toothbrushing habits — Brushing regularly helps remove plaque from your teeth before it turns into tartar or hardens around them.

The best approach to preventing tooth decay is to brush and floss your teeth twice a day, reduce the amount of sugar in your diet, and see your dentist every six months. If you have a painful tooth due to decay, it needs evaluation immediately.

An abscessed tooth

If a tooth is abscessed, it means the infection has entered or spread to the pulp, the innermost part of your tooth containing nerves and blood vessels. With an abscess, there’s not just inflammation, there’s an active infection.  The infection can spread from there into the tooth root and jawbone, causing pain in those areas, too.

The pain of an abscessed tooth is usually worse at night because during sleep, you tend to swallow less often, which allows saliva to remain in contact with the infected area longer than usual. Other signs and symptoms of an abscessed tooth include:

  • Swelling in the face, neck, or jaw
  • Pain, redness, or tenderness in the affected area
  • Fever
  • A bad taste in your mouth (from pus)
  • Bad breath
  • Pain that increases when you chew or biting down on something hard (known as biting pain)
  • Swollen gums around the tooth

An abscessed tooth is a dental emergency and will require antibiotics, root canal therapy, or extraction to stop the infection. It will not heal on its own.

A cracked tooth or crown

Another common cause of toothache is damage to the crown of the tooth underneath. You can damage a crown by biting down on something hard or grinding or clenching your teeth. If you have a damaged crown, you might also experience sensitivity to hot or cold foods and beverages and pain when chewing or biting. The solution is to see your dentist so that they can replace the crown.

Gum disease

Gum disease is caused by bacteria that live in your mouth. The bacteria can destroy the bone and tissue that hold teeth in place, causing them to become loose or fall out. Gum disease can also cause the gums around your teeth to pull away from the tooth, forming pockets of infection below the gum line. When this happens, plaque can build under the gums and irritate sensitive tissues inside your tooth sockets. This can lead to tooth pain that gets worse when you eat sweets or spicy foods. You might also experience painful gums when you eat something hot or cold.

Gum disease is a serious condition that can affect your overall health. The best solution is to see your dentist and discuss treatments.  The most common is scaling and root planing (deep cleaning). With this procedure, your dentist or periodontist uses special tools to remove the plaque and tartar (hardened plaque) that has accumulated on your teeth. Your dentist may recommend flap surgery or gum grafts if you have deep pockets between your teeth and gums that can’t be treated with scaling and root planing alone.

Injuries to the teeth and gums

Your teeth and gums can also be injured by a fall, blow to the face or mouth, or sports injury. Biting down on something hard or clenching and grinding your teeth can also injure the tooth or gum and cause pain. See a dental professional immediately if you experience a tooth injury serious enough to cause pain. You could have a cracked tooth that requires treatment.

Teeth grinding (bruxism)

Teeth grinding, or bruxism, is a common cause of toothache. This condition occurs when the temporomandibular joint (TMJ) becomes inflamed or irritated because you’re clenching or grinding your teeth together while you sleep. Over time, this can lead to soreness in your jawbone and muscles, as well as headaches. If left untreated, it can wear down your tooth enamel and make you more susceptible to cavities. Some people who grind their teeth may find relief from using a mouth guard designed for this purpose. Others find it helpful to wear night guards designed for snoring prevention as an additional measure.

The Bottom Line

When the pain is severe, it can be hard to ignore. But even if you don’t have a toothache now, it’s important to contact your dentist as soon as possible if you think one could develop. When it comes to oral health issues, waiting too long can cause more harm than good.


“Toothaches: Causes, Treatments, and Prevention – Healthline.” 27 Sept. 2019, .healthline.com/health/toothaches.

“Potential Causes Of Toothaches | Colgate®.” .colgate.com/en-us/oral-health/tooth-sensitivity/potential-causes-of-toothaches-its-not-always-a-cavity.

“Tooth abscess – Symptoms and causes – Mayo Clinic.” 01 Mar. 2019, .mayoclinic.org/diseases-conditions/tooth-abscess/symptoms-causes/syc-20350901.

“Common Causes Of Tooth Pain – Forbes Health.” 05 Aug. 2021, .forbes.com/health/body/common-causes-of-tooth-pain/.

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