A Toothache That Started on Tisha B'Av

Quick answer: Dental treatment itself does not break a fast — local anaesthetic is injected, not swallowed, and rinsing without swallowing is generally permitted. Painkillers by mouth are the part that raises the question, so treating the tooth is often the cleaner solution. Ask your rav; ask your dentist to get you seen.

The call

Late morning on Tisha B'Av. Moshe, 44, phoned from Beit Shemesh with a lower molar that had been building for two days and had chosen that morning to become unbearable. He had not taken anything, was not drinking, and had six hours of fast left.

He asked the question we hear on every fast day: is there anything you can do that does not involve me eating or drinking?

What we found

We opened for him within the hour. The lower left first molar had deep decay under a failing filling. Cold produced a prolonged, savage response, and there was early tenderness to tapping — irreversible pulpitis with the inflammation beginning to spread past the root tip.

There was no swelling, no fever, no difficulty swallowing, and no spread into the tissues. Had any of those been present, the conversation would have been a very different one, and a short one: an infection that is spreading is a medical situation, and every posek I have dealt with treats it as such.

What we did

An emergency pulpectomy under local anaesthetic. Practically, the fast-day considerations were straightforward:

• Local anaesthetic is injected into tissue. It is not food or drink.
• Water spray during treatment was suctioned continuously with high-volume aspiration, and he was positioned so nothing pooled at the back of his throat. He did not swallow.
• We did not rinse and spit more than necessary, and he was told to spit rather than swallow.
• No oral medication was given during the fast.

We removed the entire inflamed pulp, dressed the canals, and sealed the tooth. The pain was gone when the anaesthetic was still working and did not return when it wore off, because the source of it had been removed rather than masked.

He finished the fast comfortably. Had we simply prescribed painkillers, he would have faced a choice between severe pain and breaking his fast — which is exactly the choice treating the tooth avoided.

The outcome

We completed the root canal ten days later and crowned the tooth six weeks after that.

The practical lesson he took away, and which he passes on to anyone who will listen: he had noticed the tooth two weeks earlier and decided to deal with it after the fast. Two weeks earlier it would have been a filling.

What to do if this happens to you

1. Phone a dentist first, before deciding you have to suffer through it. Treatment is often possible.
2. Ask your rav about your specific situation, and tell them exactly what the dentist proposes.
3. Rinse and spit, do not swallow. Cold water held in the mouth can give some relief.
4. Break the fast without hesitating if there is swelling, fever, or difficulty swallowing or breathing. That is not a dental question any more.
5. Do not delay planned dental work until after a fast if the tooth is already symptomatic.
6. If you know a fast is coming and a tooth is niggling, deal with it in the week before.

In pain on a fast day? Message Ramat Beit Shemesh Urgent Dental Care on WhatsApp https://wa.me/972559858845 or call 055-985-8845. Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.