Dr. Silberman often gets asked the question: “Do I apply heat or cold to a toothache?” Watch our one-minute video to discover the answer:
Should you apply heat or cold to a toothache?
ALMOST NEVER APPLY HEAT to your face when experiencing a toothache. If you have an infection the heat may draw that infection out causing more swelling. Apply COLD! If you are experiencing a severe toothache the best thing is ice water in the mouth. You may have gasses trapped in your tooth. If you keep ice cold water in your mouth, the gasses will contract and pain either lessens or ceases.
“Inflammation is the body’s natural response to any infection. Heat increases inflammation. Ice helps to relieve inflammation.” —Dr. Paul Silberman, Dentist in Waldorf
What to do if you have tooth pain
- Get to your dentist as soon as possible.
- Putting it off will make it worse.
- Even if the pain eases, the underlying cause for the pain is still present and you will wind up experiencing pain again.
There are many reasons you may have a toothache. It can occur even if you have seen a dentist regularly. If you have a toothache and have not seen a dentist for a long time, do not be intimidated. Just go to a dentist as soon as possible if experiencing pain. Never worry about telling a dentist that you have not seen anyone for dental treatment for a long time. Your dental office must be a judgment-free zone. What is important is how you can start to achieve dental health now, not what you did or did not do in the past.
Are you experiencing tooth pain right now?
Call The Silberman Dental Group
Editor’s note: This post was originally published in July 2014 and has been revamped for comprehensiveness and timeliness.
I recently had two root canals. #’s 18 And 19. Both of which were broken and chipped. A week later I went in for temporary crowns. After one week the pain along my lower jaw from one side to the other was, on a scale of 1-10, at a ten! I recently went back to the dentist to have my bite adjusted. After 5 days, I still experienced pain, at a 10! I was not prescribed antibiotics or pain reliever. I called the dentist yesterday and insisted they give me antibiotics Incase there was bacteria within the teeth that went infected. Should the dentist, during my initial visit prescribed an antibiotic? I could have avoided all this pain!
Sylvia, I am sorry for this terrible dental experience you went through. You asked, “Should the dentist have, during my initial visit, prescribed an antibiotic?” This is very controversial.
I always prescribe antibiotics at the time I diagnose the need for root canal therapy and the patients never have post-operative pain. That is not what is taught in dental schools today. The treatment you received is considered the standard of care today, and unfortunately, the result you received occurs in one out of five patients. From my point of view, if the ratio was 1:5,000 or even 1:500, I might consider that approach. But because I know that one out of five is going to suffer, I pre-medicate with antibiotics. The downside is that some will have an allergic reaction to the antibiotic. I always tell the patient that if a rash or difficulty breathing develops, stop the medication and call me.
There is also concern about over-prescribing antibiotics and patients developing resistant strains of bacteria. While a valid concern, I still weigh that against what you had to go through. It’s not like I am suggesting antibiotics for the treatment of the common cold. If a tooth requires root canal therapy, bacteria are present. I want to reduce the number of bacteria before treatment. I want to “take the bees out of the hive before I stick my hand in it.” But I am in the minority. I hope that answers your question.
Hi i was seen today at the er for a tooth abscess that it causing tooth and ear pain. They gave me an antibiotic as well as 800 mg ibuprofen. However the ibuprofen seems to wear off after 5 hours and its killing me to wait 3 more hours for another dose. Can ai take tylenol too??
Hello Nichole, It is often helpful to alternate Tylenol and Ibuprofen every 4 hours. In other words, take 800 mg Ibuproven every 8 hours. Four hours later take two extra strength Tylenol (2 x 500mg) and take the Tylenol every 8 hours. Do not take either one more frequently. So every 4 hours you will be alternating 800 mg Ibuprofen with 1,000 mg of Tylenol. That should help with the pain. Tests show that is as effective as Codeine and not nearly as addictive. The antibiotics will take 48 to 72 hours to fully kick in. Once it does, the need for pain medication will decrease. I hope that helps. Dr. Silberman
Call your dentist and tell them that it is an emergency. Stress that you are in pain and cannot take it. Normally, they will fit you in regardless if there is a wait list. If that doesn’t work ask your dentist for a pain reliever –they may be able to prescribe something that is stronger than you are taking. Furthermore, if the tooth is impacted (which yours sounds like) they give you meds to relieve the swelling in order that they will be able to facilitate the extraction. If worst comes to worst perhaps call a different dentist. Normally, the ER cannot do anything for you.
Hello GoToothache! Thanks for the helpful tips. We agree that if you are in pain, you should call your dentist. They will either be able to fit you in for an appointment or offer advice on easing the pain.
My face is so swollen because of my toothache..I never in my life had this..not even when I’ve had some of my teeth.pulled..I’m 61 diabetic and can’t stand this pain…
If you can’t get in to see a dentist, go to an emergency room or Urgent Care Center. You need to be put on antibiotics to control the swelling. As a diabetic you know that the healing response is always more difficult. It is very important that you do not apply heat to your face as this will dramatically increase the swelling. It is OK to apply cold compresses. You can take Tylenol 500 mg (2 extra strength) along with Motrin (two 200 mg) every 8 hours. Or when you get your antibiotic prescription you might be able to get a stronger pain medication prescribed too.
I took advil or tynenol with cold water. My orthodontist suggested try rinsng your mouth with salt water. It will get better as your teeth align.
Rinse with warm salt water, Infection in your mouth can spread quickly. Do not use alcohol as this causes inflammation to your gums making it worse.
Hi Deborah! Thanks for sharing. Warm salt water rinses are an easy and effective way of preventing the spread of infections
If your old its all good, if not then be sure to lay of acid drinks and candy. And don’t brush your teeth right after eating these, wait at least an hour
Why does it hurt so much worse when I quit using cold water. Will it eventually stop hurting like that or will I have no choice but to try to withstand the pain when stopping the use of cold water. It hurts so bad when I stop using cold water I can barely talk. It like no pain I’ve ever had
There is an infection in your tooth. The bacteria (germs) in the infection give of a byproduct of gas. The gas can’t escape and is trapped inside the tooth. Applying cold to gas makes it contract and takes pressure off the nerve which stops the pain. A dentist can numb the tooth and open it to allow the gas to escape which will stop 80% of the pain. You can save the tooth with root canal therapy or have it extracted. I hope that answer helps.
I’m 21 and I have tooth on my left bottom side (two teeth away from my wisdom teeth that are also coming in) an it’s hurting so bad its causing me an extreme earache as well, I tried Coconut oil pulling but it hasn’t really helped and my 500mg Ibuprofen isn’t helping either. It’s to the point I can’t even sleep I just toss and turn at night. I don’t know what to do!
Sorry that you are going through this Annabelle. It sounds like you might have an infection in your tooth and you should see a dentist who would be able to diagnose the problem. It may need an antibiotic to help stop the infection and the pain. If you can’t see a dentist, go to an Urgent Care or Emergency Room. Though they don’t have the diagnostic skills of a dentist, they would be able to put you on an antibiotic to quiet the situation until such time that you can get to see a dentist. If the tooth is infected, it might need to be extracted. Or it might be saved with root canal therapy. So get to your dentist or ER as soon as possible and stop the pain. The treatment of choice is easier to select when you aren’t hurting. Good Luck, Dr. Silberman
Hello Robert! Thank you for commenting. We believe everyone, regardless of age, should be aware of sugary and acidic drinks or foods.
And great tip on waiting to brush! It is proven that you should wait to brush after having acid in your mouth or else it can further damage your enamel.
I have a visable abscess in my mouth and the pain is killing me. I have antibiotics, but is there anything I can do to alleviate the pain a little until I can get to the dentist Wednesday
Sorry you are going through this. The abscess tells me that there is no “feeling” in at least one root of the tooth. The pain is coming from the infection outside the tooth or from one of the other roots that still have feeling. A quick remedy is to hold Ice Water in your mouth in the area of the affected tooth. It should take away the pain for a while and can be continually reapplied as needed. Once the antibiotic kicks in, the frequency of the need for ice water should decrease. Hopefully, the other teeth are not sensitive to cold or this becomes a trade-off.
The reason ice water helps is because the bacteria inside the tooth give off a bi-product of gas. The gas is trapped and has no way to escape. When gas is heated it expands. Your body heat may be enough to cause it to expand and put pressure on the nerves causing the pain. The ice water gets the gas to contract and remove the pressure from the nerves. You may have to keep ice water on the night stand next to the bed if the pain wakes you. Take a swig and hold it around the tooth, then swallow and go back to sleep.
Where are you located?
I hope this helps. Good luck!
My molar tooth cracked and my tooth nerve was alive so the dentist put a crown on it without a root canal(DEC). He did mention that I may need one down the road. Anyways, I finally got the new crown on (end of Feb) and this month I have an abscessed next to my gum. It does not hurt unless something very hot or very cold is put on it. I am on antibiotics and have to wait a month to finish my root canal( the dentist started it) with an endodontist. Not understanding how I could have no pain but an abscessed on my tooth. It can get irritated with food, especially salty food; on the other side I have a temporary crown on a canine so I can’t eat on that side. Lastly, when the dentist went into the fake tooth a smell came out. Awful smell- is that from the bacteria? Never smelled it before. So happy he did not smell it. OMG. Does the abscess go away after my root canal is finished? Or how does it go away?
TY
Hi Maryanne, Sorry that you are going though this. Your dentist has provided you with excellent care. I agree that in your situation, I would have placed a crown on the damaged tooth in hopes that it would heal and not require root canal therapy. Each tooth has it’s only blood and nerve supply and the tooth shelters this from the bacteria that are in your mouth. But if a tooth cracks or decays, sometimes the bacteria can get into the tooth circulation. This may or not cause discomfort or temperature sensitivity. The bacteria take over inside the tooth and the blood and nerve gradually disappear. The abscess forms as the bacteria increase in number. That can result in swelling or pain or both, or sometimes a pimple forms to create a relief valve. Instead of pressure building up in the tooth and the abscess, the pimple (fistula) allows for drainage and relieves the pressure, and there is usually no pain. The root canal treatment cleans out the bacteria from the hollow spaces of the root while leaving the actual roots intact. Sometimes it smells really bad, like in the case of your tooth. Once cleaned out, rinsed and dried, the space in the roots are filled with a plastic type material that flows into position. That process eliminates the bacteria from the tooth, and the antibiotics kills the bacteria outside the tooth in the jawbone and gum. The infection goes away and everything heals within a few weeks, if all goes according to plan. I hope that answers your questions. Best, Dr. Silberman
Hi Dr 🙂
I realized last Sunday (5 days ago) something was not very well with one of my wisdom tooth (already grown). I saw a dentist on Tuesday and she confirmed that the tooth is going through an infection and needs to be pulled out. Therefore since 3 days I am getting Amoxicillin 1000 mg 3xday, and I must wait at least one week for the imflammation to disappear and have my tooth pulled out.
I don’t have an extreme pain, but the whole area (including my ear) is swollen; I find it almost impossible to open my mouth (only eating baby food). My question is: is the antibiotics my dentist prescribed enough? Or I have to take something else as well?
Info+.: we are having very hot temperatures where I live now (40 degrees) can it also have an impact ?
Thank you a lot!
Hello Patty. Sorry for the delay in getting back to you. Hopefully the problem has been resolved by now. But for anyone else reading this and having a similar problem, it does take time for the antibiotics to kick in and reduce the swelling. I would suggest warm salt water rinsing to help bring down the swelling. Also, apply cold compresses (never hot) to the outside of your face. Any external heat will increase the swelling and pain. That would include weather related, or sauna, or hot tub, or any other source of heat. Keep it cool. I hope that helps. Good Luck, Dr. Silberman
I am having a tooth pulled tomorrow that has had a root canal in the past. My face is super swollen and draining out of my nose. I am on antibiotics. Can I apply a warm wet wash cloth to help the abscess drain?
Do not apply heat to your face. It will draw the infection to the surface and create severe swelling. It is OK to apply cold compresses. You should not have tooth infection drainage from the nose. There should not be communication between the sinus and oral cavities. Be sure you tell the surgeon at the time of the extraction that this has been your experience. It may be necessary to apply a membrane that will separate the extraction site from the sinus to create proper healing.
I had a tooth pulled a year ago. This week I have developed an incredible throbbing pain on the gum in the tooth extraction site. What could this be?
There are a few possibilities. If part of the extracted tooth was left behind, it is possible that your body is still healing and pushing the fractured piece to the surface. Essentially, you are “teething” as the fragment pushes out through the gum. Another possibility is that a neighboring tooth is acting up and it’s very difficult to determine exactly where the pain is coming from. If you are having any sensitivity to cold, hot or pressure, the problem is likely another tooth. In any event, you should see a dentist to have the site x-rayed and evaluated. I hope that helps.
I have severe toothache, been to the dentist and nothing is visible on the xrays. The pain is unbearable, if I sip on cold water the pain subsides but only for a minute. I’m on antibiotics and painkillers but nothing is making is easier, it gets worse every day. Not even able to fall asleep, the pain is just horrific.
What should I do?
You have a tooth that is infected. It is in the early stages of infection so it does not show up on the x-ray, but that doesn’t mean the pain is any less. The bacteria causing the infection have a by-product of gas. There is no escape route for the gas to get out of the tooth so it gets trapped in the root where the nerve is located. The pressure from the gas builds up and causes the pain by pressing on the nerve. When you sip something cold, the gas in the tooth contracts and takes the pressure off the nerve, and the pain stops. But it is very temporary. It confirms the diagnosis. Also, if you take your finger and tap on that tooth, it will feel different from the other teeth. Sometimes the difference is very mild and sometimes severe. It just depends on how advanced the infection is. Bottom line is that tooth needs a root canal treatment to be saved. The alternative is to have the tooth extracted. Good luck. Doc
Thanks for the tip Dr. Silberman. It is indeed interesting to note that heat can actually cause inflammation in your tooth, since warm saline water is considered a useful home remedy to tackle infections. Rather it is the hot spicy foods which can cause gum inflammation.
Warm saline rinses are a good home remedy for minor gum swelling. An abscessed tooth is a different story. It is best not to apply heat externally as it will draw the infection to the outer surface and potentially cause severe swelling. If the abscess is draining in the mouth next to the tooth, it is again OK to use warm saline to help with the draining process. No External Heat.
dear dr silberman, my front center top tooth is very loose and there is some pain. dental appointment is in a few days time. how may I reduce the swelling or kill the bacteria that is causing the inflammation please? thank you
Until the tooth is removed, hold warm salt water in your mouth around the tooth to help bring out some of the swelling. Once the swelling is reduced, it will feel more comfortable. Once the tooth is out, it will feel even better. I hope that helps. Best, Dr. Silberman
I recently got a crown put on a tooth that had gotten a root canal about 7 years ago. I never had any pain in the tooth for all these years. After the crown was put on(About a month ago), it was fine as well.
Up until about 4 days ago. I had felt like there was something stuck between by teeth. I flossed, and there was a bit of blood. The next morning I woke up with pain at about a 5, from 1-10. Every day it has gotten worse, to now it being at a 10.
I went to a dentist yesterday(The only one with openings on a Friday). They did xrays, and said that , my root canal “Didn’t work”. I’ve had years of xrays and have NEVER been told that. They said I would need to have it redone, set me up an appointment for 10 days from now. And here I am today. In the worst pain of my life. Waiting for 10 days from today.
Does this sound normal? There is no swelling. Just a little redness around the gum that touches the crown. My tongue cannot even lightly touch the tooth without terrible pain.
Hi Paige. Sorry to hear you are going through this. Without an x-ray to diagnose, it is very difficult to determine the problem. It is possible that the root canal needs to be retreated. It is also possible that there is a crack in the root of the tooth just below the newly placed crown and a retreatment won’t work. The tooth may need to be extracted. In either case, you need to be put on antibiotics to get the infection under control. Warm salt water holds in the mouth around the tooth might help bring out some of the redness and prevent swelling to help quiet things. Also, a combination of 400mg Motrin (Advil, Ibuprofin) plus 1,000 grams of Tylenol (2 extra strength) should help you with the pain. These are over the counter non prescription medications that are very helpful when used together. I hope that helps and I hope you can get in to see the dentist sooner. Call them and explain the situation and let them know you can come in at any time on short notice. Good Luck. Dr. Silberman
Hello doctor,
I have recently had a root canal on my lower left side which has been successful. After 1 week i started to get a root canal on my lower right side (tooth no 7). I have never experienced pain on that tooth despite always eating on that side all my life. After the first appointment my dentist cleaned the tooth and put temporary filling. But now my tooth is throbbing with pain. I went to him and got the filling removed and he says its because of trapped gas. Im currently using Metrolag, klavox and cataflam. But i just can not bear the pain. I cant do anything and only feel like weeping.
Hello Paige. If the Metrolag and Klavox antibiotics have not been successful, I recommend Clindamycin 150mg four times a day for 10 days. I find it to be more effective than the other antibiotics in the treatment of tooth infection. You cannot take this medication if you have gastrointestinal problems like Crohn’s Disease or Irritable Bowel Syndrome. Also, check to see that, when you bite together, do your upper teeth contact this tooth. If so, ask the dentist to reduce the height of the tooth to eliminate contact with the opposing teeth. That will help to stop the tenderness. The tooth reduction will be necessary in the future to accommodate a crown so don’t worry about adjusting the tooth height. In addition to the Cataflam, you should add 2 extra strength Tylenol every 8 hours to help control the pain. I hope that helps. Good Luck, Dr. Silberman
I cant get in to my dentist till tomorrow I am hurting I have taken ibuprofen, used cold pack nothing is working. Even did the salt water still nothing, I cant use ice water as this only increases the pain
Hi Wendy. You can take two extra strength Tylenol every 8 hours and 2 Ibuprofen every four hours. Don’t apply heat to the outside of your face because it could create and draw out swelling. If the pain remains as intense, you might need to go to an emergency room for care. I hope that will tide you over until you can see your dentist. Good Luck. Dr. Silberman
Im getting my tooth pulled in 6 dAys I believe an infection is beginning to abscess its a weekend, should i go to the emergency room to get antibiotics or can i wait until Monday to ask my dentist?
Hi Jessica, I would recommend that you go to the emergency room for an antibiotic. Or call your dentist that is going to be doing the extraction. If there is an emergency number for the dentist, he / she could call in a prescription for the antibiotic and you could save the emergency room visit cost. I am assuming that you have already seen this dentist and an x-ray of this tooth has already be taken. If you cannot reach the dentist, you should go to the emergency room. The antibiotic will take 48 to 72 hours to become fully effective so be patient. For pain, you can take 2 extra strength Tylenol every 8 hours, and 2 over the counter Advil (Motrin, Ibuprofin) every 4 hours. And remember to avoid applying heat to your face. Stay in air conditioning. The heat will draw out the swelling to your face and become very uncomfortable and unsightly. Applying ice is OK. I hope that helps. Good Luck, Dr. Silberman