General Dentistry |2 min read

During a Toothache, Do Not Apply Heat!

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

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Editor’s note: This post was originally published in July 2014 and has been revamped for comprehensiveness and timeliness.

918 comments on “During a Toothache, Do Not Apply Heat!”
  1. Sylvia higgins

    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!

    1. 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??

        1. 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

          1. Dom

            I have been on amoxicillin for 36 hours but it seams like it is getting worse not better

          2. Amoxicillin is not my drug of choice for tooth infection. Unless you have a history of GI issues, the drug of choice is Clindamycin. See if you can have your dentist switch you to this medication. Good luck. Doc

          3. Courtney

            My gums are killing me. At first I thought it was my wisdom teeth but it has to be something else. I have to keep cold water in my mouth. As soon as it gets warm, I’ve gotta replace it. Orajel doesn’t help I’m taking my 600 mg ibuprofen from the doctor but it’s not working. I’m in so much pain. Please help

          4. Hi Courtney, Your description is that of a tooth infection, not a gum infection. You have a tooth that has been exposed to decay or some other kind of trauma. Bacteria has made its way into the circulation inside the tooth and it has damaged the circulation that usually keeps the inner workings of the tooth healthy. The bacteria in the tooth has a byproduct of gas. The gas is trapped in the tooth. Gas expands in the presence of heat and contracts with cold. Your body heat is enough to make the gas expand and put pressure on the remaining nerve endings in the tooth and in the jaw. This causes the intense pain, and it explains why cold water takes away the pain. A dentist can numb the area and either extract the offending tooth, or open the chewing surface of the tooth to release the gas as a temporary fix in anticipation of doing a root canal treatment. Your options are either extraction or root canal treatment to save the tooth. I hope that helps. Good luck. Dr. Silberman

          5. Elsie

            Hi I had 2 filling done early December on 22 and 12 it was not a deep filling but I’m feeling pain when I press where they cut I went again in January they did the filling again and put Dycal but still did not go away

          6. Hello Elsie, If the fillings were not deep, it is unusual to have these issues. And yet, here you are. You “feel pain when you press where they cut”. If the fillings were on the cheek side of the teeth, is it sensitive to fingernail pressure? And to toothbrush bristles? This would be due to dentinal exposure that comes with smoothing and shaping the filling, and it should pass. You should avoid any toothpaste with a whitening agent as this would prolong the problem. Switch to a tube of desensitizing toothpaste, like Sensodyne, or Crest for Sensitive teeth, or Colgate for Sensitive teeth. Just be sure there is no whitening agent in the desensitising toothpaste either. The questions I would ask are: any sensitivity to hot or cold, is the ache spontaneous as well as when you apply the pressure, does it wake you, does it prevent you from falling asleep, does chewing on it bother you, is there swelling, is there tenderness pressing on the gum or just the teeth. Given the limited information, I am hoping that the desensitizing toothpaste fixes the problem, but it will take 4 to 6 weeks for the problem to quiet. If I am right, it won’t get worse while you are using the desensitizing toothpaste, but it will get gradually better. If I am wrong, your symptoms will get worse and be easier to diagnose. In that case, you might need root canal therapy. Unlikely, but that is why you must be patient with the desensitizing toothpaste. If you already use a desensitizing toothpaste, switch to a prescription one like Prevident 5,000 or Fluoridex. Ask your dentist for a prescription. Good Luck, Dr. Silberman

          7. Desiree R Nation


            I have moderate to severe pain in my mouth. On one hand, I have a few teeth with very progressive cavities and they throb often until I take ibprofen. But I also have a deep tight pain in my jaw and ear and occasionally into my sinus cavity. This tightness occasionally stops me from opening my mouth wide, talking, and sometimes produces a shock-like feeling that lasts about 20 second into my jaw and tonsil/throat.
            Ice seems to cause more pain than heat. On a good day I take 600 mg ibprofen on bad days I can take up to 1200 mg a day. I can’t pin point what it is but I’m very scared of dentists.

          8. Hi Desiree, Looks like you duplicated your question and I just wrote my response to you. I hope you follow up and find a good caring dentist who will address both your fears as well as your dental issues. You have your homework cut out for you. Start your Google search today, read lots of reviews, and make the best choice you can. After narrowing down the right dentist from the reviews, go to their website and see if it feels comfortable to you. Good luck, Dr. Silberman

          9. angie

            Hi ive had a filling replaced and it was a very old one i wasnt experiencing pain before but AFTER this dentist replaced im in pain all in my jaw line as well as in between the tooth its just a red dot there its tender and at night it worsens with pain, at this point i just want to get the tooth pulled idk and all the dentist keeps saying is that its tender because of replacement

          10. Hello Angie, From your description, it is difficult to determine if the source of the pain is coming from the red dot on the gum or if it is the tooth itself. You could do some investigating on your own. If the red dot is between the teeth at the gum line, it could be a minor gum problem. Go to the pharmacy and get some numbing (teething) gel to apply with a cotton swab to the red dot. If it helps to stop the pain, you are dealing with a gum issue. Assuming the dentist has checked the gums for pocketing and it is healthy, the red dot could be a sign of irritation. Keep using the numbing gel, but rinse periodically with warm salt water to help with the healing. You could also get some prescription mouth rinse called Chlorhexidine to speed up the healing process. If the red dot is on the cheek side of the tooth a half-inch to an inch below the gum line, it is an abscess that could be either gum or tooth. It would likely mean that the tooth needs root canal therapy or extraction. It would not be the fault of the dentist. If this is the case, the infection would have been dormant and was stirred up by the dentist, but would have happened eventually regardless. Another test along with the numbing gel would be a cold test. Take ice water and hold it in your mouth to see if it elicits a response from the tooth that was worked on. If it does not, and if you tap on the tooth and it is tender, this could indicate an infection in the tooth. If you get a response to ice but it only lingers a few seconds, this would indicate it is normal and that the pain is coming from the red dot. If you get a response to ice but it lingers for a minute, it is probably an infection in the tooth. Lots of information for you that I hope is clear. Good luck with your investigation. Dr. Silberman

          11. Hello Shirley, If your intent was to ask a question, it didn’t post. Feel free to write me back. Have a great 4th of July. Dr. Silberman

          12. Brandon

            I put cold water and it helped my severe tooth pain. Now if I stop putting cold water, it’s worse. I can’t even sleep.

          13. Hello Brandon, Unfortunately the only thing that will stop the pain right now is cold water. You need to keep ice water in your mouth and see a dentist as soon as possible. The infection inside the tooth has created a gas pocket that is trapped in the root. Your body heat is enough to expand the gas and put pressure on the nerves causing the pain. The ice water gets the gasses to contract and stop the pressure which stops the pain. A dentist will numb the tooth and make an opening in the chewing surface to allow the gas to escape. Once that is done, you will not need ice water any more and the pain will stop. Find a dentist who will see you today ASAP. Good luck. Dr. Silberman.

          14. Brenda

            I am experience toothpain and itbfeels swollen and keeping me up at night how can i ease the pain.

          15. Hello Brenda, Because you have swelling, that would indicate that there is infection. You need to take an antibiotic to treat the infection and the swelling. Go to a dentist as soon as possible. If you can’t see a dentist, go to an emergency room or urgent care to get a prescription. Once the swelling is controlled, they can treat the source of the problem. Let the dentist guide you to take proper care of your problems. Good Luck, Dr. Silberman

        2. Kajuan bell

          What insurance do you take if any and are you in Jacksonville fl?

          1. Hello Kajuan, I am located in Waldorf, Maryland. It is interesting that a simple posting of my thoughts on not applying heat during a toothache has generated so many dental questions. Jacksonville to Waldorf is only 700 miles so you are welcome to come see me . My suggestion to you when looking for a dentist is to check out the reviews online. I like Google reviews better than Yelp, but that’s just a personal preference. Yelp has approached me to advertise with them and if I don’t, my five star reviews get hidden. I have 40 five star reviews, but Yelp shows my one star which I got because of a problem the patient had with her insurance and blamed my office. Anyway, good luck in finding a dentist. I hope that helps. Dr. Silberman

        3. Rani

          I had a root canal 1 1/2 years ago on a lower molar. My tooth started having pain a few months ago and I went to another endodontist for a re-treat. He went in 3 times to clean the inside over the course of 2-3 months. The pain had subsided and I felt good finally.

          A week ago I went to my general dentist and they put the temporary crown. After a few days i started experiencing the same throbbing pain in the tooth just like before. I went back to the dentist and he said the temporary crown is not high and it shouldn’t be causing me any pain.

          My endodontist doesn’t seem to want to do anything more.

          Im so confused on what I should do .

          1. Hello Rani, Sometimes when a root canal treatment is done and looks great on the x-ray, there could be a vertical crack in the root that can’t be seen on a two dimensional x-ray. The crack harbors bacteria that cause tenderness in the bone. If we know that the bite is right, there isn’t anything you can do except extract the tooth and hopefully replace it with an implant. Before doing that though, I would hit it with a round of antibiotics. If you have no GI symptoms (Crohn’s Disease, Irritable Bowel Syndrome, etc.), the best antibiotic would be Clindamycin 150mg taken four times a day for ten days. If there is no crack, but there is some residual bacteria in the bone around the tooth that can be eliminated with antibiotics, it’s worth trying. Good luck. Dr. Silberman

          2. I am having really bad pain in one of my back tooth’s the pain is so bad were it has my head hurting

          3. Hello Nyieshia, You aren’t providing me with much to go on. For pain, I would alternate taking Tylenol and Motrin every four hours. Take two extra strength Tylenol, and four hours later take three 200 mg Motrin (Ibuprofen, Advil), and four hours later back to the Tylenol, and so on. The most important thing is to get to a dentist ASAP and have the problem diagnosed and treated properly. I hope that helps. Good Luck. Dr. Silberman

          4. Shazia kauser

            Hi iv had a re root canal as i had a sinus tract pimple on my molar. The root canal was successful but its been a year and there is still a small white spot on gum endodontist has took a x ray last week the tooth is fine just slight inflammation shows up on x ray the tooth doesent hurt and had a crown on it the endodontist re treated the tooth through the crown and sealed it please help it was a private endodontist who used a microscope

          5. Hello Shazia, The sinus tract is called a fistula. When there is an infection, the pressure builds up and creates this tract allowing the pressure to be released. The infection drains through the tract so there is no pain. The dentist will have root canal filling material that is called gutta-percha. It is a flexible rubbery substance that is about an inch long and shaped like a small toothpick. The dentist can insert the gutta-percha (size 35) into the pimple without numbing. The inside of the tract has no feeling. The gutta-percha will follow the twists and turns of the tract and end at the source of the infection. An x-ray should be taken with the gutta-percha in place. It will identify the problem tooth and the source of the infection. It could be the tooth that has been treated, or it could be coming from another tooth. The problem needs to be addressed because there is an infection present, even if it isn’t causing you pain. I hope that helps. Good Luck, Dr. Silberman

          6. robert M dickerson

            Good evening Dr. I am having tremendous pain on or in a filling on the upper right side. This is, I think, what has happened-I wear a bridge for 4 years and the hook on the upper right side has broken a price of old filling in the hook has grinded a hole on that tooth. Got great pain. Oradell, BC, Tylenol do nothing Got leftover tramadol, but scared to use it. Please help!!!

          7. Hello Rob, If there is an infection in the tooth, it is possible that holding ice water in your mouth around the tooth will stop the pain. It is a temporary fix that you may need to do every few minutes, but it should at least give some relief. See your dentist as soon as possible. If the partial denture clasps onto this tooth, you don’t want to lose it and then have to remake the partial. It’s better and less expensive to save the tooth. It sounds like the tooth will need root canal therapy. Let the dentist make the diagnosis and get treatment ASAP. Good Luck, Dr. Silberman

        4. Maya

          Hi I’ve been receiving a lot of dental work for the past year resulting in 53000 dollars worth of dental bills but each time I go I have to worst pain and I’m usually prescribed pain meds but they never work so I usually add some extra ibuprofen to the mix which can be dangerous I know but it sometimes helps but not always sometimes the pain is just too much so I ice and some times when I don’t know what else to do I use heat which I know is wrong if it’s an infection but usually it’s not and because I’ve had over 14 root canals I m kinda able to tell the difference but my question is what do u do when ur already prescribed hydrocodone but are still in an unbearable amount of pain

          1. Hello Nichole (or is it Maya?), It sounds like you have really been through the mill with your dental experiences. Let me suggest a few things. When I see patients going through multiple root canal treatments in an attempt to relieve facial pain, I always include alternative sources of pain in my differential diagnosis. By that I mean finding the source of your pain may not be strictly tooth-related. There could also be a neurologic origin to the problem. If the nerves leading to the teeth are inflamed, the patient’s perception is that it’s coming from a tooth. If you haven’t had much tooth decay or trauma or history of crowns and have undergone numerous root canal therapy treatments, the problem could be neurologic. You should consult with a neurologist to see if you have nerve inflammation. When a patient is diagnosed with needing root canal therapy, has the treatment performed, and then the pain doesn’t go away, I start thinking neurology workup. It is difficult to contol pain from an inflamed nerve with narcotic pain medication. A steroid injection may help you. Best of luck. I hope this helps. Dr. Silberman

          2. Christina

            Hi. I had horrible tooth pain the other day. I went to my dentist and he said there is definitely an infection near a tooth I had a root canal and crown done on years ago. I immediately started taking penicillin but I accidentally used warm compression and woke up to half of my face swollen I’m assuming bc of the warm compressions. Anything I should do besides icing the area and continuing the penicillin? How soon should the swelling start going down? Thank you

          3. Hello Christina, Unfortunately, once a warm compress is placed on your face to “soothe” a toothache, the swelling that it causes is very difficult to get rid of. It just takes time and patience. The antibiotic will bring down the swelling, but it will take several days to a week. Applying cold compresses may help. I wish there was a magic potion but there isn’t. You might get faster results with Amoxicillin, Augmentin, or Clindamycin over basic Penicillin. Good Luck. Dr. Silberman

          4. Josh. A

            I have an abcess on my lower gum in the front and my lip is swollen right in front of it. I have been taken 875mg amoxiciliin 2 times a day for 6 days. Can I pop the abcess?

          5. Hi Josh, Use warm salt water holds in the area and it will draw out the infection so that it is easy to pop. Wait for it to come to a head. Don’t squeeze it. Continue warm salt water and it will drain on its own. Do not apply a heating pad or warmth to you chin and lip as that will make it far worse. Amoxicillin is OK if it is definitely a gum problem. If there are calcium deposits under the gum causing the problem, the dentist needs to numb the area and scale out the buildup, or there swelling won’t go down. If the problem is an abscessed tooth, I would rather see you on Clindamycin 150mg four times a day. It is a much better antibiotic for an abscessed tooth than Amoxicillin. If it is a gum abscess and not a tooth abscess, Amoxicillin is fine. Good Luck, Dr. Silberman

        5. Jenn

          As a former patient with an abscess tooth I can tell you that my dentist at the time had me taking both Ibuprofen and Tylenol.

          1. Hello Jenn, We in the medical / dental field are very sensitive to the fact that opioids were prescribed at a much higher rate in the past and that correlated with patients becoming addicted. We try to avoid prescribing narcotics whenever possible. Tests have shown that using a combination of Tylenol and Motrin (Ibuprofen, Advil) is as effective at controlling pain as a narcotic like codeine. Dr. Silberman

        6. Anita

          Had a filling removed and temp put in awaiting a root canal but am in pain even when I take pain killers

          1. Hello Anita, Depending on the degree of infection in the tooth, it is possible to stop the pain by holding ice water in your mouth around it. If the infection is in the late stages, gas trapped in the tooth (a byproduct of the bacteria) expands from your body heat putting pressure on the nerves. The ice water will cause the gas to contract and stop the pain. You may have to use the ice water often. Do not eat hot food or drink. Try to keep your body cool. You might ask the dentist to prescribe an antibiotic to kill off the bacteria that are creating the gas. My antibiotic of choice is Clindamycin 150mg every six hours. Amoxicillin doesn’t seem to work nearly as well. The root canal treatment will be a lot easier than what you are dealing with right now. Good luck, Dr. Silberman

        7. Courtney

          You can alternate every 4 hours between the two

          1. Yes, for pain control, alternate between two Extra-Strength 500mg Tylenol and three 200mg Advil (Motrin, Ibuprofen) every four hours. Dr. Silberman

      2. Jacob

        Ok so my lower back tooth is broken and it’ jus recently started giving me pain yesterday and was the worst pain I’ve endured. I’ve taken medicine and salt water and it’s helps a bit but it eventually comes back to a 10. I’m also trying to eat but I really don’t want it to hurt again, will I be fine if I jus eat on the opposite side?

        1. Hello Jacob, You didn’t mention if you’ve been to a dentist? Certainly sounds like that would be your best option. For how long can you eat on the opposite side? See a dentist and have them diagnose the problem. You will likely be given options as to how to resolve the problem and estimates for each option. Good luck.

          1. Shaun

            I’m curious as a dentist what do you think of my own personal toothache reliever? I mix cinnamon, cloves and whiskey together, I take a spice jar, put about a quarter of it full of whole cloves, about 3 cinnamon sticks and fill the container with whiskey and let it sit for a week, smells and tastes bad but can fully numb the pain instantly and for long periods of time.

          2. Interesting combination for treating tooth pain, but the cloves is the key in my opinion. It is well documented that clove oil deadens tooth pain as well as dry socket pain following an extraction. The Cinnamon is also known to help with tooth pain but I don’t know if it is as effective as the cloves. I can’t attest to the effectiveness of the whiskey unless you take it systemically. LOL Dr. Silberman

          3. By the way, if you were to drink the concoction all at once, it should stop any pain. Just sayin’. Best, Dr. Silberman

      3. Anna Pascual

        Hi Dr I can’t tolerate clydamicine will a Z-pack work!! If not what else is there as I am allergic to penicillin!! Please help

        1. Hi Anna, Z-Pack is not a good choice for tooth infection. For patients who can’t take Clindamycin, I suggest Cephalexin (Keflex). For people allergic to Penicillin, there is a small percentage of the population who also react to the Cephalexin. If a rash or difficulty breathing develops with the Cephalexin, stop taking it. It’s rare, but can happen. Good Luck. I hope that helps. Dr. Silberman

          1. Kayla Russell

            So I started a root canal on tooth 30. Then we immediately had to go into a root canal on tooth 23. I had a pressure type issue with tooth 30 but then dentist cleaned it more and I was fine. Well recently it started again it feels like someone blowing a bubble and popping it quickly but in my tooth it’s super uncomfortable and nothing helps it go away. I went back to the dentist and he cleaned and drilled more today. It immediately started back when the novacaine wore off. What is happening?! I’m terrified of the dentist and I’m so uncomfortable PS I am on an antibiotic and rotating Tylenol and Advil.

          2. Hello Kayla, It sounds like the root canal had not been completed. Once the canals of the roots are filled, the issues should resolve. It sounds like the dentist is cleaning out the roots in multiple visits, but I’m just guessing. The best bet is to clean out and fill the roots at the same visit. Also it is best for the dentist to reduce the height of the tooth slightly so that when you bite together, the upper teeth are not in contact with the lower root canal tooth. If I am right, you can get immediate short term relief by holding ice water in your mouth around that tooth. Have the dentist fill the roots ASAP and get this procedure finished! Good luck. Dr. Silberman

        2. Hope Phillips

          Ok I just had my top moller tooth pulled a week ago. When it was the for me to remove the gauz the blood clot was stuck to the gauz pad. I have called my dentist and they can’t do anything cause I’m currently 38 weeks pregnant , so long story short i am suffering. Yes I am having pain during the day but I am developing more pain at night to where I’m constantly going through a small bottle of vanilla extract just to keep my surrounding teeth and jaw from hurting more. I clean my mouth every time I eat to make sure nothing gets into the extraction site but I can’t bare this pain anymore I know I have a dry socket but what other home remedies can I use or pharmacy stuff can I use to help with this pain?

          1. Hi Hope, This stress can’t be good for either you or the baby, so let’s get right to it. Clove oil or clove gel works like a charm at stopping dry socket pain. It is an over the counter medication that you can get an any pharmacy. If it is a lower tooth extraction, the clove liquid will work well because gravity will pull it down into the open socket. For an upper tooth, the gel works better because it won’t drain out of the extraction site like a liquid. The way it works: the clot that was lost was your layer of protection against exposed nerve endings in the jaw bone. If the clot was present, air couldn’t get to those exposed nerves and you wouldn’t be feeling any pain. The clove treatment quiets those exposed nerves very well. You will have to apply it for 7 to 10 days, as needed, until the gum tissue starts to grow over the exposed nerves. I hope that helps. Good luck to you and your baby. Dr. Silberman

          2. Emmanuel

            i’m have a very bad toothache for 2 i taking amoxicillin which the doctor prescribed me with ibuprofen now it’s a abscess on it , is that normal for a toothache it came out the blue

          3. Hello Emmanuel, It is not uncommon for a toothache to “come out of the blue”. Many times when there is a cavity, there aren’t any symptoms. Once the bacteria in the tooth decay grows into the nerve, the problems begin, sometimes intensely. The abscess is an indication that the bacteria from the decay have made their way through the tooth and into the jawbone. The antibiotic should help, and the tooth should either be extracted or treated via root canal therapy to save it. Another avenue for bacteria to enter the tooth is if there is a crack or trauma, but the outcome is the same as with decay. I hope that answers your question. Good Luck, Dr. Silberman

          4. Colleen

            Help! I had sensitivity in the lower bottom left side of my mouth. Went to the dentist and she gave me a carbon paper which I bit down on and she determined it was my end tooth. She said it was cracked/fractured and needed a crown. Had a temporary crown put on in the tech adjusted it a little bit. As the days progressed I had more and more pain there. Went back and the tech took it off about three or four times and sanded it down. Went home the next day it hurt really really bad, especially when I was eating but I barely chewed anything. The next day went to the dentist and the dentist filed down the tooth and the tooth above it. Had an airline ticket and left the next day to visit my daughter. Pain wasn’t very bad at all and could be remedied with just a couple ibuprofen maybe once a day. Then today after I had some warm water the area top and below started hurting and hasn’t stopped for about 12 hours. She sent me on my trip with antibiotics and hydrocodone ibuprofen but don’t really want to take that. She mentioned that my ligaments might be all sore because the upper tooth kept hitting the lower tooth for over a week. Because of that I’m hesitant to take the antibiotics as I’m sensitive to them. No fever no swelling no pain in other areas. Have three more days before I go back home and then four more days till I see a dentist after that. Any suggestions please?

          5. Hello Colleen,

            You have provided excellent clues, so let’s get started solving the mystery. When you went to the dentist and a crack in your molar was identified, they did the right thing by placing a temporary crown. A crack in a tooth advances like a crack in a windshield. It extends to a certain point, and then you hit a bump in the road just right, and the crack extends a bit further. The same is true for your tooth. The crack begins in the center of the top of the tooth and works its way into the tooth towards the root where the nerve and circulation are located. Sometimes, the crack takes a turn towards the cheek or tongue and a cusp fractures off providing relief temporarily. Then a crown is placed. The other scenario is that the crack advances vertically into the nerve and circulation resulting in contamination by bacteria that are naturally present in the mouth. This is your situation. Because the dentist could not tell the extent of the crack, a temporary crown was placed to prevent the advancement of the crack. That was the right thing to do. If caught early, your symptoms would disappear and the crown would be permanently cemented at a later date. Your current symptoms confirm that the crack reached the nerve and circulation resulting in an infection in the tooth. The bacteria destroy the nerve and circulation center, reducing that tissue to pus and gas which are trapped with no exit. The clue that confirms this was your sensitivity to heat. The trapped gas in the tooth expands from any heat stimulus and causes pain on the remaining nerve and outside the tooth in the jaw bone. It is not uncommon for the pain to radiate to the opposing tooth when this happens, but there is no infection in the opposing tooth. It is just your brains’ misinterpretation of the stimulus. The next step would be for you to take the antibiotics to quiet the infection and the pain until a root canal treatment can be performed on the cracked tooth. Then the crown can be permanently cemented to prevent further cracking. A short-term fix is to hold ice water in your mouth to reduce the expansion of the gas trapped in the tooth. Remember to avoid heat. No hot foods and do not place any warm compresses externally. No direct sunlight. No hot tub. I hope that helps. Good Luck, Dr. Silberman

      4. SD

        My uncle, whose daughter was also a very talented dentist, was not only our family dentist, but many of the same folks throughout our entire region. His empathy for his patients was off the “charts” (sorry!) &, outside of ethics, led almost his every decision outside of obvious dental training.

        Dr, your comments quoting the “20% chance of patients having pain” stats is the absolute PERFECT example of the time he would have NEVER have even rolled the dice. They got them. Period.

        I went to a dentist who’s around my age (mid 40s) near where he practiced for many years & prior to some major upper teeth replacement work, he performed (4) RC’s on me (this put me at 18 for total) on a Wednesday prior to Thanksgiving. During the procedure, he also drilled into a pocket & a sinus cavity / pocket was nicked & the “hottest” liquid ever came pouring into my throat. I won’t go into details, but I wasn’t sure if I could finish, and I’m not a wimp). Once I got done, I was up at the counter & there was no antibiotics (I would’ve be adamant w/o the sinus pocket hit, but 200% after).

        He acted like he didn’t want to, & finally I CONVINCED HIM — like I was asking for a pocket full of high proof oxy whatever.

        I said “I will PROMISE you, by Monday, this will turn into an infection of epic proportions. I know my body.”

        By Saturday morning, I couldn’t talk. It was the worst sinus infection I’ve EVER had. I haven’t had one since, on a positive note. So…maybe that’s a cheaper version of that $8500 “elective” BS surgery to relieve each side of your nostrils.

        You are a VERY good dentist. You care. Dentists have an advantage over many other docs — they can see many things other doctors can’t. (Not 100% but still) there’s no use to be jerks just because you’re “new skoool”, ya know?!

        1. Thank you Stuart for the nice compliment, and for sharing your story. For those reading who didn’t see my “20%” reference, allow me to clarify. I have found that in patients who have a root canal treatment and do not pre-medicate with antibiotics prior to that treatment, one in five has pain and swelling. Not one in 500 or 5,000, but one in five! Of those patients who pre-medicate with antibiotics (preferably Clindamycin), resulting pain and swelling are almost non-existent. The antibiotics should be taken, at minimum, the day prior to the visit, the day of, and the following week. Having said this, you may actually be the exception to the rule. Most people do not have 18 root canal treatments in their lifetime. My 20% rule applies to those who have one or two, or go a year or two between root canal treatments. Overuse of antibiotics can lead to bacterial resistance. Some caution does need to be taken in the overuse of antibiotics. Only take it when a bacterial infection is present, such as is the case with an infected tooth requiring root canal therapy. Good Luck, Dr. Silberman

        2. Samantha

          Please help I am getting a shock like pain in my tooth it’s my fang. But the one next to it is cracked I can’t handle the shocks how do I get rid of the shocks please

          1. Hello Samantha, It is unusual to get the type of pain that you describe. I have seen in it my patients who have overdone teeth whitening. It is described as shocks or zingers that occur spontaneously. This usually passes within a few days. If the problem persists, you should be evaluated by a dentist. I hope that helps. Good luck, Dr. Silberman

      5. Genevieve

        I broke my left first molar to the gum and my dentist placed a crown over ot since the entire tooth could not be saved. She informed me that I needed to floss everyday since food can easily pass and get stuck. Been going well so far until one day I glossed and maybe cut the gum it bled but now I am left with pain to my gum which on scale 1-10 I give 6 and sensitivity to my sinus above the tooth and eye.

        Could this be from the cut or do I now have an infection under the crown?

        Noting there was no cavity to the tooth prior to breaking it.

        I plan to go to my dentist but I am thinking they will have to remove the crown and the tooth already cannot be saved since it is broken.

        Should she have done a root canal on the tooth before placing the crown?

        What else can be done besides full removal.

        1. Hello Genevieve, When a tooth cracks, it is hard to tell the extent of it. I usually put the crown on the tooth first and take a wait-and-see approach. 50% of the time, the tooth heals with no problem. When it doesn’t, it requires root canal treatment. If I can spare the patient an unnecessary root canal, I try to do so, and it sounds like your dentist is on the same page. If the crown was permanently cemented, an opening can be made on the chewing surface to allow the root canal treatment to be performed. This would be followed in several weeks by a filling. A post and core filling can also be placed to strengthen the tooth. A steel post inserted into the largest root can provide long-term stability. I don’t think your symptoms are consistent with being caused by flossing. Sounds more like an infection needing root canal treatment. I hope that helps. Good Luck,
          Dr. Silberman

      6. Tiffany

        I Recently got a crack in my tooth filled. Why does my tooth and the whole front of mouth hurt? I’m in more pain now than before the filling.

        1. Hello Tiffany, When a tooth develops a crack, it is difficult to determine how far the crack extends internally. It can’t be seen on an x-ray. The best we can do is place a filling or crown to eliminate any decay and prevent the crack from advancing any further. If the crack has reached the center of the tooth where the nerve and blood supply are located, it may not have any symptoms. But there are bacteria in the saliva that do not exist in this area of the tooth. Those bacteria can travel through the crack and infect this area causing an infection, and it can still be symptom-free. When the filling or crown is done, it stirs up the bees in the hive (the bacteria in the tooth) and the tooth hurts worse. Unfortunately, it seems that your tooth is infected. You will need root canal treatment and a crown to save the tooth. The dentist can put you on an antibiotic to quiet it for now. The filling was the correct treatment. We try the simple thing first and if it works, no root canal is needed. For you, it didn’t work. All is not lost. You just need to follow through with fixing the infection. Good luck, Dr. Silberman

      7. Richard Vert

        Sounds to me like a “doctor” that cares for his patient first and being politically correct last THAT”S THE GUY I WANT !!!

        1. Thank you Richard. Best, Dr. Silberman

          1. Dawn

            I had a filling done last November. Immediately afterwards it started hurting worse than it did before the filling. (He did not put me on antibiotics before the filling. First dentist I’ve ever had that didn’t.) I mentioned the pain to him at my next appointment a few weeks later and he told me that it was just a deep cavity and it will need extra time to heal. Fast forward to now. I’ve seen this dentist at least 6 times since then for other work and each time I told him that the tooth was still hurting quite a bit. (Last appointment was about 4 weeks ago) He continued to tell me “extra time to heal.” I finally convinced him to look at it yesterday. Not only is it infected, but the one next to it is now infected. He prescribed me antibiotics and referred me to a dental surgeon to have those two teeth removed. But they can’t get me in for several weeks. Meanwhile I can’t go for more than 30 seconds without cold water on the infected tooth or it hurts so bad it brings me to tears. We don’t have an emergency dentist in our area. Are the antibiotics going to help or am I just in pain until they get me in to the surgeon in 3 weeks? I start a new job next week. I need some sleep.

          2. Hi Dawn, Sounds like a nightmare scenario. Sorry to hear you have to deal with this. Let me address a few of the comments you made and then offer some suggestions. It is not uncommon for a tooth with a large area of decay to be without symptoms until the filling (or crown) is placed. The bacteria in the decay are like bees in the hive. Once you shake them up, they get active and the tooth responds accordingly. I agree with the dentist that the tooth could have been going through a healing phase while it was sensitive immediately after the filling. Some dentists would rush to do a root canal treatment but I would wait a few weeks to see if things quiet. I don’t normally put patients on antibiotics for dental treatment unless they have had a joint replacement or certain types of heart procedures performed, or if they are scheduled for root canal therapy. I am not sure why your tooth can’t be treated with root canal therapy if the bone support is good. Do you have an endodontist in your area? That would be a dentist who specializes in root canal treatment. It would be worthwhile to get a second opinion from an endodontist. A tooth infection is rarely spread from one tooth to another. I can’t think of a scenario where that could happen. It’s possible that adjacent teeth can develop infections individually that would both require root canal therapy to save them. Or alternatively they could be extracted to “fix” the infection. If you were prescribed Amoxicillin, I am not a fan. It is the standard but, in my experience, it doesn’t work. I recommend Clindamycin (as long as you don’t have any GI issues). You can take 150mg every six hours or 300mg every six hours depending on you weight and the strength of the infection. If there isn’t a dentist available, ask an Emergency Room or Urgent Care facility for help. Once the antibiotic kicks in, the pain should subside, usually within 24 to 72 hours. Meanwhile, ice water is your friend. Do not apply heat to your face or eat hot foods. Stay out of direct sunlight. Cold compresses on your face will help. I hope some of these thoughts are helpful. Good Luck, Dr. Silberman

      8. Claire

        So um, hi, I’m 39w5d pregnant. I actually have a scheduled C-section appointment for tomorrow morning. But yesterday morning I woke up with severe tooth pain that 3 of my teeth ranging from front middle and back all the sudden started throbbing and causing really bad pains so bad I only got two hours of sleep. I had my mom this morning buy orajel. So I could sleep some. Pain is still there but not as bad as it was. My question is what should I do to alleviate the pain before midnight so I’m not in pain during my c section? And is orajel safe to take this close to a scheduled surgery?

        1. Hi Claire, Sounds like you are really ready to have that baby. I hope the C-section goes well tomorrow. It is okay to continue to use the Orajel. But as far as the pain medication, you need to speak to the OB/Gyn. I really can’t advise you in that department. During pregnancy, it is very possible that the gums have reacted to the hormonal changes you are going through. If that’s the case, after tomorrow, your hormones will be returning to normal and the gum issues will dramatically subside. If it is gum pain, warm salt water rinsing of the gums will help. If it is tooth pain, holding ice water in your mouth could help. If I were a betting man, I would bet on the gums as the source of your problem. Good luck, and see a dentist for a proper diagnosis and treatment plan as soon as possible while your mom looks after the baby. Dr. Silberman

      9. Jackielyn C Malate

        Hi, i will just share the toothache era of my boyfriend 🤦 the pain was severe and all his mother gave was antibiotics, he can’t go to dentist because of poverty and here I am surfing online finding what’s the right thing to do because it’s already 4 days and still the pain remains though when taking antibiotics it lessen the pain but in a minute it keeps coming back. It was very severe pain to the point that her head also get affected.

        ~Hoping for a good feedback. Thank you very much

        1. Hello Jackielyn, To treat the pain, if the infection is advanced, it is likely that holding ice water around the bad tooth could help dramatically. In advanced cases it can stop the pain completely. If the infection is in the early stages it won’t help, but it’s worth a try. Do not apply heat to the face, or eat or drink any hot foods. As for seeing a dentist, you need to make some phone calls. First try your local dental society and explain your situation and get their advice. In my area we have Donated Dental Services that are supported by the State. They may have something like this in your state where dentists volunteer their time to folks who can’t afford treatment. Also, Catholic Charities may have some opportunities in your area. Find out who the state legislators are that represent you where you live and ask them for help. Most elected officials have staff that are often very responsive to their constituents. Good luck. I hope this helps. Dr. Silberman

    2. Kevin

      I had a tooth infection last year and went to three different dentist and they wouldn’t give me antibiotics even though my tooth was infected⅘

      1. Hi Sylvia (or is it Kevin), My response to your comment regarding treatment of tooth infection via antibiotics is that not all dentists are convinced it will help. Or if they think it will help, they don’t want the patient exposed to a medication that could cause an allergic reaction. My position is that is nonsense. If you have an allergic reaction, stop the medication. If you have difficulty breathing or a rash develops, stop the medication. Take some Benedryl and if the reaction is severe, go to an emergency room for care. The odds of that are so extremely low, it doesn’t make sense not to go with an antibiotic. The post-treatment discomfort after root canal therapy is almost zero when the patient is premedicated with antibiotics. This is one dentist’s personal experience from 40 years of practice. But I am in the minority in this regard. I suggest finding a dentist who will premedicate you prior to treatment. Good luck. Doc

      2. Michael Davis

        Hey um I can’t afford to go to the dentist and I have a chipped molar and what I think is an absyss on my gums and it is causing me pain I have tried salt water(slightly worked) and ice cold water (increased pain) but the pain is still there I can’t sleep at all what do I do?

        1. I suggest you look up your local and / or State Dental Society (Association) and ask them for advice. Depending on the State in which you live, there are State funded organizations that provide assistance to people in need for their dental care. In my area we also have Catholic Charities that provide 4 weekends a year where they have an open clinic in a high school gymnasium. They set up in four different locations around the state. It’s all volunteer and we see a thousand patients over the course of the weekend. I’m sure that has been put on hold since the Pandemic, but hopefully it will resume. Good luck and I hope that you get the help you need. Dr. Silberman

      3. Samantha

        Hello I have a really bad toothache on one of my molars that is broken. They told me they couldn’t save the tooth anymore. They prescribed me with amoxicillin and Tylenol and later prescribed me clindamycin 150 mg and ibuprofen. I’ve gone to 2 different dentists because I want the tooth out already but they say they can’t do anything. Is it because it is too swollen? I feel the pain all the way to my throat and ear. Idk what to do. The pain is at a 10.

        1. Hello Samantha, you need to go to an Emergency Room or Urgent Care if the throat symptoms include swelling that could jeopardize your breathing. IV Antibiotics may be necessary. Do not apply hot compresses or any form of heat to your face, which would make the swelling worse. If the pain is from the swelling, warm salt water holds in the mouth could help to get drainage and decrease the swelling. If the pain is from the tooth, holding ice water in the mouth could help with the pain. With this degree of infection, 300 mg of Clindamycin every 6 hours would help, but check with your dentist. Getting the tooth out ASAP is the goal but rely on the dentist for the right timing. Good luck. Dr. Silberman.

          1. Ee

            I have a abscess on my gums and canker sore inside lip and bad breath. Dentist said she couldn’t pull my tooth until the infection is gone but the ibuprofen and antibiotic they proscribed aren’t working. Can I rotate ibuprofen and Something else?

          2. Hello Ee, Sorry to hear you are dealing with this. Tests now show that the effectiveness of alternating Tylenol and Ibuprofen is approximately equal to a narcotic like codeine without the side effects. Take 600mg of Ibuprofen (Advil, Motrin) and alternate with two extra-strength Tylenol (2 x 500mg tablets). This should help while the antibiotics are kicking in. This is probably all the treatment you need until you get the extraction. But for future reference regarding the canker sore, if you have repeated problems with them, the product I recommend is Debacterol. It is now over-the-counter and takes 90% of the pain away with one application. It used to be distributed in dental offices only because the method of application must be closely adhered to. Also, it’s not inexpensive. But it works. The key to avoiding canker sores (technically known as aphthous ulcers) is to avoid fingernail biting, chewing in foreign objects like pens and pencils, avoiding citrus and tomato products. And don’t let your toothbrush scratch you when you brush. Circular motions on the teeth helps prevent them. I hope this helps. Good luck with your tooth extraction. Dr. Silberman

        2. Brandon

          Hello Dr. I’m experiencing between a 9 and 10 of pain on one of my lower right molars. A few years ago a dentist I had seen did a filling but just a few months ago that filling broke off and it took the entire innermost side of the tooth with it. A dentist I’m seeing did two crown preps for it and I have a temporary crown on now but the tooth never really hurt until a temporary crown was put on it, it didn’t hurt when it broke. Now the pain is almost unbearable and constant, and any pain that I feel from the tooth is mimicked in my jaw and my right temple. Is very sensitive to tapping on the tooth, and when I use the mouth wash I was prescribed (periogard) it causes pain that immediately shoots from that tooth, through my jaw to my right temple. Also being military we have no contact with our dentists until they call and schedule our appointments so I may be stuck waiting for awhile. What do you think is wrong and could you recommend any remedies while I wait if possible? Thank you.

          1. Hello Brandon, If the original filling was large, the bacteria in the decay at that time could have contaminated the nerve and circulation inside the tooth. It is a long slow process for that infection to grow to the point where you have symptoms. Another possibility is that when the tooth broke this time, it created a hairline fracture that allowed bacteria in your mouth to reach the nerve and circulation starting the infection. In either case, the tooth is now infected. Any drilling on the tooth will accelerate the infection process that had already begun. The dentist will remove the temporary and do a root canal treatment and replace the temporary. This will stop the pain. Meanwhile, you could go to an Urgent Care and have them prescribe Clindamycin 150mg 4 times a day (if you have no GI issues). It is the best antibiotic for tooth infections. This will quiet the toothache. Take some pain medication as follows: Alternate Tylenol with Motrin (Ibuprofen, Advil). Take 2 extra-strength Tylenol, and four hours later take 600mg of Motrin. Alternate them every four hours. Good luck and I hope that helps. Dr. Silberman

    3. jenny christensen

      Been to ER and a dentist. Pain and swelling on one side of face. Lower last back tooth I can not even touch cause it’s so painful. Dentist took X-ray of the tooth and saw no infection. What else could it possibly be. Could infection be in a different tooth but making that one hurt? I’m in so pain pain and don’t know what to do

      1. Hello Jenny, Sorry to hear you are going through this. It could be a wisdom tooth erupting. This is common from age 15 to 30. If there is no evidence of tooth decay and no infection, I’m guessing this is the source of the problem. Wisdom teeth come up in spurts. They grow a little, the gum over top swells, the opposing tooth hits the swelling causing more swelling. That’s why babies cry when they are teething. I would take warm salt water and hold it over the area to help take the swelling of the gum down. I would have the dentist check to see if there is room for the tooth and, if not, either refer you to an oral surgeon to have it extracted, or let the dentist take it out him / her self if comfortable with doing so. I hope that helps. Good Luck, Dr. Silberman

      2. Krys

        Hello, I had a wisdom tooth extraction about a week ago. I have developed a slight infection. Pain, swelling on inside and outside but no pus. My gum is so swollen it is over my last molar. My doctor recommended heat pads, massaging the area and prescribed antibiotics (Amoxicillin and Clavulanate). Is this a good alternative? I have read many places heat can make infection worse.

        1. Hello Krys, Following a wisdom tooth extraction, I would not apply heat externally. If you have swelling around the extraction site, do warm salt water holds in the mouth. That will help to bring down the swelling. Also, I do not disagree with the dentist prescribing antibiotics if he / she feels that infection is present. Removal of the tooth is the key to healing as it allows infection to drain through the extraction site as needed. I hope that helps. Good luck. Dr. Silberman

    4. Cynthia webster

      I just want my toothache to be gone what can help it go away faster thank you

      1. Hi Cynthia. Sorry to hear you are going through this. You really didn’t provide me with enough description to help you. The best advice would be to get to a dentist as soon as possible to make a proper diagnosis and treatment plan for you. Feel free to write back to me if I can be of further help. Give me more information: your age, description of the problem, pain, swelling, bleeding, and how long this has been going on. Good Luck. Dr. Silberman.

      2. Barbara

        2 weeks ago I experienced small amount of lower molar sensitivity. Several days later that tooth chipped and my dentist repaired.
        Sensitivity increased from that tooth area and I returned to dentist. He said no decay and no abscess at this time from X-ray.
        Sensitivity has greatly increased over the last 5 days. Ice water is the main short relief for pain. Very challenging to rest. Not eating. Just juicing.
        Dentist told me to give tooth a little time to recover from the filling. My gum has receded around the tooth.
        Not sure what to do.
        Thank you for your thoughts.

        1. Hello Cynthia or Barbara, The “give away” is the fact that you get relief from ice water. The diagnosis is an abscessed tooth. Even when nothing shows up on an x-ray (yet), the relief from cold tells me that there is an infection and the tooth will need root canal therapy to fix the problem. You can confirm the diagnosis by tapping on the tooth gently and comparing it to the other teeth around it. It will feel different . . . . not necessarily pain. . . . just different. Use the back end of a metal spoon or fork to tap gently and make sure. I hope that helps. Good Luck, Dr. Silberman

    5. Michelle Miller

      Hello, I have been having progressively worsening tooth pain for weeks and now I am at the unbearable stage. My dentist scheduled me for the first available appointment next Tuesday and gave me Hydrocodone, Ibuprofen, a sedative to take the day of oral surgery, and Pen VK. I was specifically told not to take any of the medications until the day of surgery, which is 5 days away. My mouth is hurting soooo bad!!! Pain is 10/10 and on both sides of my mouth. I am literally in agony. I don’t understand why I can’t take any of the pain medication until after surgery. Does this seem right or did I misunderstand? I am literally dying of tooth pain. Please help!

      1. Michelle Miller

        Ibuprofen and Tylenol neither one provide any relief and I have an ulcer I need to be careful taking NSAID pain medication with. I’ve also tried salt water, oragel, and just plain warm water. Plea hell me!!!

        1. Hi Michelle, Sorry to hear you are going through this. You may have misunderstood the instructions. See what is written on the prescription bottle. Most times the pain medication prescribed is designed to tide you over until the treatment can be done. You should check with the doctor, but I would think that you can take it now. Also, if you have an infection that has killed off the nerve of the tooth, the pain is coming from gasses building up in the tooth with no where to go. Heat causes gas to expand. Your body heat could be causing the gas to expand and cause the intense pain. If this is the case, holding ice water in the mouth will cause the gas to contract and stop the pain temporarily. This, in conjunction with the prescription pain medication should quiet the situation. I hope this helps. Good Luck. Dr. Silberman

          1. Kirsten

            I think my teeth infection caused gum disease. Can this be cured? If so how? My bottom gums look so bad but I don’t have insurance. The dentist wants 1300$ upfront What do I do? The inside of my throat is turning blue and purple. The hospital can’t do anything. And I’ve never been in so much pain.

          2. Hello Kirsten, Sorry you are going through this. In answer to “Can this be cured”, there are very few dental problems that can’t be cured when treated in a timely manner. I can’t tell from your description what the problem is and what the treatment would be. Some suggestions as to where to go from here because of your limited finances. Check to see if there are any dental schools in your area. They usually have reduced fees and, because they are academic institutions, they would have a large cross section of instructors that could address the teeth, gums, throat and any oral treatment needed. Another option is to contact your local dental society and ask if there is any charitable organization in your community that can help you. The national dental association is the American Dental Association in Chicago. If you have any trouble locating your state or local dental society, give them a call for guidance. Also the Catholic Charities has Mission of Mercy in some areas that set up for free treatment four times per year. It’s on hold now due to Covid 19. When they do have these marathon 3 day sessions, the lines are long but there is no cost to you as it is all volunteer. In our area, we have a hundred dentists and dental hygienists meeting in the local school gym with portable dental treatment units. Also, you should contact your local health department and ask for recommendations. In my area, we also have Donated Dental Services. Local dentists volunteer to take patients in need who are referred for screening to Donated Dental Services by local clergy. Lots of avenues for you to investigate. I hope at least one of them works out for you. Good luck and stay safe. Dr. Silberman

        2. Danielle

          I had a root canal three days ago and I started feeling pain towards the end of the root canal but once the numbing wore off the pain was so bad and has been worse as days gone on. Have pain in ear down side of face and jaw and where the root canal was done in tooth . When I chew down it hurts . Ice water gives some relief . I had an Abcess on my gums before they started the root canal but it wasn’t causing any pain . However now I have so much pain since this root canal was done . I know they used heat while doing the root canal not sure if that information is helpful but I can’t sleep and I don’t know what the issue was . Last time I did root canal on opposite side of mouth didn’t have extreme pain . I am also 18 weeks pregnant

          1. Hello Danielle, If the cold water makes it feel better, that can mean one of two things. If the tooth that had the root canal is a multirooted tooth (molar or bicuspid), there may be an extra canal that still needs to be filled. The other possibility is that there is another tooth that is causing the problem. It is sometimes difficult to isolate which tooth is the source of the pain. The dentist should reduce the height of the root canal tooth so that it is not in contact with the opposing tooth when you bite down. The infection at the tip of the root makes it feel like the tooth is too tall and you hit it when you bite together. This causes additional pain and is an easy fix via the bite adjustment. You should also be on antibiotics. My “go to” is Clindamycin 150mg four times a day. Even though you are past your first trimester, You should check with your OB to make sure that taking antibiotics is OK for you. It sounds like they used heat to place the filling which softens the filling material for the best placement in the root. This is very common today though not used by every dentist. In the proper hands, it provides an excellent result so I don’t think that’s part of the problem. I hope this helps and congratulations on the pregnancy. Good Luck, Dr. Silberman

      2. Hi Michelle. See my other response. Best of luck to you. Dr. Silberman

    6. James Green

      I had this pain about a week ago, and it hurt whenever any hot or cold entered my mouth. I went to the dentist and they found a hole in one of my teeth, filled it and fixed the issue. The next day I woke up in excruciating pain. I got another emergency appointment, and upon xray they could find nothing wrong, only that my wisdom tooth might be impacted. He prescribed me Amoxycillin for preventing infection between my wisdom and molar (which is where most of the pain was) and Dihydrocodein for my sleepless nights. The painkillers did literally nothing, and I’ve had 3 hours sleep over these past 4 nights and it’s at the point I need cold water in my mouth 24/7 or the pain is too much. Checked my teeth today and my back molar (the one I suspected) and the molar next to it (the one he filled last week) are both now green. Is it possible they got this infected with 0 signs on an xray in 3 days? Thanks, James.

      1. Hi James, Sorry to hear you are going through this. The application of cold stopping the pain temporarily is the clue that leads me to believe the problem is the tooth they filled, and not the wisdom tooth. A tooth can be without symptoms until it is filled, and the dormant infection that was already inside gets stirred up by the treatment. It is possible that it is a combination of the wisdom tooth plus the one that was filled, but the Amoxicillin would have quieted your wisdom tooth gum problem over the four days that you’ve been taking it. The filled tooth needs root canal treatment or extraction to fix the problem. If the root canal treatment cannot be completed today, the dentist could numb the tooth and open it to allow for the pressure inside the tooth to be released and the infection removed. Then a medicated cotton can be placed inside the tooth to help with the infection as well as keep food out of the roots. Also the height of the tooth should be reduced to stop you from biting on it and give it a rest. It will need a crown in the future anyway, so reducing the bite would be very helpful now, and necessary later to accommodate a crown. Meanwhile, continue with the application of cold to keep getting some relief until such time that the dentist can fix the problem. Good luck. Dr. Silberman

    7. Alex

      I have a chip tooth I used cold compress it went away for a moment then started back what can I do to relieve pain fa good.other then getting tooth pulled.

      1. Hi Alex, From your description, it sounds like you have an infection in your tooth. It could have been caused by a cavity or trauma. Either way, the remedy is to see a dentist who can fix the problem. The tooth can be removed, or you can probably save the tooth if the support of the bone and gum is good, and there isn’t too much of the tooth that has been lost to decay. It would likely require a root canal treatment followed by a supporting core filling and finally a crown. Dentists call it a crown while some may call it a cap which covers the tooth completely and helps to stabilize the problem. The crown prevents the tooth from getting week and fracturing. I hope that helps. Get to a dentist ASAP. Good Luck, Dr. Silberman

      2. Jennifer Leon

        What would my options be for constant daily pain after I eat on tooth 2 or 3? Doesn’t hurt when I drink cold but bothers me sometimes after I have warm food. Xrays show no cavity or infection. Would this mean I have a crack or fracture? Would root canal be needed? Would a CBCT scan show the crack? Thank you

        1. Hello Jennifer, It sounds like it’s pretty simple to diagnose your condition. You have an abscessed tooth. If it is in the early stages, it usually doesn’t show up on a conventional 2D x-ray. The 3D CBCT could show a crack if there is one. Did the dentist test for it by having you bite on a Tooth Sleuth? It is a plastic bite stick that you can place on each cusp of each tooth to determine if there is a crack. Sometimes a crack can be seen clinically by shining a high intensity while light on one side of the tooth. It can illuminate a crack because the light doesn’t pass through it the same as on the light source side. The thermal sensitivity is the giveaway to your condition. Cold drinks can actually make it feel better while hot drinks make it worse. There are gasses trapped in the tooth from the infection that expand with heat and put pressure on the nerve endings in the bone outside the root tips which causes the pain. Cold stimuli like ice water makes the gasses contract and the tooth feels better. You can identify which tooth it is by applying a cold stimulus to each tooth individually. The one that doesn’t respond is the culprit. Place the ice at the gumline on the cheek side. As soon as you feel the cold in the tooth (not on the gum) remove it and see how long the cold lingers. All of the back teeth will respond similarly, except the bad tooth will not respond. Or it may have a delayed weaker response than the others with a slight linger. I suggest root canal therapy and a crown. If there is a crack, the crown will hold the tooth together to prevent further fracture. If the crack extends into the bone, it may not be salvageable. I hope that helps. Good luck. Dr. Silberman

    8. Kim confer

      I went to quick care because I was having terrible pain and my mouth come to find out I have a severe infection they gave me medication two different antibiotics and a nausea pill I’ve been taking it like I’m supposed to for the past I think it’s been 4 days I’m still having the pain what should I do

      1. Hello Kim, You didn’t say if your infection is coming from a particular tooth or a generalized mouth infection. Usually, if it’s tooth, the question is about a tooth. I’m going to assume that your infection is gum related. If I’m wrong, write back to me. Gum infections can be quieted with antibiotics but the cure is to get a deep cleaning from a dentist / dental hygienist, to remove the buildup that is causing the problem. Meanwhile, you can get a numbing mouth rinse from any pharmacy. Ask the pharmacist for guidance. There are prescription mouth rinses that are stronger than over the counter. My favorite is Magic Mouthwash which would have to be called in to a pharmacy. It is a combination of Benedryl, Lidocaine, and Kaopectate. I hope that helps. Good luck to you. Dr. Silberman

    9. ahra

      I just experience severe tooth ache 36hrs . if i scale it from 1-10 its a 10 i cried and i feel its swelling is it possible to remove a teeth even its still swelling ? or in pain

      1. Hello Sylvia, It is better to take a tooth out when there is no swelling present. If the pain can be controlled with antibiotics and pain medication first, that is preferred. But if the swelling is not severe, the extraction can still be done. See a dentist as soon as possible. Good luck, Dr. Silberman

    10. Deborah Bushland

      Hi, I had a root canal about a year or so back and was feeling great up until recently when the tooth in question began to hurt again but 10 times worse. I can’t even take a big breathe threw my mouth as air hurts, and room temperature water shocks my tooth. What do I do?

      1. Hello Deborah, It is highly unlikely that the root canal tooth is the culprit, assuming that the root canal treatment was completed. I’m guessing it’s another tooth in the area of the root canal tooth. A tooth that has been treated with root canal therapy over a year ago would not be able to feel a cold stimulus. I recommend you see the dentist and have them take x-rays and run some tests to see which tooth is causing the problem. Good luck, Dr. Silberman

    11. Sean

      I had a traumatic experience and I’m scared to go to the dentist

      1. Hi Sean, I suggest you Google “Dentists in your area” and start reading reviews. The dentists with compassion will stand out by what their patients say about them. Sorry you had this bad experience, but not all dentists are the same. When you call for an appointment, a really good dentist will set the tone in his/her office and will make you feel welcome from the moment you call. Good luck. Dr. Silberman

    12. Malina Vosburgh

      I woke up yesterday with an abscessed tooth swelling on my left cheek. I went to the emergency room and received antibiotics and was told to see my dentist. The earliest they can get me in is October 8th which is a month and a half away.. will the antibiotics heal it for the time being how long until my face swelling goes away. My kids are freaked out and I’m freaking out and don’t want to return to work.

      1. Hello Sylvia (or is it Malina), Be sure to avoid applying heat to your face because it dramatically increases the swelling caused by an abscessed tooth. If you have already applied heat, there isn’t much you can do to reduce the swelling except to let the antibiotics take their course. The swelling after heat application can last a week. Without heat application, the swelling will last 72 hours provided that the correct antibiotics are prescribed. The antibiotics will mask the problem temporarily but not heal the problem. I always see my patients the same day if they are in pain. It would take five minutes of my time to take an x-ray and diagnose the problem. I would prescribe the appropriate antibiotic and get you on the schedule for treatment, and most importantly place you on a short call list for openings that come up sooner. If your dentist can’t see you for a month and a half, find another dentist. Google dentists in your area and find one that has good reviews. If your problem is tooth infection, Clindamycin is the antibiotic of choice. If the problem is gum or gland related, Amoxicillin is the antibiotic of choice. I hope that helps. Good luck to you. Dr. Silberman

    13. Debra

      If I have an imbedded tooth does the dentist have to dig it out and how does he go about doing so and will it cause horrible pain?

      1. Hello Grandma Deb, I can’t tell what technique the dentist will use nor how you will feel afterward (for removing an impacted tooth). So many varying factors. It mostly depends on what it looks like on the x-ray. If it is not causing you swelling or pain now, by the time you reach Grandma status we usually just take an x-ray every year to make sure that it is not changing (Cystic growth, etc). But my guess is that you are having swelling or pain, or both, and that is why they want to take out the tooth. Ask the dentist the same questions. They can easily answer this with the x-rays in hand. If they expect you’ll have pain afterwards, they will prescribe the appropriate medication to keep you comfortable. Most extractions are not difficult and heal quickly. Good Luck, Dr. Silberman

    14. Victoria Yakubu

      My gum is swollen and my tooth at the left hand side in front i.e 4th tooth in front left side hurts and has affected both up and down.what do i do?? Dentist very expensive here.. is there any other remedy??.

      1. Hello Victoria, You will likely need to have an x-ray taken, so you need to go to a dentist. You can call ahead to different offices and ask for an estimate for both an emergency visit and an x-ray. Then they will be able to give you a diagnosis and an estimate for the necessary treatment. If there is infection present, they could prescribe an antibiotic to quiet the problem until such time that you afford the treatment. Do not apply heat to your face as this could increase the swelling. Good luck, Dr. Silberman

    15. Abdul Wahid Baloch

      Hello sir, i have severe pain since last day, upper left side in one tooth, only ice and cold water giving relief. I am taking following medicines
      Cap.solvocef 500mg
      Tab. Flagyl 400mg
      But above medicine is not giving me relief except cold water or ice. Kindly guide and help me in this regard

      1. Hello Abdul. You have found the best way to get relief, temporarily. Applying ice water to the bad tooth will stop the pain. The problem is that there is an infection in your tooth. The circulation into the tooth has been damaged, so the antibiotic can not kill the bacteria inside. The bacteria thrive on being in a dark, warm, moist environment. The give off a biproduct of gas that is trapped in the tooth. The cold water causes the gas to contract and stop the pain for a while. Your body heat is enough to warm the gas and cause it to expand again, and the pain returns. The treatment is to save the tooth with root canal therapy, or have the tooth extracted. See a dentist as soon as you can, and I’m sure you will be offered those options. Good Luck, Dr. Silberman

    16. Oxana

      I get 4 crowns done in Ontario canada in one of them dentist broke his file and just left in in my tooth , year later was so much pain I have to remove the tooth, second crown broke off and it brick my tooth I have to pay more money for dentist to rebuild what they call temporary tooth, now I have big pain in a area where my other crown only cold help pain go away ,and this crown right beside the one I had to remove my tooth because it was broken file , I don’t know anymore what to do , so much money spent and pain is 10out of 10 🙁

      1. Hello Oxana, It looks like you need to see a dentist who has the skills to get your dental health back. Do a search online for dentists in your area. Read the reviews carefully and they will lead you to the right person. Sorry you are going though this. For the tooth that is causing the pain now, you have found the short term solution is to hold ice water in your mouth around that tooth. You can also take Tylenol and Motrin, alternating them every four hours. A prescription of an antibiotic like Clindamycin would also be helpful to quiet the infection which is the cause of the pain. Good Luck, Dr. Silberman

    17. James

      I am having major pain on my lower back teeth on the right side. It hurts and I been having pain for like 2wks finally went to Doctor and I got prescribed some antiobiotics. But when you touch on it it hurts like hell. I am thinking I need a root canal but for some reason the Dr is saying I don’t need a root canal but it is giving all the signs of me needed one. Maybe need to redo my filling or get a crown put on. But I am thinking o really need a root canal. Now my glands are swoll under neck and it feels like I have a sore throat. Either pull this tooth or give me a root canal

      1. Hello James, What you are describing can either be caused by an infected tooth that needs to have a root canal treatment or extraction, or it could be caused by an erupting wisdom tooth or a gum infection. Either way, I recommend you wait a couple days until the antibiotic kicks in and quiets things down. Once things are less inflamed, it is easier to make a diagnosis. If it is tooth infection, Clindamycin is the antibiotic of choice. If it is a gum problem or wisdom tooth, Amoxicillin is the antibiotic of choice. I hope that helps. Good luck. Dr. Silberman

        1. Martina

          Hi, I had big filling on tooth which fell out on my bottom left side in the back. I do not have wisdom tooth on that side. There is still some filling left in my tooth but I have to wait 5 more days to go to dentist. I have bad pain in my bottom jaw and feel like the bone is swelling. Do you think this pain could be caused by fallen filling? I started taking antibiotics which I was prescribed before for similar problem and also taking nurofen helps a bit. I am really scared of dentists and the good one I had left. Could this pain be caused by something else then tooth such as sinus infection? As I had blocked nose on that side the day before the pain started. The tooth itself does not hurt only my jaw bone near the ear and my throat. Thank you for any advice.

          1. Hello Martina, It’s difficult to make a diagnosis in your case without seeing you. Because the tooth doesn’t hurt, it is possible that the pain you are feeling could be caused by something other than the tooth. It’s possible it could be a sinus issue because you also describe having a sore throat and sinus congestion along with the swelling. You might have both a sinus problem and a tooth problem. I think once the swelling goes down from using the antibiotics, you will start to feel better. Do not apply heat to the area as that will make the swelling worse and increase your pain. In addition to the Nurofen, you can take extra strength Tylenol. Alternate them every four hours to help control the pain. Good luck. Dr. Silberman

  2. GoToothache

    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.

    1. 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.

    2. RosaMaria Ramirez

      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…

      1. 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.

        1. Jamie

          Recently had a root canal performed on an upper right tooth (the one before the last molar) 3 days after being home I’m having WORSE pain than I had before going in. It’s weird because I’m getting pain obviously from the tooth they put a temp filling (I go to my reg dentist Aug 11) but I’m also feeling INTENSE pain 2 teeth up from it my “fang” it’s SEVERE like scale 1-10 it being a 15 pain. On the bottom and between.

          I’m trying to get into the Endo for an emergency apt however it’s the weekend and they’re closed. I haven’t been able to eat anything not even soup bc everything is irritating my mouth. My regular dentist was unable to give me pain meds as he’s out of the country til my apt on the 11th but his nurse prescribed me the antibiotics you recommend. I’ve been on those for 2 days now. 🙁

          I’ve had a lot of dental work done like my 4 front teeth are fake and I’ve had MANY root canals. This however has been the worst pain ever.

          1. Hello Jamie, Sorry to hear you are going through this. 20% of all patients who have had root canal treatment and did not premedicate with antibiotics have pain after treatment. I always premedicate and never have postop issues. But this is where you are now. Your antibiotics have to catch up to the level of infection. It is OK to increase the dose from one Clindamycin 150mg every 6 hours to two Clindamycin 150mg every six hours. Doing the math, that is 300mg every six hours. Also, hold ice water in your mouth around the tooth. If the pain stops, it indicates that there is another canal that needs treatment, or there needs to be additional treatment on one or more of the canals that were just done. If the cold makes it worse, it would be from another tooth. My guess is that it is the tooth that you just had treated. It can cause radiating pain including to your “fang” as well as to the opposing teeth. For pain, alternate Tylenol and Motrin every four hours. Take two extra strength Tylenol to start. Four hours later take 600 mg of Motrin (Advil, Ibuprofen). Then start alternating. I hope this helps. I feel strongly that the ice water will keep you comfortable until the antibiotic kicks in. Good Luck, Dr. Silberman

      2. Rock

        Hello I woke up to ear and throat pain on my left side and I seen my doctor and they prescribed azithromycin. Later on the next day I realized it was my tooth because my face the lower part of my jaw is swollen and won’t go down to normal size. Right as the pandemic occurred I had two teeth that broke off at the gum-line on opposite sides of the bottom of my teeth (the bottom k9s) although there wasn’t any pain I was nervous to go in to the office since I have interstitial lung disease and im considered at risk. These last couple months I didn’t have pain until now but I’ve been rinsing my mouth with mouthwash, water/hydrogen peroxide mix, putting cold compress on my face 24/7. Any help please!!!! I’m allergic to penicillin and I’m currently taking predisone, iron pills, vitamin d and c pills, cellcept for my lung disease and allergy medication!

        1. It is safe to go back to the dentist. While we were closed during the early stages of the Pandemic, we spent many hours a day on webinars to learn about the virus and how to deal with it. Most dental offices have taken the precautions necessary to be able to open safely and treat patients without great risk. My suggestion for you is to get back to the dentists ASAP to have the infected teeth extracted. You should inquire about their safety protocols first and let them know of your concerns. And by the way, you have been doing the right thing by applying cold compresses (not heat). I hope that helps and good luck to you. Dr. Silberman

          1. Dennis

            Have a broke lower tooth I’m in clinda 300 mill 4 times a day and its been day 3 and the pain is still terrible on and off but mostly on …how long can this go on for?

          2. Hello Dennis, Clindamycin is the drug of choice and sometimes takes a few days to kick in. It works faster if you have not applied heat. No hot liquids, hot compresses, hot showers, saunas etc. If the tooth is not sensitive to cold, hold ice water in your mouth around the tooth and the pain should subside without a minute. Keep ice water in the mouth as often as you need it to stop the pain. Also, apply cold compresses to your face to cool down the area. You can get eugenol liquid and apply it to the tooth. As for medication, take two extra strength Tylenol every 8 hours (2 x 500mg) and three Ibuprophen (3 x 200mg) every 8 hours. Alternate the Tylenol and Ibuprophen (Motrin, Advil) so that you are taking pain medication every 4 hours. Have your dentist render treatment as soon as possible, either via root canal therapy or extraction. I hope that helps. Good Luck.
            Dr. Silberman

        2. Chris

          I just wanted to say what a GREAT dentist and person you are. Most people will not answer questions unless you are their patient, and I’ve read your responses to everyone. Absolutely kind of you to do so. I was directed here after googling a question, and you had answered my exact question. Thanks for being such a great Doctor. You are appreciated

          1. Wow! Thank you Chris. It was very nice of you to take the time to write this comment. I appreciate it very much. You should know that this is the first actual response from any individual that I have received, and ironically it was not prompted from a response of mine to you personally. I often wonder if my advice has been heeded, much less appreciated. LOL So thank you again. Have a wonderful Thanksgiving tomorrow, and stay safe in this crazy pandemic. Follow science and wear a mask. Dr. Silberman

          2. Jim

            I wholeheartedly agree with Chris comment. This is the most caring informative dentists site I have seen while searching for toothache relief in the middle of the night.Google pulled up this site and I so wish I didn’t live half a country away . Dr Silberman would be my new dentist !! To take the time to reply so kindly and thoughtfully to all these questions must be the consuming. God bless you Dr. Silberman, your answers help more people than you can possibly know. I wish more people would acknowledge that.

          3. Hello Jim, Thank you so much for your kind words. Whether it’s a pandemic or this crazy world in which we live, (though it’s cliche’) we are all in this together. Giving of oneself with no expectations for something in return is its own reward. I am just happy that I can share information to those who need my help. Your note of thanks just adds to my rewards. So thank you very much. And if you ever move to Waldorf, Maryland, it would be my pleasure to take care of your dental needs. Best, Dr. Silberman

          4. Kay

            Yes I have to agree with previous comment ! You are a wonderful REAL dentist who knows what he is talking about , who truly cares about others tooth pain /problems and gives the best advice FREE idk one that would do such a thing like you doc .your the first dentist to mention the cold water thing lol everyone including some dentist thought I was crazy when I would say that’s the only thing that helps my toothache ! ( bring back old school dentistry’s” lol .google brought me here and I already know my diagnosis after reading comments lol . * bad tooth pain hole in tooth excruciating pain only relieved with cold water *

          5. Thank you Kay for taking the time to write. It is interesting that such a basic thing regarding hot and cold stimulus is not understood by some dentists. But I’m glad we have access to information through the Internet to expand knowledge. Thanks again for your kind words. Dr. Silberman

          6. ami

            Hello Dr Silberman,
            I second what Chris said. Me too i was searching a question and google directed me to you and i have been reading along your answers.

            Thank you so much for the advice and support you give to the people.

          7. Thank you Ami. I appreciate your kind words and your taking the time to express them. Have a great day. Dr. Silberman

        3. Simran

          Hello, my lower first molar had a long standing caries and i had sensitivity, there was bleeding from the tooth so the dentist started rootcanal. all went fine without antibiotics and analgesics until the last phase of obturation. Just after the obturation, i started feeling pressure pain on biting and it increased eventually then it became continous. And the intensity increases after consuming hot liquids. It relieves after antibiotics n analgesics. Later when i visted to dentist he took an xray, there was no abscess but PDL widening, and a bit short post obturation radiograph. then why is the pain aggravated after the rootcanal therapy and it increases allot when i try gargling with hot saline water.

          1. Hello Simran. Your description was helpful for making a diagnosis. If heat is still causing pain, there is still gas trapped in the tooth that is expanding when you drink something hot. The trapped gas can either be in a canal of the tooth that still needs to be obturated (filled). Or it could be the area at the tip of the root that is unfilled “short”, which is visible by the “post obturation radiograph.” Or lastly, it could be coming from an adjacent infected tooth that also needs root canal therapy. My guess would be one of the first two options, and the treatment would be the same. Removing the obturation and refilling the tooth to the apex (to the end of the root tip) and making sure all canals are filled is the most likely remedy. Also, whenever possible, I try to reduce the height of the tooth immediately following treatment so that when you bite together, there is no contact with the opposing tooth. This provides relief during the healing period following root canal treatment. The body will respond to this adjustment over the next few weeks with “equilibration.” The tooth will gradually rise back into contact again and become fully functional on its own. I hope that helps and good luck to you. Dr. Silberman

    3. Julia Honea

      My upper jaw hurts tremendously. It’s the top back tooth. I took 2 extra strength Tylenol. I was not even able to sleep. I stayed up all night today. The only thing that seems to subside the pain temporarily is holding water in my mouth. The Tylenol didn’t seem to make a difference. I recently went to the dentist and was cavity free. So I am confused as to why it hurts to the extent it does.

      1. Hello Julia, Given that the tooth feels better with cold water held in your mouth, I suggest you go back to your dentist to be re-evaluated, or go to another dentist for a second opinion. Relieving pain with cold water is usually a sign that you have an infected tooth. Gasses that are trapped in the tooth caused by the infection can expand from your body heat and put pressure on the nerves in and around the tooth. The cold water cause the gasses to contract and helps to stop the pain. The source of the infection could be from tooth decay (a cavity), a history of trauma, a fracture line, etc. Do not apply heat to your fact externally because it will draw out the infection to the surface and cause swelling. Continue with the ice water holds until you can see your dentist. I hope that helps. Dr. Silberman

        1. Jennifer

          I was having a tooth extracted last year and it broke. The dentist did a root canal and I’ve kept the roots in my mouth. Now I’m having severe pain not relieved by cold water and barely touched by Norco and prescription strength ibuprofen. I’m waiting for my dentist to call in an antibiotic as their office is closed til Monday. I just want the pain to stop!

          1. Hello Jennifer,

            If your “tooth was being extracted and it broke”, why did they decide to try to save it by doing a root canal? It is possible that when the tooth broke, another crack formed going down the root. The crack would give sanctuary for bacterial growth and the only way to fix the problem would be extraction. An antibiotic will quiet the situation, but it sounds to me like that tooth / root should come out. I hope that helps. Good luck. Dr. Silberman

          2. Brittany Elaine Pope

            Im pretty sure i have an abscess. I went to the er cuz the dentist isnt open. They gave me amoxicillin and hydrocodone/acetam for the pain and its not helping. When they gave it to me at the hospital it worked just fine but im on day 2 and now its not. I have to keep cold water in my mouth just so im not in pain. What do I do?

          3. Hello Brittany. Sorry to hear you are going through this. It sounds like you have an abscessed tooth. The ice water helping with the pain is the way to definitively diagnose an abscess. I am not a fan of Amoxicillin for tooth infection though it is commonly prescribed for it. Because you have already started on it, I would stick with it if the dosage was 250mg three times a day. I would suggest increasing the dose from 250mg three times a day to 500mg three times a day. If you started at 500mg, I would switch to Clindamycin 150mg four times a day. It is more effective against tooth infection than Amoxicillin, in my opinion. It is important that you have no GI issues (ulcers, colitis, IBS, Crohn’s Disease) in order to take Clindamycin, but I believe you will get relief more quickly. And of course, have the tooth treated by extraction or root canal therapy to resolve the problem. I hope this helps. Good luck. Dr. Silberman

        2. Brittany Elaine Pope

          Im pretty sure i have an abscess. I went to the er cuz the dentist isnt open. They gave me amoxicillin and hydrocodone/acetam for the pain and its not helping. When they gave it to me at the hospital it worked just fine but im on day 2 and now its not. I have to keep cold water in my mouth just so im not in pain. What do I do?

          1. This was a duplicate and I responded already. Good luck. Dr. Silberman

  3. GoToothache

    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.

    1. Jaliya Johnson

      My sister pregnant her wisdom tooth have a cavity nothing is working we tried everything the dentist won’t pull it because they have to put her to sleep the tooth pain wake her up at night she can’t sleep or think

      1. There should be a way to get this tooth numb without putting your sister to sleep. I suggest going for a second opinion. Also, the dentist could numb the tooth and remove the part that’s causing the pain. After delivery, she can go back to fix the tooth. Good luck and I hope she has a happy and healthy baby. Doc

        1. Anthony Jone

          Two teeth extracted that were infected I was on antibiotics 2 weeks before extraction…now it been 5 or more day and seems to be still draining and pain I have been on antibiotics for over two weeks now what so I do help joy

          1. Hello Anthony, You need to go back to the dentist and have them evaluate the extraction site. It is possible that you have what is called a dry socket. When a tooth is extracted, a blood clot forms where there roots of the tooth were, filling in the void. The clot keeps the inner bone covered and keeps air from reaching the exposed bone surface. If the clot is lost, the exposed bone has nerve endings that cause pain. The dentist can pack some material in the site to cover the bone and stop the pain. More antibiotics would not help this condition because it is not an infection. Also, there may be something else going on if there is both pain and drainage. A dry socket usually has no drainage. Regardless, you should go back for a re-evaluation. I hope this helps. Good luck and stay safe during the Covid 19 Pandemic. Dr. Silberman

          2. Robert

            Hello. I have some dental problems at front teeth and others as well.
            One morning i woke up with headache, nose pain. I took antibiotics and pain killers but the nose pain never went away.
            After few months started feeling the pain at ears, eyes, and overall feel tired .
            I went to neurology and did an M.R.I which showed nothing wrong at the head. Did a C.T. at nose which showed nothing wrong. Can these symptoms be related to teeth problems? thank you

          3. What kind of problems are you having with your front teeth? An abscessed upper front tooth can cause “nose pain” as well as headache. I suggest you go to a dentist for evaluation. A serious complication known as cavernous sinus thrombosis can occur if an upper front tooth abscess goes untreated. Do not delay. Do not apply heat too your face and stay away from hot drinks. If you are cleared by a dentist, you do not have to avoid those things. Good luck to you. I hope this helps. Dr. Silberman

          4. Nicholas

            You give great advice and I need some badly!! I am very young and need all teeth pulled and a full denture. I went to a local dentist 3 days ago when I started having unbearable pain. This dentist wanted nothing to do with me since after insurance id still owe $7,500 and don’t have it. They just wanted me out of their office at that point. The next day my face blew up like a balloon and I knew I had an infection so I had to go to the hospital for antibiotics. If you can tell me in your experiences, is there anything I can do? Insurance will cover 7 teeth annually but will I find a dentist who will be willing to pull the ones causing me pain that’ll be covered? Or will everyone want to do the whole job or nothing?

          5. Hello Nicholas, So sorry to hear you are going through this. The important thing is to get the infection under control, and it sounds like you are on the road to making that happen. The antibiotics will quiet the problem, but not cure it. It will buy you some time to get a game plan in place before moving forward with treatment. Remember to avoid applying heat to your face, being in the sun, or anywhere that’s hot, because that will bring out more swelling until such time that you get the treatment you need. Now to the game plan: Find a dentist who will work with you. If you have a credit card, charge the work and pay it out over time. If you don’t have enough credit limit, ask if they have a credit service like Care Credit. This is a medical / dental line of credit that can only be used for health purposes, and qualifying for credit is easier. Your dental insurance is there to help, but only slightly. Many policies have a limit to what they will pay annually per person. They are in business to make money and they know how to structure your policy, not to help you, but to be profitable. Ask for a treatment plan proposal from the dentist. This will break down the cost of each treatment, including each tooth extraction and any extra care required during the extraction process. It will also list the cost of the denture. Get a proposal for both an immediate denture and a permanent denture. The immediate denture would be inserted at the time of the extractions so that you will always have teeth to smile with, and it will act like a bandage covering the extraction sites. After the mouth has healed, you would go back to have a permanent denture made. The reason for the two dentures is that, during the healing process following the extractions, the gum will shrink and get healthy and tight as it pulls away from the immediate denture. That space between the gum and the denture will cause little if any suction and they will become loose. The permanent denture will match the healed gum area precisely and will hopefully prevent the need for any adhesives to hold the denture in place. Once you get the permanent, the original immediate can be sent back to the lab for a reline. That way it will fit your mouth as good as the permanent one, but it offers you a backup in case of emergency. The dog will love your denture and chew it to pieces, and when that happens, you’ll have a backup. So be warned, take your denture out at night to give your gums a chance to breathe (never leave it in overnight except for the night following your extractions) and when you do take it out, put it in a safe place out of reach of the dog. I hope that helps. Good luck to you. Dr. Silberman

          6. Kelly C

            Hello, your information and these questions/comments have been so helpful. I have a question I’ll try to keep short. I haven’t had insurance so haven’t been to a dentist in several years. I went to urgent care for two infected teeth at the same time. They prescribed amoxicillin 875mg 2x/day for 10days. It will be a week tomorrow and one tooth the abscess went down on my gum and is fine but the other has gotten just a LITTLE bit better pain wise during the day but when it hits about 3:30 I feel so much pressure, feels like my tooth is going to explode, hurts in my jaw, throbbing, can feel every breath I breathe inside the tooth and sometimes pain into my ear. I get a headache and I’m taking Tylenol and ibuprofen but I feel like I’m taking to much. I have an appt Monday the 22nd for X-ray/exam and extraction if they can do it same day if it doesn’t need surgery. This particular tooth use to have a filling and over a year ago the filling came off and it has a huge hole and the hole goes very deep into my tooth. I’ve tried so many home remedies and most just give a quick temporary relief I’m in so much constant pain I’m completely worn out and I have 3 kids 🙁 Do you have any recommendations? I go back to work next week and I’m praying I can figure something out for relief. Thank you!

          7. Hello Kelly, Sorry to hear you have to cope with this AND take care of the three kiddos. That’s really challenging. It sounds like you have two different types of infections going simultaneously because the Amoxicillin was effective for one and not the other. The one that was not helped is the one with the hole. Your description of being able to feel every breath tells me that the tooth is still alive, and applying ice water would not be helpful, but would be detrimental. Often in severe toothache situations, applying ice water helps, as you’ve probably read in some of my other answers. Not in this case. I would call the dentist and explain your situation, and ask to be put on a short call list. Hopefully you can be flexible and get in to see the dentist ASAP. I have a same day emergency policy. I will see anyone in pain the same day to at least be able to make a diagnosis and recommend treatment. The best home remedy for a cavity as you’ve described is some form of cloves. Clove oil can be put on a small cotton ball and placed into the cavity for relief. Any pharmacy carries it. Or you can literally grind up cloves and add a drop or two of olive oil and place that paste into the cavity. Cloves is the key to relief, plus covering the exposed area with a clove paste will protect it from the air. Continue alternating Tylenol and Motrin every four hours. If your dentist can’t see you until the 22nd, call other dentists to find one that will take a same day emergency. Online reviews are helpful in making the right choice. I hope that helps. Good Luck, Dr. Silberman

  4. Deborah Clambers

    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.

    1. Hi Deborah! Thanks for sharing. Warm salt water rinses are an easy and effective way of preventing the spread of infections

      1. Victoria Ellis

        I have had a toothache for over a month. The dentist extracted my back tooth but I am experiencing severe pain in my lower tooth that is a root canal with a crown. The dentist did x-rays and said there is nothing wrong with my root canal. Is sending me for a 3-D image to see if there is a crack. Appointment is a month away!!! What can I do for the severe pain until then???

        1. Hello Victoria, The 3D x-ray is the correct next step in the diagnostic process. But waiting a month would be challenging. Call your dentist and tell him/her what is going on. See if there is another dentist with the 3D technology that could get you in sooner. To get some relief while waiting for the 3D, the dentist could reduce the height of the tooth slightly so that the opposing tooth isn’t constantly impacting it. Also, a round of antibiotics (Clindamycin 150mg every six hours for 10 days) would probably help with the pain. I hope that helps. Good Luck, Dr. Silberman

  5. Robert Saurez

    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

    1. Valerie

      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

      1. 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.

        1. I can’t afford to go to a dentist someone told me to go to the local feed store and buy fishbiotics cephalexin is this a suitable substitute till I can get into the dentist

          1. Hello Worried, That’s an appropriate name for how you should feel if you are considering taking fish antibiotics. While it is true that the antibiotics used to treat fish are the same as humans and other animals, it is the only pharmaceutical group that is unregulated. You have no idea if the strength per dose is accurate, or what the purity of the product is. The cost of the fish antibiotics would probably be around $30. For a little more, you could see a dentist and get a proper diagnosis with treatment options. Call some dental offices and ask if they could see you to have an evaluation at minimal cost. If you need an antibiotic, an appropriate one can be prescribed. An alternative is to go to an emergency room or urgent care, and they should be able to prescribe for you too. Your best bet is seeing a real dentist. Call some dentists and explain your predicament. See if one will take you to diagnose the problem and take an x-ray for a set fee. Good luck. Doc

          2. Dave

            This is the problem I have, the cold water takes the pain away but 10 seconds later it comes back even worse so I have been drinking cold water constantly for the entire day, I’m worried about what happens when I have to go to sleep because I wont be able to drink water.

          3. Ice water is an excellent means of keeping severe tooth pain under control. It doesn’t work in all situations, but when it does, it’s immediate and often total relief. When gases are trapped in a tooth, your body heat is enough to expand those gasses and it puts pressure on live nerve endings. The cold water lowers the temperature and relieves the pain. You may have a sleepless night because it might be the only thing that works until a dentist can give you some dental anesthetic to numb you. At that point, either the tooth can be removed or an opening in the tooth can be made to allow the gasses to escape. Either way, the pain should be relieved.

          4. Leandro

            Hello Dr,

            I’m currently in intense tooth pain. I was told by a dentist that I need two root canals and that I have an infection in one of them, the other one is cracked. I just graduated and have to travel back to my country next week, but I’m afraid that the pain in the airplane will be unbearable. Currently the only thing that keeps the pain away is taking sips of cold water every 30 secs. While traveling though, I won’t be able to do that because I need to wear fsce protection due to covid. Can you please suggest some strong medicine that will numb the pain for the entire trip? It’s just one day. Thanks in advance.

          5. Hello Leandro. Sorry to hear that you are going through this. You have found the short quick fix to calming a tooth in an advanced state of infection: sipping ice water. An antibiotic will help to stop the pain by eliminating the bacteria that are causing the problem (gas trapped in your tooth). But it will take 48 hours. Until then, I would continue sipping the ice water. I would suggest alternating 2 Extra Strength Tylenol and 3 over the counter Motrin. Take one or the other every 4 hours. The antibiotic of choice is Clindamycin 150mg every 6 hours (if you are not allergic to it and if you have no gastrointestinal issues). You could go to an Urgent Care if you can’t get in to see a dentist. You could get a prescription from them for the Clindmycin, and possibly for a narcotic for pain. If you can avoid the narcotic, I would advise it. Bottom line is that you need to get these teeth treated, either with Root Canal Therapy or extraction. Everything else is a temporary fix. I hope that helps. Good luck. Dr. Silberman

        2. Kedanna Rosewater

          Whenever my mouth is empty I’m in extreme pain, I’m having to keep cool water in it at all times. I’ve taken over the counter pain killers and they don’t seem to be doing anything for the pain. It hurts all over I can’t tell where it’s coming from, it hurts to eat or have anything to hot or cold. Even going just a few minutes without a liquid in my mouth about brings me to tears. I called my dentist but they are closed due to the virus.. I can’t sleep or do my job like this. They called me in amoxicillin 500mg but nothing for the pain.

          1. Hello Kedanna, From your description, it is very hard to make a diagnosis. The fact that it hurts all over the mouth leads me to believe that it is a tissue problem not a tooth problem. An abscessed tooth is usually localized enough that you can tell which side of the mouth the pain is coming from. But a tissue problem (cheeks, gum, tongue, palate) can all be inflamed if there is something else going on. It could be a bacterial or fungal cause, and the treatment for them are different. Your dentist should have an emergency number where you can reach out to someone on call. If they don’t, call another dentist locally until you find one that will accept your call. They should be able to ask the right questions and have you take pictures with your phone to send to them so that a proper diagnosis can be made, and the appropriate prescription medication can be offered. If I am right, a prescription for Magic Mouthwash would be very helpful. It is a combination of Benedryl, Kaopectate, and Lidocaine. The Benedryl acts as an antihistimine, the Kaopectate coats the inflammed surfaces, and the Lidocaine numbs it to give temporary relief until the correct antibacterial or antifungal medication is taken. I hope that helps. Good Luck. Dr. Silberman

      2. Annabelle

        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!

        1. 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

          1. Grace

            Is it contraindicated to have my tooth extracted if I am still having a toothache?

          2. No. If you have no swelling or minimal swelling, having the tooth extracted should not be a problem. There may be other medical complications that would prevent the dentist from doing the extraction, but that should have been reviewed by the doctor already. If not, I’m sure they will look at your medical history to determine if it is safe to extract your tooth.

    2. 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.

    3. Adline

      Hello my lower broken tooth is causing me a severe pain to the point i hit my head and wish for death,i went to the dentist today and he gave me some antibiotics to heal the abscess before removing my tooth i went home and took the meds it stopped for only 2hours and started hurting like crazy again and it wont stop at all i dont know what to do :’) helpp

      1. Hopefully your situation has been resolved. For pain management, we recommend alternating Tylenol (2 x 500mg tablets) with Motrin (Ibuprofen, Advil, 2 x 200mg tablets) every four hours. Do not take more than 6 Tylenol or 6 Motrin in a 24 hour period. If the tooth isn’t cold sensitive, holding ice water in your mouth can quiet the pain. I hope you are doing better now. Best, Dr. Silberman

        1. Mika

          I went to a DDS for pain in tooth #18, which was throbbing somewhat and sensitive to pressure. X-Ray showed this tooth previously had root canal treatment, so he assumed the pain was referred from tooth #19 and performed a root canal on that one. Over the next 2 days the pain worsened, still apparently emanating from #18. I went back in at which point I was referred to an endo specialist who would not be able to see me for 5 days from that point. I was given an Rx for antibiotics and told to take double the max recommended dose of Advil to manage the pain. Today the gum around the tooth is quite swollen. The pain is unbearable. I would have preferred to try to save the tooth but at this point will try to find someone to extract it in order to obtain relief. How common is it to have a previously endo treated tooth to cause issues? The root canal had been done over 10 years ago.

          1. Hello Mika,
            A tooth that has had root canal treatment can fail and eventually need extraction. My success rate on root canal treatment is 98%, provided that the patient follows up that treatment with a supporting post and core filling and a crown. Some of the causes of root canal failure include a missed canal that needs filling. Usually this will flair within a year of the original treatment, but it could take several years to become symptomatic. Of course it is best to find and treat all of the canals at the initial treatment, but if not, it can be treated successfully later. It is rare for a missed canal to flair after 10 years. The more common cause of root canal failure after 10 years is that the tooth can fracture. Bacteria can develop in the crack and there is nothing that can be done to fix the problem except to extract the tooth. There is less frequency of fracture if a post is placed in the main canal to give internal reinforcement to the tooth. I like to make the comparison that it is like rebar in cement. Not all dentists do this, but I’ve seen too many molars fracture without the help of the post. Just my opinion. Once extracted, the tooth can be replaced with an implant in most cases. There may be a bone graft placed at the time of the extraction to facilitate the placement of the implant at a later date, in 3 or 4 months. I hope that helps. Good Luck, Dr. Silberman

  6. Patty Huston

    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

    1. 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!

      1. Maryanne Callaham

        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?

        1. 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

      2. sara

        I will tell you I am on antibiotics now for 4 days !! and I have been taking ibuprofen 800 milligrams and alternating and IT DON’T WORK! I have also took a tramidol 100 milligrams! and IT didnt work the pain was so bad that I turned my head upside down to stop the pain for just a bit of relief!!! anyone who has pain get ambensol!!! the gel kind it is magic!!!!!!!stops the pain instantly!!!

        1. Hello Sara, If Ambesol worked, the problem is likely more gum related than tooth related. Tooth pain would be unaffected by a topical anesthetic like Ambesol. Having said that, the antibiotic of choice for gum problems is one in the “cillin” class, like Amoxicillin. You should be taking that every 8 hours (500mg). If it is a tooth problem, Clindamycin is the drug of choice, either 150 mg or 300 mg every 6 hours. The correct antibiotic should become effective after 48 hours. For gum problems, warm salt water holds in the mouth would be helpful. A teaspoon of salt in an 8 ounce glass of warm water held for a minute or two every few hours will help. I hope that helps.

          1. Russell

            Hello Dr so recently the nerve in my tooth died and it was also infected around my gums and was spreading but my dentist put me on antibiotics and I alternated between two pain medications it’s been 4 days and the swelling and infection is going away and there’s no more pain now I just have to get a root canal I was just wondering if I could take a hot shower because I know if u apply heat to an infection Thats not good and I don’t want the infection coming out so is it okay if I take a hot shower?

          2. Hello Russell, I wouldn’t allow the heat to be in contact with the area for very long. I have seen where a sauna caused an abscessed tooth to swell the face considerably. Take your hot shower but don’t let the hot water run on that side of your face, and don’t stay in for too long. Have a cold compress ready to apply to your face when you exit the shower, just to be on the safe side. Good luck. Doc

      3. Stacey

        I’m going through some hella pain with an abscessed tooth right now. It just started yesterday. My whole tooth is gone and all that remains is the root under the gums. The pain is unbearable. But I was always told that cold water was bad to use as it holds the infection in where warm water extracts it out, but ice cold water is the only thing that works for me. Glad to see a professional recommending it. Even though it only lasts a few seconds at most. I was also told not to swallow the water because then I’m just swallowing the infection and that can cause me to be sick. Is that true?

        1. Hello Stacey, So sorry to hear that you are going through this. Yes, the cold water held in the mouth will stop severe pain in some cases, but just for a short while, as you stated. It is OK to swallow the water. That is not going to pass your tooth infection to the digestive tract. Hopefully you are going to a dentist ASAP to have that root removed today. Or at least be put on antibiotics which will stop the pain in 48 to 72 hours until such time that the root can be removed. As for the controversy between heat versus cold, the rule of thumb is to never apply heat externally to the face to soothe a tooth infection. That will draw the swelling to the outside of your face. If there is gum related swelling or following an extraction, warm salt water holds inside the mouth will help the unhealthy gum tissue to heal. Cold can be applied externally, but I’m not sure how much that will help. When cold is held in the mouth to stop the pain, the reason is because there are gasses trapped in the root with no place to escape. The gasses are formed from bacteria in the infection. Cold water causes the gas to contract and take away the pain. by removing pressure on the nerve. I hope you feel better soon. Best, Dr. Silberman

      4. I broke off a small piece of my upper back molar a month ago. The dentist suggested I have the tooth pulled, but I pressed for other options. The dentist then put a filling in after cleaning out the decay.
        Now the tooth is throbbing..I went back in yesterday, the dentist tapped on the tooth and it was not sensitive. She said the filling looked securely sealed. She told me to gargle with warm salt water. (I just put a hot press on the gum area and it feels good.)
        Our options are.
        1.Pull the tooth. My dentist said this would not jeopardize the integrity of my other upper teeth and would not be noticed.
        2. Seek out a dentist to do a root canal.
        3. Hope that the heat treatment will calm down the ache.
        What do you suggest?

        1. Hello Theresa. Did the dentist run any other tests besides the tapping test? Did the dentist take an xray to see if there was any infection visible at the root tip? Did the dentist test the tooth with cold and compare it to your other teeth? Did the dentist check your bite with carbon paper to see if the filling was high? Did the dentist apply an electrical stimulous to determine if the tooth is still alive? All of these tests are critical to make a diagnosis and to present treatment options. If warm salt water makes it feel good, it could very well be a gum issue. It is possible that something is stuck under the gum, like a piece of popcorn, and it may loosen on its own with warm salt water. Depending on the results of the tests listed above, the tooth may need root canal treatment to save it. Or it can be extracted if you decide that the cost of the root canal is too great. FYI, do not apply heat outside the mouth. No hot compresses, saunas, hot tubs, etc. If the tooth is abscessed, the external heat will cause face swelling and a lot more discomfort. Warm salt water inside the mouth is OK if it relieves the pain. I hope that helps. Good luck.
          Dr. Silberman

    2. Angela

      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!

      1. 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

        1. Dana

          Hi Doc! How long does it take reversible pulpitis to reverse?

          1. Hi Dana, I usually tell my patients that antibiotics will quiet a tooth within 48 hours, but it won’t fix the problem. It lessens the pain by 80%. The fix is an extraction or root canal therapy and either will stop the pain completely. I hope that helps. Doc

  7. Laura

    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?

    1. 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.

    2. Heather Woodard

      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?

      1. 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.

      2. Renasha Moodley

        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.

        1. Renasha Moodley

          What should I do?

        2. 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

  8. 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.

    1. 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.

  9. jason

    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

    1. 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

    2. I went to the er today and I have a decyed tooth that’s hurting me server pain and can get my medicine until 10 in the morning anything I can do to get some relief until I get my medicine

      1. If your tooth is not sensitive to cold, the infection may have killed the nerve inside the tooth, allowing the infection to pass into the jaw. The ER should would prescribe an antibiotic to deal with the infection. But if you have no sensitivity to cold temperatures, holding ice water in your mouth around that tooth will be a quick short term fix. The ER may also give you some pain medication, but if not, you should alternate 2 x 500mg Tylenol with 3 x 200 mg Motrin (Advil, Ibuprophen). Take Tylenol, then in four hours take Motrin, then four hours later back to Tylenol. Good Luck. Dr. Silberman

  10. Paige

    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.

    1. 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

    2. Rojpreet

      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.

      1. 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

  11. Wendy d Riley

    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

    1. 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

  12. 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?

    1. 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

      1. Rodneica Lawrence

        I was told by a dentist that they couldn’t pull my wisdom tooth because i have another wisdom tooth growing under another so now im stuck wondering how im gonna get my wisdom teeth out can you help me?

        1. Hello Rodneica, I am not sure exactly what your condition is. It is unusual to have a second wisdom tooth below another one. It happens, and in that circumstance, it is possible that the deeper one would be left in place and x-rayed every 3 to 5 years to make sure that there is no cyst formation around it. Consider getting a second opinion from an oral surgeon. Good Luck. Dr. Silberman

  13. Toothhurty

    I’m having the absolute worst pain in my jaw , I’m visiting my family in ny and have an appointment with my dentist when I get home to California. Went to the Er twice first time I got antibiotics and a pain blocker shot , nothing changed for the better 4 days later my face was really swollen and the pain was 100 times worse went back this time I got a cortisone shot and some pain pills nothing Is helping I feel like I want to cut the inside of my mouth the drain the infection is there a safe way to do this at home

  14. Thomas Lyles

    I’ve had a toothache on my right side a a few days and went to a dentist and was prescribed antibiotics and tylenol 3 with codeine. The pain med did not do anything. I had to end up getting whiskey and putting it on my tooth. About half way through my antibiotics the other side starts to hurt. I finish the antibiotics and still hurts on the left now should I call and see if I could get another round of antibiotics?

    1. Hello Thomas, I would call the dentist and explain what you are going through. It’s possible that a different type of antibiotic would be more effective. Also, I am having just as much, if not more success, avoiding opiods like Tylenol with Codeine. Try alternating two extra strength Tylenol with 2 200mg Motrin (Ibuprofen, Advil) every four hours. In other words, take two Tylenol, then four hours later take two Motrin. Continue to alternate as needed. If you are not having cold sensitivity, it is possible that there are gases building up in your tooth that are causing your pain. Take a glass of ice water and hold the water in your mouth until the pain subsides. If trapped gas in the tooth is the problem, it will be relieved by the cold water. It is a temporary fix, but it works great. The treatment of choice would be extraction or root canal therapy. Good Luck, Doc

    2. Hope all is well! I’m having some very intense pain on the right side of my mouth and found out tooth #31 is infected. I’ve been on antibiotics and am on the Tylenol/Advil rotation, which is helping a little bit but not much. I am scheduled to get all 4 of my wisdom teeth pulled along with #31 pulled at the same tile by an oral surgeon. Does that make sense to get them all pulled in one sitting? I’m quite nervous the post-op pain will be unbearable due to the infection on top of the wisdom teeth getting pulled. Any advice to calm my nerves and what do you think the pain will be like? I really appreciate your help!

      1. The extraction of wisdom varies in the degree of complication. Easy ones require Tylenol or Motrin post-operatively while impacted ones require a narcotic for pain control. Adding the extraction of #31 to the mix will have no additional impact on the type of pain you experience. Once the infected tooth is removed, the pain goes with it and the extraction site heals. Usually I recommend patients take a day or two off to rest following extractions and minimize their activity, and modify their diet to be soft foods. Don’t worry.

  15. Maddie K

    I had a deep cavity on one of my top molars. My dentist did a filling 4 days ago. Everything was fine until the anesthesia wore off and I got home. I have been in SEVERE pain and I am very uncomfortable. The only thing that subsided the pain is when I fill my mouth up with water and let it just sit in my mouth. Strange but it works… also I am pregnant so I’m only able to take Tylenol for pain. I have tried orajel, clove oil, etc nothing is working. I really just want this pain to stop. I think my dentist may have drilled a little too much and possible irritated my nerve. First time I went to that dentist other than a cleaning. Please help.

    1. Sounds like this was a cavity that was so deep, it caused an infection that your body was tolerating. The tooth was like a hornets nest of bacteria instead of bees. The dentist’s work stirred up the hive and you are feeling the result. The reason that the cold water helps is because there is gas that is trapped inside the tooth. The bacteria give off a by-product of gas and there is no escape. The cold water causes the gasses to contract and take the pressure off of the nerve endings. The treatment is to get the tooth numb and have the dentist open the chewing surface to allow the gas to escape. Once the gas is out, the pain will not come back after the numbness wears off. The next step would be to fill that space where the bacteria were, and that process is called root canal therapy. The alternative is extraction, but if you can save the tooth, try to do so. Good luck and I hope you have a happy and healthy baby. Doc.

  16. Chris

    Had a root canal yesterday and the doc said I would still feel the unbearable pain I was in before for a day or two afterwards. My question is why does the ice water trick still work after it was done?

    1. If all of the canals of the root were filled, there should be no space left in which gasses can collect, so the ice water trick should not work. There are some possibilities. If the dentist did a partial root canal treatment and did not fill the roots, there could be gas build up and the cold water would work. Or if the canals were filled and one canal was overlooked, same holds true. Also, it is hard to tell if the pain is coming from the tooth that was worked on. It is possible that the tooth next to this one also needs root canal treatment, or one that is in the opposing jaw. Sometimes the brain gets confused and can’t tell if the pain is upper or lower jaw. I hope that helps.


      1. Sandy

        I have had 2root canals on my front teeth after I had crowns put on them, but my nose and front teeth still hurt! Ice water helps them . Yet the doctors are telling me it is a nerve making my nose and teeth hurt. I have been on Clindamycin 3 times. Please advise as I don’t want to take a nerve medicine all of my life. Should I just have them taken out?

        1. Hello Sandy, Assuming that the canals of the roots of your front teeth have been completely filled leaving no trapped gas pockets in them that could expand and contract with temperature change, the next likely cause of the problem is another tooth. Sometimes with tooth pain, it is difficult to isolate the tooth that is causing the pain. If ice water takes away the pain, it must be a trapped gas pocket in a root that is causing it. Front teeth are the least complicated when it comes to root canal treatment, so I have confidence that the source of the pain is not the teeth that have already received root canal therapy. Clindamycin is the drug of choice for tooth infection. If it made the problem ease up while you were taking it and then return when you went off of it, it is likely tooth infection that is causing the problem. That would be further evidence that it is another tooth. If the Clindamycin has no effect, it could be nerve inflammation, which is what your doctor is suggesting. A neurological workup is you next step in figuring out what’s going on. I hope that helps. Let me know if you have any further questions. Dr. Silberman

  17. Victoria

    Several months back, I broke a tooth pretty bad. About three months ago I developed an abscess with puss coming out of it and I was prescribed an antibiotic, it seemed to work. I made a huge mistake and didn’t have it extracted at that time. So about a month ago the abscess came to visit again. My dentist prescribed Amoxicilin and scheduled an appointment for a surgical extraction. Well, my appointment wasn’t until this up coming Friday. About 9 days ago, the abscess was there again and the pain was beyond horrific. So, my dentist called in a Rx for Clindamycin 150 mg HCL to take tid for 7 days. I called my dentist yesterday because I had already completed the antibiotic, but there is still puss coming out and the pain is so horrific. I haven’t slept, but about a total of 5 hours in the past 3 days. I feel exhausted, but this pain will not subside for me to sleep at all. So, here I am at 3:50 in the morning and my dentist is squeezing me in at 3 PM to do the surgical extraction. I am counting down the hours hoping that it will come quick. My concern is, since there is still infection and Clindamycin did not work, what happens now? Will the extraction just clear up the infection? Can I take another antibiotic at this point if no other antibiotic has helped? I know very little about teeth, but I do work in a hospital and have a fear that I will get c-diff.

    1. Once the tooth is extracted, the infection will clear without the need for additional antibiotics. The infection will have “an exit route” though the extraction site. I hope that helps.


      1. Victoria

        Thanks so much. My tooth has now been surgically removed and the clot has formed well thus far, but the amount of pain I am in is horrific. I previously had 3 wisdom teeth removed and had less pain than what I am experiencing after this removal. My dentist said that OTC Motrin should work, but it doesn’t even ease the pain. What now? Do I just wait it out? Am I supposed to have this much pain?

        1. Without seeing the xray, it’s difficult to answer your question. Most simple extractions that require no removal of bone have minimal post op pain and are treated with Motrin or Tylenol, or a combination of the two. I usually recommend alternating them every four hours. If you start with 400mg of Motrin (Advil, Ibuprofen), then take 1,000 mg of Tylenol in four hours. Then four hours later go back to 400mg of Motrin and continue alternating every four hours until you don’t need it anymore. If there was bone removed at the time of the extraction, some narcotic medication may be necessary until initial healing has set in. An intermediate medication that is a prescription but not as strong as some medications is Tramadol. You could suggest that to your dentist. Good luck. Dr. Silberman

  18. so i had half a root canal done back in february and that tooth hurt for like 4 hours one night and then i woke up and my cheek was swollen. my tooth hasn’t hurt but it’s been swollen for 3 days now and i went to the dentist yesterday. he gave me antibiotics and nothing will take the swelling down. i’ve applied ice packs and done everything. idk what to do

    1. Having half a root canal done is like delivering half the baby. Not good for you or your baby, or in this case, tooth. The roots of your tooth are like straws with a thick outer shell and a thin opening that runs down the center. These canals can be treated by being cleaned out and filled to prevent bacteria from growing in them. That is a root canal treatment. If you empty the canals and don’t fill them, there is no circulation or nerve in the tooth, so it will feel OK for a while. But without circulation, there is no way for your body to clean out the bacteria that will inevitably form in that dark, warm moist space in the canals. The bacteria build up in number and pass into the bone at the tip of the roots, causing pain and swelling. So here you are. If oral antibiotics are not working, you may need to be hospitalized for intravenous (IV) antibiotics. If the swelling is not too severe, you might be able to increase the antibiotic dosage orally. Consult with your dentist. Most importantly, do not apply heat to the swelling. It will dramatically make it worse. Good luck. I hope that helps. Dr. Silberman

  19. Sara

    Hi Dr. Silberman

    I felt a bump on the gum below my second to last tooth on bottom and the dentist after taking an xray said he thinks it is a fractured root in a root canal tooth and might require extraction. I had iced it and the bump went from the front of tooth to behind it actually. When I went to dentist he drained it and I am on third day of antibiotic. I don’t have pain and the swollen gland has now disappeared but I do think there is a little swelling still on that side of my mouth. Does that mean that there still may be pus or could it be that the tissue is just inflamed… Should I be using ice externally still as well as a little internally holding ice cube.. Nothing hurts and antibiotic seems to be working but since it’s Thanksgiving week and antibiotic ends Wednesday want to keep any infection/bacteria at bay…

    Also is it good to continue with warm salt water rinses and is using hydrogen peroxide rinse a bad idea… I know I once used that on my knee each day and it actually didn’t heal since it kept tissue raw it seemed… Nothing hurts but there seems to still be a little more fullness on that lower side of my mouth . If I do need it extracted do you know if usually there is a waiting period to see if the area reinfects to determine this.. Thanks for a great blog.

    1. When a tooth is diagnosed with a root fracture, the only solution is to extract the tooth. The sooner, the better. It can be replaced in the future (implant, fixed bridge, etc). Minor swelling can occur with or without pus being present. The inflammatory response of the gum tissue can create minor swelling too. Warm salt water rinses on a tooth that has been previously treated for root canal therapy is fine as is rinsing with peroxide. Applying heat to a tooth that has not had root canal treatment is a bad idea.

  20. Angel

    I have been on antibiotics for about 5 days now, clindamycin and flagyll, due to a cracked tooth that is due to have a root canal in a few days. It has been extremely swollen and painful…it’s subsiding some, but I cannot open my mouth more than about a fingers wdith without major pain, and have been pretty much “eating” soups and stuf i don’t really need to open my mouth much to consume. I do have swelling in the jaw, and do cold packs off and on all day. Is there anything I can do to help with the pain and inability to open my mouth? If I can’t open my mouth wide enough how the heck can they do a root canal? I’m worried and don’t know what to do.

    1. You are correct that a root canal won’t be possible if you can’t open very wide. Sometimes the antibiotic takes a while to be effective, especially on a lower tooth where the circulation is poor. It might be necessary if the swelling persists to go to the ER for IV antibiotics. You will need to work closely with your dentist to make that determination. This level of swelling happens very infrequently. It is usually associated with someone applying heat to the outside of the face in an attempt to get some relief. Heat is what brings out the swelling. It is possible to get the swelling without the heat though . . . . . it happens. The antibiotics you are taking are the same as what I would have prescribed. Hopefully your swelling has subsided, but if not, consider the ER. Good luck.

    2. The limited opening of the mouth is due to the swelling from the infection. Once the swelling and infections subside, you should be able regain the ability to open wide again. The root canal treatment might need to be postponed. Some infections take longer than others to be resolved with antibiotics. Oral antibiotics might not be strong enough to control the infection and IV antibiotics will do the trick. This is rare, but it can happen. Your dentist may want to increase the strength of the dosage of the antibiotics. And remember, do not apply heat to the swelling. It will make the swelling dramatically worse and increase the pain.

    3. The limited opening of the mouth is due to the swelling from the infection. Once the swelling and infections subside, you should be able regain the ability to open wide again. The root canal treatment might need to be postponed. Some infections take longer than others to be resolved with antibiotics. Oral antibiotics might not be strong enough to control the infection and IV antibiotics will do the trick. This is rare, but it can happen. Your dentist may want to increase the strength of the dosage of the antibiotics. And remember, do not apply heat to the swelling. It will make the swelling dramatically worse and increase the pain.

  21. Amber

    My dentist did a freeze test on #11 after a filling a year prior…now it hurts like mad now. Does that mean I will have to get a root canal or will it calm down?
    I have jaw/teeth pain on lower and part of my upper teeth we did xrays and found my wisdom tooth is on that main nerve and the tooth is trying to erupt.

    1. Hi Amber, I’m not sure what you mean by a freeze test. If a filling is large, the tooth may eventually become sensitive to cold or hot or pressure, even though there are no symptoms immediately after placement. In your description, it has been a year since the filling was placed. To test the tooth we take an x-ray to see if there is visible infection at the tip of the root. We do a tapping test and compare it to other teeth to see if it feels different. And we do a cold test where we apply a cold stick to the tooth in question and compare it to the teeth around it or the mirror image tooth on the other side of the mouth. This could be what you mean by a freeze test. These tests help to determine if the tooth needs root canal treatment. Based on your description, it sounds like the tooth need root canal treatment. I usually put my patients on a round of antibiotics to calm the situation, and then to the root canal treatment. It’s best to remove as many bacteria as possible before doing the treatment. Take the bees out of the hive before you stick your hand in it. I hope that helps. Best, Dr. Silberman

  22. Erin

    I went to the dentist yesterday as I was in agony. She said my wisdom tooth is coming through and that’s what is causing the pain. There is some swelling and I have been given a 3 day course of antibiotics. I’ve been taking Ibuprofen and paracetamol regularly but the only thing that is helping is holding cold water over the tooth but as soon as the water is gone it starts hurting again

    1. Hi Erin, Sorry to hear you are going through this. The source of your pain is coming from gasses that are trapped inside the decayed / infected tooth caused by bacteria. The antibiotic will decrease the bacteria present and the gas production will slow as a consequence. Your body heat is often enough to expand the gas and put pressure on the nerve causing the pain. Be sure to avoid heat (coffee, tea, saunas, direct sun, hot showers, etc) The cold water reduces the pain because it causes the gas to contract and takes the pressure off the nerve. Getting the tooth extracted will give you the relief you are looking for. The antibiotic helps gradually to relieve the frequency that you’ll need the cold water. But getting the tooth out will solve the problem. I hope that helps. Best, Dr. Silberman

  23. Ann

    Hi Dr. Silberman, Had a crown placed in Oct. From the time the temp was placed to the permanent placement, my tooth hurt. Probably should have had them check the bite on the temp but by the time i decided to, the permanent crown was ready to place. The seating of the permanent really hurt and has since. One 200 mg Ibuprofen takes the pain away quickly and thoroughly. Had 2 bite adjustments done which helped quite a bit but the throbbing was still there off and on. Sensitive to cold but pain immediately disappears when cold removed. Doesn’t hurt to brush or floss unless i get too deep. Can feel the edge of my crown with my fingernail. Feel like it hurts at the gum line. Salt water takes the pain away after several minutes. Very confusing symptoms of both reversible and irreversible pulpitis at the same time. Have an appt in 2 weeks. would appreciate any input. Thanks so much!

    1. Confusing symptoms indeed. I’m guessing that the tooth needs root canal treatment or extraction. I am betting that this is a molar, or a two rooted bicuspid. If a tooth has multiple roots like a molar, each root has its own nerve supply. One root could be infected while another is irritated. Infection is not reversible while an irritation is. That is why you might get symptoms of both. The infection eventually will take over and the choices are still going to be root canal treatment or extraction.

  24. Ann

    Forgot to mention, my tooth was crowned because it was cracked. But had no pain before the crown prep.

  25. Kristen Delor

    Got a silver filling replaced a month ago to a white one. About 2 or 3 weeks ago it started to hurt/ throb occasionally. Flash forward to a couple of days I’m having intense pain to hot. The only thing that helps is holding cold water on it. Calling Monday!! Hoping it’s just gas trapped in the tooth and doesn’t require a root canal): Maybe a new filling??

    1. When the ice water holds take away the pain, that usually means you have two choices. Have the tooth extracted or save the tooth with root canal therapy. A new filling isn’t going to help. When an old filling is replaced, it is usually because there is new decay present. By removing the decay and the old filling, the goal is to stabilize the problem. But if the decay has progressed into the circulation, an infection has already begun, even if you have no symptoms. The new filling can stir up the “bees in the hive” and the symptoms begin. Looks like that’s what happened in your case.

      1. Sarah

        My son in law has an abscess in his mouth and he keeps having a hot bath he thinks its helping.. I’ve told him that it will make it worse. Am I right

        1. Hello Sarah, If a tooth is abscessed, a hot bath is the worst thing you can do. Also hot compresses, heating pads, direct sunlight, saunas, and so on. The heat draws the swelling to the surface of the face and is much more difficult to control the infection. Sometimes that swelling can be great enough that it crosses the midline of the body and impairs breathing. He needs to seek treatment as soon as possible. If your diagnosis is correct, a prescription for antibiotics can help. The tooth may need to be extracted or have root canal therapy to save it. Good luck, Dr. Silberman

  26. Jennifer Walford

    About 80% of my teeth have broken at gum level due to my health. Chemotherapy, systimic lupus & other things have destroyed them. The ones not broken are cracked and breaking apart. I’m in constant pain. About 3 months ago I started getting huge pockets of ( what I’m assuming isinfection due to it being yellow) in my cheek, jaw & we’ll my entire mouth. Then the swelling & pain dropped off. My doc (not a dentist)said they drained into my neck glands & sinus. Well now my entire right side of my face, neck ECT has swelled up huge & the pain is unreal. What can I do to handle the pain. I have no money to go to a dentist let alone have them all pulled. Plz any ideas would be so helpful. It’s so bad!

    1. Sorry to hear you are going through all of this. Each State has its own system for handling cases like yours. In the State of Maryland where I am located, I work with two different organizations. The first is known as Donated Dental Services (abbreviated as DDS). Many churches refer their needy parishioners to DDS which screens the prospective patient for their specific dental needs, and then refers them to a volunteer dentist, such as myself. I render treatment to these patients at no charge. In return, the State offers me Continuing Education credits which will go towards my re-licensure. The other organization is called Mission of Mercy. It is either a function of, or hugely supported by, Catholic Charities. Each quarter annually, they take over a high school or college gymnasium in different parts of the State and set up 100’s of dental chairs for treatment of the indigent. Dentists, hygienists, assistants, administrators, etc, all volunteer for 3 days to take care of as many dental patients as possible. I suggest you check with your State Dental Association and find out what they have that is available to you for either free dental care or at a dramatically reduced cost.

      1. Tony S

        week cycle of amoxicillin be effective in suppressing a toothache/infection – about 1 month?

        (Started it 4 weeks ago. Would’ve had likely root canal by now but delayed by Covid-19 crisis)


        1. Tony, Amoxicillin can help treat a tooth related infection. It will quiet the problem but not resolve it. I prefer Clindamycin over Amoxicillin, but only if you have no history of GI problems. It is common for your symptoms to return a month after taking the antibiotics for a week. I would try to get the tooth treated. If your dentist is not open, call around to find an endodontist (root canal specialist) who is open during the Pandemic. Many endodontists are staying open to help relieve hospital emergency rooms from non-Covid19 related emergencies. Good Luck. Dr. Silberman

  27. Krystal Johnson

    First I would like to say you clearly don’t know everything. Putting cold on a hurt tooth makes it much more painful. Putting HOT TEA ON A HURTING TOOTH DOES IN FACT HELP IT. it’s a natural remedy.

    1. Hi Krystal, There are degrees of infection when it comes to decayed teeth. During the early stages, the nerve of the tooth is alive and irritated by the decay. The first stage of infection is sensitivity to cold and applying cold would make it worse. As the infection advances, the bacteria destroy the circulation and the nerve of the tooth. In the advanced stages of infection, the tooth can no longer feel the cold, but the heat will cause the gas to expand inside the tooth and cause pain. Holding ice water in the mouth at that point will relieve the pressure from the gas and stop the pain. I advise that you have the tooth treated as soon as possible before it advances to the later stages of infection. Also, please remember not to apply heat EXTERNALLY to your face as this will draw out the infection and cause swelling. I hope that helps. Dr. Silberman

      1. Rich

        This is exactly the experience I have had, hyper sensitive to cold at first and now I have to control it every 30 seconds with cold and no longer sensitive to cold.. I need the cold! Getting it pulled

        1. Hello Rich, I’m glad this was helpful. I hope your extraction goes smoothly. Good luck. Dr. Silberman

  28. Reeba

    Dr. Silberman , I had both my lower wisdom tooth’s removed 4 days ago, the right side hurts a lot . And my lower front teeth started having dull pain. Why does it hurt? And Which painkiller would work best?

    1. Hello Reeba, Whenever a tooth is extracted, the body goes through a natural healing process where the extraction site fills with blood and it coagulates (meaning that a clot forms), and the bleeding stops. The clot acts like a plug that keeps the root area bone from being exposed to air. If the clot is lost, the pain from the exposed air can be very painful. I suggest you go back to the dentist who did the extraction and have the site packed with a gel that will soothe the exposed bone. The packing is not uncomfortable at all, and the relief is 90% and is immediate. If the dentist cannot take care of it, you can do it yourself. Buy some sterile gauze, a plastic syringe for rinsing the extraction site, and a bottle of Oil of Clove. Rinse the extraction site with the squirting of the syringe using water or peroxide. Take a small piece of gauze approximatlely 1/4 inch by 1 inch, dip it in the Oil of Clove with some sterile tweezers and put the gauze in the extraction site. Leave it for a day. Change it on day two, and every day as needed until the pain has stopped. If you do nothing, it will heal on its own in a week, but it won’t be comfortable left untreated. Good Luck. I hope that helps. Dr. Silberman

      1. Reeba

        Thank you Dr Silberman, I’ve booked an appointment for tomorrow. I shal let you know how it went . Thank you so much.

  29. Ayrah

    Going Through very tuff situation. Cant contact with my dentist just bcoz of virus. My root canel teeth is paining too much. I got hole in another tooth also.. But still cant understand why my root canel tooth is paining like hell. Can i apply cold water in root canel teeth… Becoz i felt like warm water increase my pain.. So i m avoiding warm water… Help me pls.. And i m 14weeks pregnant also..

    1. Sorry to hear you are having this problem. Holding ice water in your mouth in this situation should help you. But it is a short term fix. It sounds to me like there is an additional root in your root canal tooth that needs to be cleaned out and filled. This can happen sometimes. You should do the ice water trick until such time that you can get an antibiotic prescribed by the dentist, and one that your OB/GYN approves of. You should be OK in that department as you are out of your first trimester. Once the infection is quieted, the dentist should look for the additional root to fix the problem. The alternative is to extract the tooth. I hope that helps. And I hope your pregnancy has an easier go of it than your tooth. Best, Dr. Silberman

      1. Twizzy

        Hi~my tooth has been aching since April and I don’t really have a good night sleep.. since we are in quarantine due to the pandemic I cannot visit the doctor for a while what should I do?

        1. I would keep the pain in check by alternating Tylenel and Motrin (Advil, Ibupofen). Take two extra strength Tylenol. Then four hours later take two Motrin. Then four hours later go back to 2 Tylenol. Continue alternating every 4 hours to keep it quiet. Also, hold some cold water in your mouth and see if the tooth is sensitive. If so, avoid cold drinks. If not, holding ice water in your mouth may help a lot, and avoid hot drinks. It depends on the status of your tooth and the level of infection to determine whether it is cold or hot sensitive. Test it on your own and you decide what’s best for you. I hope that helps. Good Luck. Dr. Silberman

  30. LB

    Hi- One week ago, had a root canal on tooth #30. This is a tooth that has been cracked for many years and recently developed decay. My jaw underneath the site still feels a bit swollen and “pinches” at times, and I sometimes feel the pinching towards my chin. I don’t feel pain, it’s just uncomfortable and I’m very aware of the feeling. Prior, to my root canal, I was on Amoxicillin for one week and the endodontist said he didn’t see any infection during the procedure. I also wear a night guard an have terrible TMJ. Could I still be healing? Maybe it takes longer for me because of the TMJ? Thank you in advance.

    1. Hello LB, It is common for there to be some discomfort after root canal treatment. I recommend alternating Tylenol 500 mg x 2 every 8 hours, and Ibuprofen (Motrin, Advil) 200 mg x 3 every 8 hours. Alternate the medications so that you are taking Tylenol, then Motrin 4 hours later, then Tylenol 4 hours after that. . . .and so on. If there is swelling, there is infection. I would recommend going back on the antibiotic, and my drug of choice would be Clindamycin 150mg every 6 hours. It should not be taken if you have GI issues (Crohn’s Disease, IBS, etc). Once the infection clears, you’ll feel better.I hope that helps. Dr. Silberman

  31. Shaneka

    Hello Dr.Silberman

    So i have a seizure disorder. I was eating when i went into a seizure and the folk broke tooth 30 right side bottom row. I’m in trouble pain and i been taking 8oo mg ibuprofen and 300 mg Clindamycin and salt water rinse and cold ice water in my mouth. It’s hard to find a dentist to remove this tooth asap. They not taking patients with Medicaid. So i have to play cash. And i don’t have the money. What can i do. And is there anywhere i can get it removed faster. Then Next thrusday. Because the dentist that did my x-ray wanted me to call around for another dentist to remove it and it’s hard to find one….tips please

    1. Hello Shaneka, Contact your local dental association or State dental association. Every State is different. In Maryland we have Donated Dental Services which can offer guidance. Some areas depend on local churches to refer patients who need care. Catholic Charities also have their Mission of Mercy program which may be able to help. The underserved community gets free dental care four times a year in Maryland through Catholic Charities. Clindamycin and ice water holds should help, but might take a few days. You should alternate the Ibuprofen with Tylenol. Alternate them every four hours. In other words, 4 hours after the Ibuprofen, take two extra strength Tylenol. Then four hours later, take the Ibuprofen. Hang in there. Hope this helps. Dr. Silberman

  32. Lisa

    I have been in severe pain for over a week now and nothing is working for the pain. I was told it was infected and was given amoxicillin, which hasn’t helped at all and Ibuprofen 800mg, of course not helping. I was already taking Norco for a chronic health issue and that isn’t helping, even though my pain doctor said take 2 at a time. I want the tooth out but was told it can not be pulled while infected. Is that true? No matter in 4 days it’s scheduled to be pulled.

    1. Hello Lisa, Depending on the circumstances of the infection, extracting a tooth while it is still infected can be problematic. But if you have been taking an antibiotic and it is in your system at the time of the extraction, it should be fine. Norco is a combination of a narcotic pain medication and Tylenol. You could also take 600mg of Ibuprofen (Motrin, Advil) every 8 hours. It would help with the pain as it is an anti-inflammatory. Do not take any additional Tylenol. Also, if the infection has created a trapped gas pocket in the tooth, you might get immediate relief with “ice water holds”. Take a swig of ice water and hold it around the tooth. If it’s a gas pocket, the cold water will cause the gas to contract and take the pressure off of the nerve ending, which would stop the pain. Any discomfort that would be created by the cold water would be short lived so hang in there. The severe pain should subside within a minute. You may have to do that regularly until the antibiotic kicks in. If you have been on the Amoxicillin for several days, you may want to switch to Clindamycin 150 mg four times a day. There may be bacteria that the Amoxicillin isn’t hitting, but the Clindamycin would. And remember, do not apply heat to your face or inside the mouth. Good luck and I hope that helps. Dr. Silberman

  33. Maria

    I had molar 18 extracted 5 days ago. The extraction site does not hurt as much as my bottom front teeth hurt. There are no sutures and I was not prescribed any medication. The only thing that relieves the pain is keeping ice in my mouth, I’ve tried 600 mg ibuprofen and nothing, as well as with Tylenol. Is there anything else I I can do. I recently had a cleaning as well and my front teeth were not an issue. The dentist also mentioned TMJ but i was never diagnosed. Is there anything I can do to help with the pain? Or is this something that will go away as the extraction site heals.

    1. Hi Maria, Sorry to hear you are going through this. There are two issues to discuss with you. First, it is not uncommon to have a “dry socket”5 days after an extraction. This happens when the healing clot that is in the extraction site is dislodged. Air hits the exposed bone and causes pain. The dentist can apply a medication into the site, without numbing and without difficulty, that can make it feel better. If you are unable to get back to the dentist, go to any pharmacy and buy some oil of cloves. Also get a plastic syringe that you can use to flush out the site with warm salt water. Take an eye dropper and put a drop or two of the clove liquid into the site after flushing with the salt water, and gently bite on some gauze. Having said that, I don’t think you have a dry socket because holding cold water in your mouth would not help it. Now let’s talk about the second issue. I think you have another tooth problem. You need to have the other teeth checked to see if there is an abscess. The cold water would make an abscessed tooth with gasses trapped in it feel better. Go back to the dentist and get checked for a dry socket and for another bad tooth. I hope that helps. Good Luck, Dr. Silberman

  34. Stephen

    Pretty nice of a dentist to help with questions. I myself have what I’m guessing is a trapped pocket of gas because cold water really helps until I swallow it. I’m really scared to get a root canal as I’ve had extractions before and he ever shot me up with 2 things in my mouth before and it still hurt. Do you have to be awake for a root canal? do you think dentist would be able to sedate you if your terrified of a root canal and the pain? I also have government insurance right now so I don’t know if it would even cover it.

    1. Hello Stephen, I was an instructor in the Department of Oral Diagnosis at the University of Maryland Dental School for years. My private practice got too busy for me to continue working at the school. I miss teaching, so the internet affords me the opportunity to answer dental questions. Glad I can help you. To answer your questions: The cold test would indication that there is an abscessed tooth that needs root canal therapy. If you are very apprehensive, you could ask for something to relax you prior to your visit. There are always risks with “being put to sleep” so for something that is as relatively easy as a root canal treatment, I would not recommend that. Root canal treatments get a lot of bad press. My experience is that most of my patients doze off during the procedure because they are long and boring and NOT uncomfortable. I am in the minority of dentists, but I routinely put my patients on Clindamycin 150mg (an antibiotic) prior to treatment (unless there are medical reasons not to do so like a history of GI illness or allergy to the Clindamycin). It reduces the infection making it easier to get the tooth numb, and my patient’s post operative discomfort is almost none (no swelling, no pain). Most dentists who don’t prescribe antibiotics preventively, wind up putting one in five of their patients on antibiotics AFTER doing the root canal because of swelling and pain. If it was one in five thousand, or even one in five hundred, I might consider doing it that way. But 20% of patients suffering makes no sense to me. I can’t help you with your insurance questions. The dentist’s staff should be able to help with that. I hope this was helpful. Good luck. Dr. Silberman

      1. John

        Hi doc, mighty nice of you to give free advice like that. Is it normal for an abscess to keep growing after 3 days of antibiotics? I went to the dentist with a chipped filling but no symptoms, did a root canal, sealed the tooth, face swelled up, dentist prescribed Augmentin (I’m in Europe), went in as adviced to get the temporary filling removed as it was best for the tooth to remain open until the infection was in check. After 3 days of Augmentin I feel like this thing might burst in my mouth. I alternate Nurofen and Panadol, not unbearable pain anymore but increasing in swelling. I’m probably going back in Monday, just wanted to get a second opinion. Thanks!

        1. I am not a fan of Augmentin for tooth infection. I prefer Clindamycin if you have no GI problems. If you have applied heat to the area, you are causing more problems because the bacteria proliferate in the presence of heat. Avoid heat. Apply cold to reduce the pain and the swelling. IF the root canal was competed, meaning that the roots were filled so there is no place for bacteria to grow, the tooth infection should slow. There is no reason to leave the tooth open if the root canal has been completed and the roots filled. I suspect that the treatment is not completed and that they are leaving the tooth open to drain. This could take a long time and might not work. I think it is better to be sure the root canal treatment is complete, the roots are filled, and the breeding ground for the bacteria has been eliminated. Once that is done, the swelling should go down. See if you can get Clindamycin. The normal does is 150mg every six hours, but you might need to bump it up to 300mg every 6 hours. Good Luck, Dr. Silberman

    2. Barrett

      Jello I’ve been having severe gum and tooth pain as across my entire gum and tooth line from rear teeth to the front teeth the pain always begins in the gums and moves out to the teeth the pain lasts a few days then receded to non existence I have been to three different dentists and none of them can find anything wrong in should note that ate the time the pain starts I have not eaten anything in hours and I I rarely drink soda so km not sure what’s causing this any advice

      1. Hello Barrett, Because you have been to three different dentists and none of them can see the reason for your pain, I would see a neurologist. Your symptoms could be from an inflammation of one of the nerves, such as trigeminal neuralgia. Once the inflammation is removed by either steroid injection or oral medication, you will get some relief. Good luck. Dr. Silberman

  35. HoneyOne

    Hi Dr Silberman,
    I had a filling on Wednesday. It’s now Sunday and the pain seems to be getting worse.
    I have a good dental history.
    However a cavity was discovered between my teeth on the 2nd tooth from the back on my upper left.
    The cavity was deeper than expected and the dentist remarked that we were lucky to have found the cavity for repair when we did.
    I experienced pain on the afternoon of the filling.
    The next day I had no pain.
    That evening I wore my set of retainers (they keep my teeth in place following straightening).
    I woke up in pain. Since then, the pain has been getting worse.
    I went to the dentist on Saturday and he said the area looked fine and performed well for all the sensitivity tests.
    The issue I’m concerned with, I previously had a benign tumour removed from the sinus cavity directly above the tooth.
    The tumour was huge, it was causing the bone to expand. All the lining was removed at the time of surgery. The surgery was 2.5 years ago so the lining should have grown back.
    I’ve taken Amoxycillin for 24 hours.
    Do you have any advice about what to do?
    How many days should I wait to go for another opinion?
    Should I go to an ENT of a dentist?
    Thank you,

    1. It sounds to me like your retainer may need to be adjusted to fit the new filling. I would try that first. If the problem persists, the tooth may be infected and require root canal therapy. The testing of that tooth over time will determine what treatment is necessary. If infected, the tooth will become gradually more symptomatic, indicating the need for treatment. I do not believe that your symptoms are related to the treatment you received 2 1/2 years ago. Good luck. Dr. Silberman

      1. Quantineequa Jackson

        seeing the advice of a cold liquid or ICE directly on the infected tooth would literally send me shooting to the moon like a rocket in pain with what i am currently dealing with. i know it works for others but holy hell absolutely off limits for me.

        1. Applying cold directly to an infected tooth takes away the pain when the infection is advanced. In the early stages of infection, the tooth is hyper-sensitive to cold. You know best when it comes to your own particular situation. Listen to your body. If you aren’t sure, try it . . . . . even if it is one time. You may be surprised that it could help. In all cases, applying heat externally is a bad idea because it can draw the infection to the surface and cause severe facial swelling. It sounds like you need to see your dentist ASAP to fix the problem. Best of luck to you. Dr. Silberman

  36. Madalyn

    My dentist of 27 years retired. I had not gone to a dentist for four years. I am 68 years old. The reason I am sending this question to you is I need your advice about the new dentist who recently crowned my molar. One of my molar crowns I had for 11 years came off when I flossed. I went to a local dentist and his staff temporarily used adhesive to put it on. I was told it would most likely come off again by the dentist. I explained I was having financial problems. He was cold and dismissive and said that I would probably need to have the tooth pulled in that case. I understand at the time that he gave me the only option available in my financial situation. I scheduled an appointment with them to have my teeth cleaned. They scheduled the appt. in three months. I babied that crown. I would not have my tooth pulled. I am a religious flosser. I cancelled my appt. with the office because of his attitude towards me. The crown lasted me another year. I flossed it off again. I finally got into see another, close by, dentist after three days. They had just reopened dental offices in my state. I knew nothing about this dentist except 3 Yelp reviews. He was young and nice and he had his staff put the crown on. He looked at my tooth. The crown was more a cap and did not cover the tooth. I asked him if it had decayed he told me no. I told him about my job, Covid 19 related, I was not working at the moment. So there was only so much I could afford. He told me I had two options he could cement it back on or I could have it crowned. He and I never mentioned pulling it. I made up my mind to get my teeth cleaned. They also did full mouth xrays. Well after the xrays he said my upper back molar had cracks it also had a big filling. He showed me a color photo. The cracks looked hairline to me. But he said he felt this needed a crown more then the tooth that they had put temporarily adhesive on. Well my crown fell off again during flossing.. I had not scheduled an appointment to have my upper back molar crowned. Well again I went in and one of the ladies who was part of his office staff ground down the adhesive so she could get the cap to fit on my tooth. The dentist was not there that day. She told me not to count on the crown staying on and that it could come off anytime. I was not to floss it. They scheduled in two weeks to have a new crown made in office to replace the unstable crown. Since the crown would be made by the dentist the procedure would take 2 and a half hours. I was happy to finally get this tooth taken care of. Well he had a heck of a time getting my old cap to come off. It apparently wasn’t as urgent and unstable as his staff assistant told me. When he was grinding my tooth he flooded my mouth and I choked pretty bad. Then when he was putting on the permanent adhesive he tried to floss the crown off and he struggled and struggled it finally popped off. He did more adjusting of the crown and again he did the same thing flossing it so hard it flew to the back of my throat and I almost swallowed it. I bent over not swallowing and thank God it fell into my hand. He also was not acting very confident, which had me concerned. He finally adjusted the crown to be able to easily floss it. He asked me about the bite and I told him it seemed a little high. He ground it down and it was hard to tell but seemed alright. I was very grateful to get my crown done it was a much larger one. With my wonderful retired dentist who had done my other molar crowns it was so easy when he did them and no problems. This time when I tried eating it seemed to catch on upper teeth and was painful to chew. It wasn’t so sensitive the first few days. Now I am experiencing great sensitivity. My crowned tooth aches with warm and cool water. I have been taking aleve. When I wake up my tooth aches slightly. I have not been eating on that side for fear I might add more trauma to the tooth. It has almost been two weeks. It wasn’t so sensitive at first but it seems to be getting more sensitive as time goes on. It is so sensitive, if I stroke the crown It hurts very slightly. I am afraid. I have never had a root canal. I don’t want to lose this tooth. I just need to have your advice Should I go to another dentist and get advice. I don’t understand why he wanted to crown the other molar first. Then all of a sudden this one became the priority. Is this normal practice or should I be on my guard? I have been under a lot of stress getting Covid at the end of February and now having to deal with what they call Post Covid Fatigue. I got tested a few days before my crown came off and I was negative for Covid 19. I would greatly appreciate your response. I feel so helpless.

    1. Hello Madalyn, Sounds like you have had quite the dental journey, and had to deal with getting Covid 19 too. I hope your Post Covid Fatigue passes so that we only have to deal with your tooth. I would go back to the dentist who placed the crown and have him check your bite. From your description, your “excursive movements” may be off. By that I mean that when you chew from side to side, the opposing tooth is being blocked in some way by the new crown. This would cause hot and cold sensitivity in the new crown. The dentist will have you chew on some carbon paper. I usually suggest to the patient to “bite, chew, grind and slide” on the carbon paper. That covers all of the directions of chewing and will leave a mark on the crown to be adjusted off. The dentist will adjust and repeat until the bite is right. Hot and cold sensitivity is more common in teeth that have just received treatment, and especially those with an improper bite. Once the bite is adjusted, I would suggest using a desensitizing toothpaste (Sensodyne, Crest for Sensitive Teeth, Colgate for Sensitive Teeth, etc.). Between the adjusted bite and the desensitizing toothpaste, the sensitivity will go away if the problem is an irritation. If the problem is an infection, the sensitivity will get worse in spite of the bite adjustment and desensitizing toothpaste. Time will tell and you need to be patient for a couple of weeks. If the tooth starts to ache by itself or is sensitive to temperature with a lingering discomfort of a minute or so, it will probably need root canal therapy. The other issue is whether you should stay with this dentist. I would stay put for now, but you might call around to see if there is a dentist who will offer you a free consultation / second opinion. I have always provided that service to the public. If a patient has been diagnosed properly, I refer them back to their dentist for treatment. Getting confirmation on diagnosis and treatment plan gives us the peace of mind we all need at times. I hope that helps. Good luck to you. Dr. Silberman

  37. Dean

    I ate a chip 4 days ago and it triggered pain on my tooth and the pain has been killing me since then. I take 600mg of ibuprofen at night to help me sleep and it helped lower the pain level for the past two days, which was good because I don’t take it during the day to avoid taking it too often. Today, I woke up with a bad ache again, and I can’t even drink cold water because it hurts so much at contact. Should I try a warm salt water rinse? I Tried rinsing with peroxide and it doesn’t work. Engenol drops helps but wears off within a few hours. I don’t know what to do at this point. I’ve never experienced this much pain before. I’m researching dentists in my area, but some of the reviews scare me even more. I don’t know what else to try for temporary relief while I find a good dentist.

    1. Hi Dean, It sounds like you have cracked a tooth. It is like a crack in a windshield of your car, if you can relate to that. A crack suddenly appears and stays until you hit a bump in the road, and the crack extends further. In a tooth, the crack can go vertically towards the nerve or away from it towards the gum. It sounds like yours is towards the nerve. If the crack is through the tooth to the root at the bone level or below, it may need to be extracted. If it is to the nerve but not to the bone level, it could be saved with root canal therapy and a crown. As to how to treat it until you see a dentist, I would do your best to avoid biting on it. And avoid cold. Do not apply heat as it will help create an infection. Pain medication can help. I would recommend two extra strength Tylenol (2x500mg) every eight hours. And 600mg Motrin every eight hours. Take them alternating every four hours for continuous relief. Use the eugenol drops as often as you need to keep it quiet. Bottom line: get to the dentist for a diagnosis and treatment plan. I hope that helps. Good Luck, Dr. Silberman

      1. Phillip Gosser

        So I’m having to keep ice water in my mouth to take away the pain which is bad enough to make a person pass out. I read you said something about gasses trapped inside the tooth. Dentist is not an option. Is there a way to get ride or release those gasses. I can’t keep this ice water much longer.

        1. Hello Phillip. Somehow your question was duplicated, and I already answered and posted once. Please see my prior response or reach out to me again. Good Luck. Dr. Silberman

  38. Phillip Gosser

    So I’m having to keep ice water in my mouth to take away the pain which is bad enough to make a person pass out. I read you said something about gasses trapped inside the tooth. Dentist is not an option. Is there a way to get ride or release those gasses. I can’t keep this ice water much longer.

    1. Hello Phillip. Sorry to hear you are experiencing this toothache. The ice water trick works, but is a short term fix, as you’ve come to learn. Unfortunately, there is no way to resolve this other than seeing a dentist to numb the tooth and make an opening in the chewing surface to release the trapped gas. That would be the first step in the root canal treatment necessary to save the tooth. The alternative treatment would be to see a dentist, or oral surgeon, to extract the tooth. Probably not the answer you wanted to hear, but those are your two choices. Good luck. Dr. Silberman

  39. christy partlow

    I am currently experiencing an extreme swollen face from an abscess tooth and I am confused on what I should do to help the swelling go down should I take a hot compress or a cold compress I have not had my teeth polled or had any kind of dental work in the last eight years I’m currently waiting to get all of my teeth polled to get a full set of dentures

    1. Hi Christy. My answer to your question is simple. Never apply heat to your face when dealing with tooth infection. It dramatically increases the swelling and makes the infection much worse. If you have already done so, you can start applying cold compresses. But you will also likely need to get some antibiotics. If the swelling is severe, you may need to go to an emergency room where antibiotics can be administered intravenously, directly into your bloodstream. Severe swelling can be lethal and nothing to play around with. If the swelling is under your jaw and crosses the midline of your face, it can impact your breathing. If the swelling is in the upper jaw in the front of the mouth, the infection can flow up to the brain (Cavernous Sinus Thrombosis) and can be lethal too. So go for treatment immediately, and good luck. Dr. Silberman

  40. Mandy

    I had a broken tooth for quite some time that eventually lead to an abscess. On a Friday it was hurting bad and by Saturday, I noticed a hard bump on my jaw near where the broken tooth was at. Got in Monday to a dentist and they removed the tooth, saying the abscess had moved to my jaw because it had nowhere else to go.. but they did not provide any antibiotics. The infection is still there, the bump is present. Do I just wait for it to drain on its own? Pain is controllable with ibuprofen .

    1. Hello Mandy, The infection will gradually drain through the extraction site. There is no need for antibiotics at this point. I recommend very warm salt water holds in your mouth in the area of the extraction. No swishing. Just hold it in the area of the extraction to draw the infection to the surface. It will either drain or gradually dissipate on its own. Give it a few days. I hope that helps. Good luck. Dr. Silberman

  41. Cristina

    Hello Dr Silberman. First, thanks. You clearly care.

    Here is my question. I had a root canal in June (#3) and another one in October (#31). I started having pain in #3 about three weeks ago but the last week became unbearable. I feel like it radiates now to the whole right side of my mouth!

    I’ve been taking Ibuprofen, which helps but wears off quickly. I usually don’t take any pain meds so when I do (once a year or so), Ibuprofen works like a charm. Not right now. The only thing that helps is to hold cold/room temperature water in my mouth (I have really sensitivity so trying to avoid ice water).

    I called my dentist and my endo. My endo gave me an appointment for next week and prescribed amoxicillin. My dentist looked at a CT/x-ray they took when I went for the post second root canal filling and didn’t see anything. My dentist even suggested not to take the antibiotic and demand the endo saw me right away. I tried but couldn’t get an appointment. My endo just prescribed stronger pain killers, which I may try to avoid for now (if I can).

    This is the worst pain I’ve felt (and I live with chronic pain). I’m very confused about what could be happening since I already had a root canal 🙁

    Please help! Thanks so much!

    1. Hi Cristina, Sorry to hear you are going through this. There are a few possibilities regarding the source of your pain. #3 may have an additional root that needs to be filled. It is not uncommon for a root to fill up with gas, a bi-product of bacteria trapped inside. The gas expands with heat and puts pressure on the nerves outside the tooth in the bone, or any remnant of nerve in the root. Your body heat could be enough to cause the expansion. That is why the cool water makes it feel better. It could also be that #3 is not the problem and that the roots have all been filled. It could be coming from #2 or #4. It is very hard to identify which tooth is the culprit. Other factors could be causing you pain, like a vertical fracture of the tooth. But if the CT scan did not show it, and if both #3 and #31 are crowned, it’s not likely. Plus the fact that cold makes it feel better is pretty conclusive that it is gas trapped in a root somewhere. I would definitely not wait on the antibiotic. Amoxicillin is popular but Clindamycin works better for this type of pain. You can’t take it if you have any GI issues (irritable bowel syndrome, Crohn’s disease, ulcerative colitis, etc.) Taking antibiotics is controversial in dentistry and, in my opinion, it shouldn’t be. If you have a hornets nest, don’t stick you hand in the nest without making sure the bees are gone. Clindamycin does a good job of reducing the bacteria (the bees) which are the source of your pain. It’s not a cure, but it should make it feel 80% better. Meanwhile, use the cold water to keep it quiet and start taking the antibiotics ASAP. Good luck and I hope that helps. Dr. Silberman

  42. Mo D

    Hi, Dr. Silberman, I’m hoping you can help! I had a root canal on top premolar three weeks ago. Afterwards, I felt pain on any pressure on the temp crown. I went to get the bite adjusted. It hurt a bit less. Went in again for a root canal evaluation on the other side and the dentist (not the same one), hit all my teeth with the little percussion instrument and slammed it into the temp crown. I almost passed out it hurt so bad.

    So now the tooth still hurts a lot on any pressure. My first dentist checked xrays and scans for infections or accessory canals and saw nothing. The two back cusps of the tooth hurt terribly on any pressure (even light tooth brushing). Dentist tried to numb me back up to see if tooth was cracked under the temp crown, but he could not numb me up. He tried in 8 different places with several different anesthesias.

    So now he can’t get the temp crown off and he can’t numb me up. I took dexamethasone for 2 1/2 days and am feeling a little better after a week. The dentist wants to put me under sedation and extract the tooth. I would rather not have an extraction if I can avoid it.

    Plot twist in that I got a premolar root canal last year on the other side last year and due to COVID, never ended up getting it crowned. The back two cusps on that tooth are also still sensitive to pressure.

    I am worried it might be a neural problem and that an extraction would make things worse. I have not been able to chew since before Thanksgiving.

    Thanks for any ideas you can provide. My dentist has had over 10,000 patients and cannot figure out why I cannot be numbed up anymore when I was for the root canal.

    1. Hello Muriel, Sorry that you are going through this. It is very unusual to not be able to numb an upper premolar. If an infiltration injection (numbing on the cheek side of the tooth) is not sufficient to numb the tooth, then certainly a palatal injection on the roof of the mouth behind the tooth would numb it. Also, though it is controversial among dentists, I always prescribe antibiotics for root canal treatment. My go to is Clindamycin 150mg 4 times a day for 10 days. You did not mention if antibiotics have been tried yet. After a round of antibiotics with the tooth out of occlusion (shortened to be out of contact from the opposing tooth), I would re-evaluate. At that time I would check the tenderness to tapping on the tooth and possibly take another x-ray to see if there are any new changes. If there are new changes, it’s likely that there is a crack in the tooth and it would have to be extracted. My gut tells me it’s not neural, but you can’t rule it out. Try other treatment first and see how it goes. Good luck. Dr. Silberman

  43. Kristin Schwartz

    You are simply wonderful! I stumbled on your site looking for some help and read A LOT of comments and your replies. What a great dentist you are to provide all this advice to anyone! You are a kind and simply stellar guy, I applaud you!

    1. Thank you Kristin. You are a real mensch for saying so ….. LOL Warm Regards, Paul B. Silberman, D.D.S., MOT

  44. Mike Meier

    I had to go to the dentist this week because of severe pain in a molar (#30). The tooth had a deep filling that the dentist had replaced this past July because the original filling had fallen out. The x-ray this time showed an abscess at the root and I was referred for a root canal and given a prescription for Penicillin. I have been on the Penicillin for 4 days and the pain is not easing up at all-in fact it is getting worse. The pain is radiating to my other teeth and across my entire jaw. I am taking ibuprofen and acetaminophen every 6 hours but it barely touches the pain. The endodontist cannot get me in for treatment until the 19th-which is ten more days. I am unsure if I can continue like this for that much time. Should I consider just having the tooth pulled now or do I have other options?

    1. Hi Mike, Sorry that you are having to go through this. To stop the pain immediately you can hold ice water in your mouth next to the tooth. You may have read my thoughts on this in other posts, but if not, it’s worth repeating. Your tooth is on a classic trajectory. When the tooth was refilled, it was probably already damaged by decay, even though it was asymptomatic. Now that the bacteria from the decay has taken over the tooth, they have created a by-product of gas that is trapped inside. Ice water will get the gas to contract and take the pressure off the nerve endings and stop the pain. Your body heat is enough to get the gas to expand and cause the pain. You can’t keep ice water in your mouth until the 19th, so I would recommend asking your dentist to see you tomorrow on an emergency basis. He can drill open the top of the tooth to release the gas and stop the pain. It is not a difficult nor painful process. Releasing the gas will give you relief until you can get to the endodontist (root canal specialist) on the 19th. As long as the dentist has numbed the tooth to open it and relieve the gas, I would ask that the height of the tooth be reduced so that you can bite together more comfortably. The tooth will need to have a crown placed on it anyway, so doing this will help you now, and less tooth reduction can be done later when you get the crown. I am not a fan of Penicillin for tooth infection. Clindamycin 150mg every 4 hours is better against the type of bacteria found in a tooth abscess. If you have any GI issues, I would stick with the Penicillin. You might suggest switching to your dentist and get his / her opinion. It’s just my opinion having done this type of work for decades. And a reminder, avoid applying heat to your face and stay away from hot food and drink until you have resolved this problem. I hope that helps. Good Luck. Dr. Silberman