Why Does My Tooth Hurt? How to Tell What Is Causing It

What the Pain Pattern Usually Means

Nerves are poor witnesses about location but good witnesses about cause. Find the line that sounds most like yours.

• A quick zing from cold or sweet that fades within seconds. Usually sensitivity or early decay — the nerve is irritated, not damaged. Our guide to teeth that are sensitive to cold explains why.
• Sharp pain only when you bite down, gone the moment you let go. Typically a crack, or a filling sitting a fraction too high. Tooth pain when biting covers how the two are told apart.
• An ache that lingers for minutes after something hot or cold. This is the one that matters. A nerve still hurting after the trigger has gone is usually inflamed beyond recovery, and lingering pain to heat is the strongest single sign of it.
• Deep throbbing that keeps you awake and does not care which way you lie. More like a dying nerve or an abscess at the root tip. Why toothache gets worse at night explains the mechanism.
• Pain for two days, gone for a week, back again. An inflamed nerve that has not finished dying. It escalates; it does not settle. See tooth pain that comes and goes.
• A sore spot on the gum beside one tooth, often with a bad taste. Infection finding a way out. A gum boil that drains and returns is still active between flare-ups.

Why Nothing Looks Wrong in the Mirror

People are often half-convinced they are imagining it, because the tooth looks perfectly normal. That is the usual situation, not the unusual one.

Most decay starts in the contact point between two back teeth, where neither a toothbrush nor your own eyes reach. Cracks in enamel are often invisible until a light is shone through the tooth from the side. An infection at a root tip sits in bone several millimetres below the gum, where there is nothing to see at all. An x-ray is what turns a guess into a diagnosis, which is why we take one before suggesting treatment rather than after.

What it finds decides the fix. Early decay is a filling; a nerve that has died is root canal treatment, which keeps the tooth you already have. Waiting to see whether it settles is usually the more expensive choice — the same problem is a filling in March and a root canal in July.

When the Pain Is Not Coming From a Tooth

A fair number of the aches we see every week never were a tooth problem.

• A sinus infection presses on the roots of the upper back teeth and can set three or four of them aching together, with a heaviness that worsens when you bend forward. Sinus infection or toothache sets out how to tell.
• Clenching and grinding leaves teeth tender to bite on and jaw muscles sore in the morning, usually on both sides. Grinding as a cause of tooth pain has the details.
• Referred pain works in both directions, which is why a lower molar can present as earache and an upper tooth can feel like pain behind the eye.

The American Association of Endodontists has a plain-language guide to what different kinds of tooth pain indicate.

If It Starts on a Friday Afternoon in Beit Shemesh

Timing changes the decision here in a way it does not in most places. Our clinic on Harav Kook 28/1 is open Sunday to Thursday 08:00 to 20:00 and Friday 09:00 to 17:00, and Shabbat is reserved for genuine emergencies only. A tooth that starts aching on Tuesday morning and one that starts at three o'clock on Friday are the same clinical problem and two different practical ones.

So if a pain begins on a Friday and it is the kind that lingers or throbs, say so before the clinic closes rather than deciding to see how Shabbat goes. A nerve that is bearable at 16:00 is often the same nerve that has you awake at 02:00 with nothing open. Same-day appointments are possible at the Beit Shemesh clinic. Mild sensitivity or a chipped edge with no swelling genuinely can wait until Sunday.

You can also describe this in English. Dr. Joel trained in the United States and treats in both Hebrew and English, and "it throbs for about a minute after hot tea" leads somewhere different from "it hurts sometimes".

What Actually Helps Tonight

None of this treats the cause. It buys you a night's sleep.

• An anti-inflammatory painkiller rather than paracetamol alone, with food and according to the packet. Most tooth pain is inflammation, so ibuprofen tends to do more. Which painkillers help a toothache covers doses and safe combinations.
• Keep your head propped up. Lying flat raises the pressure inside an already inflamed tooth.
• Warm salt-water rinses — half a teaspoon in a glass — calm an irritated gum.
• A cold pack on the cheek, wrapped in a thin towel. Not heat, which makes swelling worse.
• Swallow painkillers; never pack them against the tooth. An aspirin held on the gum burns the tissue and does nothing for the nerve.

How to stop tooth pain until you can be seen goes further, as does the ADA's MouthHealthy page on toothaches.

When to Skip the Dentist and Go to a Hospital

There is a line past which a dental chair is the wrong place to be, and it is worth knowing before 2am rather than after.

Go to a hospital emergency room, not to us, if swelling is spreading toward your eye or down into your neck, if you are having trouble breathing or swallowing, if you cannot open your mouth more than a finger's width, or if you have a high fever with chills and feel genuinely unwell. An infection in those spaces needs intravenous antibiotics and monitoring. The warning signs that change the urgency goes through each one, and MouthHealthy's page on dental emergencies draws the same line.

Short of that, be seen the same day for facial or gum swelling, fever alongside the tooth pain, a bad taste that keeps returning, or pain no painkiller touches. Those usually mean an infection has left the tooth.

If you are not sure which of these describes your tooth, send a WhatsApp saying what sets the pain off and how long it lasts after the trigger is gone. That one sentence usually tells us whether you need seeing today or on Sunday. Call or WhatsApp 055-985-8845. Ramat Beit Shemesh Urgent Dental Care is at Harav Kook 28/1, Beit Shemesh, with same-day appointments when a tooth cannot wait and emergency dental care outside normal hours.