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Toothache (cont.)

When to Seek Medical Care

One should call the doctor or dentist for advice for the following concerns:

  • Dental pain may not be relieved by over-the-counter medications.
  • If one experiences severe pain after a tooth is pulled. This may occur on the second or third day after tooth extraction. This is a result of the tooth socket being exposed to air. The condition is known as "dry socket syndrome." If the patient develops this condition, he or she should see a dentist within 24 hours.
  • Pain may be associated with swelling of the gums or face, or the patient may have discharge around a tooth. Fever is an important sign of infection in dental disease. Simple dental decay (caries) does not cause fever. These signs may signify an infection surrounding the tooth, the gum, or the jaw bone (mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended to be done inside the tooth (endodontic drainage), a "root canal" is performed.
  • Broken or knocked-out teeth may occur from an injury. Unless associated with more severe injuries, the dentist should be contacted as soon as possible. Swallowed teeth and permanent tooth loss are considered dental emergencies. Tooth loss due to injury (traumatic loss) is cared for differently in children who have lost their primary teeth than for older children and adults with injury to their secondary teeth.
  • Pain may be present at the angle of the jaw. If every time the patient opens their mouth widely they have pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big. The dentist may be able to suggest solutions to this problem.
  • Wisdom teeth can cause pain. As wisdom teeth (molars) are coming out, they cause inflammation of the gum around the erupted crown. The gum overlying the crown may become infected. The tooth most commonly involved is the lower third molar. The pain may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot be closed properly. In severe cases, pain in the throat and the floor of the mouth may make it difficult to swallow.

Any history of trauma, chest pain or history of heart disease, or rashes may suggest causes of pain other than purely dental origin. These symptoms with toothache or jaw pain indicate that the patient should visit the doctor or a hospital's emergency department.

  • High fever or chills: This may indicate a more widespread infection that might require more than antibiotics by mouth.
  • Recent head or face injury: If the patient experiences headache, lightheadedness, nausea, vomiting, or other symptoms that concern them after an injury to the face or mouth, the patient may have a more serious injury in addition to the dental injury.
  • A facial rash associated with a toothache: This condition may improve with medication. The doctor should be able to decide what is appropriate.
  • Any jaw pain occurring with chest pain: Although jaw pain is most commonly caused by dental disease, it is sometimes referred pain from other areas. People with heart disease, especially people who have had stents placed, people with diabetes, or those who have had heart surgery may have jaw pain as a symptom of heart attack (myocardial infarction) or angina (ischemia). If the jaw or tooth pain is associated with lightheadedness, sweating, or shortness of breath, the patient should see a doctor.
  • Trouble swallowing or excessive pain or bleeding from gums: If the patient has a history of a weakened immune system, diabetes, or steroid use, they are more susceptible to infections. Infections can often be more severe and extensive or caused by unusual organisms. Dental and gum infections in people with these conditions may require more aggressive treatment. An abscess may need draining or IV antibiotics, for example.
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