Toothache That Won't Go Away: What's Causing It and When to See a Dentist Urgently
Why Won't My Toothache Go Away?
A toothache that lingers is your body's alarm system telling you something is wrong inside the tooth or the tissues around it. Unlike a headache or a sore muscle, tooth pain rarely resolves on its own — because the causes are structural or infectious, not inflammatory in the way a bruise is.
The frustrating thing is that tooth pain can be maddeningly vague. It might throb, ache, pulse with your heartbeat, shoot into your jaw, or disappear for an hour only to come roaring back. That inconsistency doesn't mean the problem is minor. It usually means the nerve inside the tooth is involved — and once the nerve is irritated, the pain tends to escalate rather than settle.
Here's a straightforward breakdown of the most common causes.
What's Causing My Toothache?
Tooth Decay (Dental Caries)
This is the most common cause of persistent toothache in Australia. Decay starts on the outer enamel and works its way inward. In its early stages, you might not feel anything at all. But once the decay reaches the dentin (the softer layer beneath the enamel) or the pulp (the nerve centre), the pain becomes constant and hard to ignore.
What it feels like: Sensitivity to sweet, hot, or cold foods and drinks. As it progresses, a dull ache that becomes a sharp, throbbing pain — especially at night.
Treatment: Small to moderate cavities can be treated with a filling (150–350). If the decay has reached the nerve, root canal therapy (800–1,500) may be needed to save the tooth.
Dental Abscess (Infection)
An abscess is a pocket of pus caused by a bacterial infection, usually at the tip of the tooth root or in the gum tissue. This is one of the most serious causes of toothache and requires urgent treatment — dental infections can spread to the jaw, head, and neck, and in rare cases become life-threatening.
What it feels like: Intense, throbbing pain that may radiate to your jaw, ear, or temple. The gum near the affected tooth may be swollen, red, or have a visible bump (like a pimple). You might notice a foul taste in your mouth from the draining pus. Fever is possible.
Treatment: Antibiotics to control the infection, followed by root canal therapy or extraction. An abscess will not resolve on its own — it needs professional drainage and treatment.
Hot tip: If you have facial swelling, difficulty swallowing, or a fever alongside your toothache, don't wait for a dental appointment. Go to your nearest emergency department. These are signs the infection may be spreading.
Cracked or Fractured Tooth
Cracks in teeth can be surprisingly difficult to detect. You might have a hairline crack that doesn't show up on a standard X-ray but causes sharp pain every time you bite down on a particular spot.
What it feels like: Sharp, fleeting pain when biting or chewing, especially on certain foods. The pain might come and go unpredictably. You may also notice sensitivity to temperature changes. If the pain began after part of the tooth broke away, follow our immediate guidance on what to do after chipping a tooth.
Treatment: Depends on the depth and direction of the crack. Options range from bonding or a crown (1,200–2,000) to root canal therapy or, in severe cases, extraction.
Gum Disease (Periodontitis)
Advanced gum disease doesn't just affect your gums — it can cause deep, aching pain around the teeth as the bone and tissue that hold them in place break down. If your toothache is accompanied by swollen, bleeding gums, loose teeth, or persistent bad breath, gum disease may be the culprit.
What it feels like: A deep, diffuse ache rather than sharp pain in one specific tooth. Gums may be red, puffy, or bleed when you brush.
Treatment: Professional deep cleaning (scaling and root planing) to remove bacteria below the gum line, followed by an ongoing maintenance programme. Costs vary depending on severity, typically 200–600 per quadrant.
Teeth Grinding (Bruxism)
Many people grind or clench their teeth during sleep without realising it. Over time, the constant pressure can cause tooth pain, jaw soreness, and headaches — particularly first thing in the morning.
What it feels like: A generalised ache across several teeth (rather than one specific tooth), jaw stiffness, and morning headaches. Your partner might tell you they can hear you grinding at night.
Treatment: A custom night guard600-800) protects your teeth from further wear. We also assess for underlying causes like stress, sleep apnoea or an unstable bite.
Impacted Wisdom Teeth
If your wisdom teeth are coming through at an angle or don't have enough room to emerge fully, they can press against neighbouring teeth and cause persistent pain in the back of your mouth.
What it feels like: Aching or pressure at the very back of your jaw, sometimes accompanied by swollen gums, difficulty opening your mouth fully, or a bad taste.
What it feels like: Aching or pressure at the very back of your jaw, sometimes accompanied by swollen gums, difficulty opening your mouth fully, or a bad taste. If this keeps flaring up, it's often the point where wisdom teeth removal goes from "maybe one day" to "let's sort this out.
Treatment: Assessment with X-rays to determine position. Wisdom tooth extraction may be recommended if the tooth is impacted, trapping food, or causing repeated infection and pain. Costs for wisdom teeth removal range from 300-600 per tooth for simple extractions, or 400-800 for surgical extractions
Referred Pain (Not Always a Tooth Problem)
Sometimes what feels like a toothache isn't coming from a tooth at all. Sinus infections, TMJ disorders, ear infections, and even tension headaches can create pain that's felt in the teeth. This is called "referred pain," and it's more common than you'd think.
What it feels like: Vague, hard-to-pinpoint pain in the upper teeth (sinuses) or pain that seems to move around. It may worsen when you bend over, lie down, or clench your jaw.
Treatment: Your dentist can rule out dental causes with an examination and X-rays. If the pain is referred, they'll point you toward the right specialist.
When Should I See a Dentist Urgently?
Some toothaches can wait a few days for a regular appointment. Others need attention now. Here's how to tell the difference:
See a dentist within 24 hours if:
Pain has lasted more than 1–2 days and isn't improving
The pain wakes you up at night
You notice swelling in your face, jaw, or gums
You have a fever or feel unwell alongside the pain
There's a bad taste in your mouth (possible abscess drainage)
Pain is severe and not controlled by over-the-counter painkillers
A tooth feels loose or has changed colour
Go to a hospital emergency department if:
You have significant facial swelling (especially near your eye or throat)
You have difficulty breathing or swallowing
You have a high fever (above 38.5°C) with facial swelling
You're experiencing uncontrollable bleeding from the mouth
What Can I Do for Tooth Pain at Home (While Waiting for an Appointment)?
Home remedies won't fix the underlying problem, but they can help manage the pain until you see a dentist.
Over-the-counter painkillers. Ibuprofen (Nurofen) is generally the most effective for dental pain because it targets both pain and inflammation. Paracetamol (Panadol) is an alternative if you can't take ibuprofen. You can alternate the two for stronger relief — take ibuprofen, then paracetamol 2 hours later, and continue alternating. Always follow the dosage instructions on the packet.
Saltwater rinse. Dissolve half a teaspoon of salt in a glass of warm water and gently swish for 30 seconds. This helps reduce bacteria and can soothe inflamed gums. Repeat 2–3 times a day.
Cold compress. Apply an ice pack wrapped in a cloth to the outside of your cheek for 10 minutes on, 10 minutes off. This reduces swelling and numbs the area.
Elevate your head when sleeping. Lying flat increases blood flow to the head, which can intensify throbbing tooth pain. Prop yourself up with an extra pillow.
Avoid triggers. Stay away from very hot, very cold, sugary, and acidic foods and drinks until you've seen a dentist. Chew on the opposite side of your mouth.
Don't put aspirin on the gum. This is an old home remedy that does more harm than good — aspirin is acidic and can cause chemical burns to the soft tissue.
What Happens at a Dental Emergency Appointment?
If you come to Surry Hills Dental Centre with a persistent toothache, here's what you can expect:
Conversation first. We'll ask about your symptoms — when the pain started, what makes it better or worse, whether you've noticed any swelling or changes. This helps us narrow down the likely cause before we even look in your mouth.
Clinical examination. Your dentist will examine the affected area, checking for visible decay, cracks, swelling, or gum disease. They may tap on teeth to identify which one is causing the pain, or apply a cold stimulus to test nerve responses.
X-rays. Digital X-rays give us a clear picture of what's happening below the surface - decay, infection, cracks, bone loss, or impacted wisdom teeth that may need wisdom tooth extraction.
Diagnosis and treatment plan. Once we know what's causing your pain, we'll explain it clearly and walk you through your options. If the issue is straightforward (a cavity or a minor crack), we may be able to treat it then and there. If it's more complex, we'll manage your pain immediately and schedule the follow-up treatment.
Don't Sit with the Pain — Let Us Help
A toothache that won't go away is telling you something, and the answer is always better when you find it early. At Surry Hills Dental Centre, we see emergency dental patients from Surry Hills, Darlinghurst, Redfern, Waterloo, and across Sydney's inner city every week — and we'll get you out of pain as quickly as possible.
Book an emergency appointment at Surry Hills Dental Centre or call us now. Same-day appointments are available for patients in pain.
We're on Crown Street in Surry Hills, a short walk from Central Station. If you're in pain, don't wait — call us and we'll fit you in.
Frequently Asked Questions
How long is too long to ignore a toothache?
If a toothache lasts more than 1–2 days, or if the intensity is increasing, you should see a dentist. Tooth pain that goes away on its own can sometimes mean the nerve has died — which sounds like good news but actually means the infection is still there and can cause serious problems.
Can a toothache go away on its own?
Occasionally a mild ache resolves if it was caused by temporary sensitivity or minor gum irritation. But persistent or recurring toothaches almost never resolve without treatment. The underlying cause — whether it's decay, a crack, or an infection — doesn't heal itself.
Is it normal for a toothache to come and go?
Yes, and this doesn't mean it's getting better. Intermittent pain often indicates a cracked tooth or early nerve involvement. The nerve can become irritated and then settle temporarily, but the pattern typically worsens over time.
Should I go to the dentist or the hospital for a toothache?
A dentist is almost always the better choice — they can diagnose the cause and provide treatment. Hospital emergency departments can manage pain and prescribe antibiotics, but they typically can't perform dental procedures. The exception is if you have significant facial swelling, difficulty breathing or swallowing, or a high fever — those require hospital-level care.
Do I need wisdom teeth removal if my wisdom tooth hurts?
Not always. Mild discomfort from a wisdom tooth that's still erupting can settle on its own. But if the tooth is impacted, keeps getting infected, or is damaging the tooth next to it, wisdom tooth extraction is usually the long-term fix. We'll assess it with an X-ray and talk you through your options before recommending anything.
Can I take antibiotics for a toothache without seeing a dentist?
Antibiotics alone don't cure dental infections — they control the spread of bacteria temporarily, but the source of infection (usually inside the tooth or at the root tip) needs to be physically treated. Taking antibiotics without dental treatment just delays the inevitable and can contribute to antibiotic resistance.
Why does my toothache get worse at night?
When you lie down, blood flow to your head increases, which raises pressure around the inflamed nerve and intensifies pain. Nighttime also means fewer distractions, so the pain feels more prominent. Try sleeping with your head slightly elevated and taking pain relief before bed.
How much does an emergency dental visit cost in Sydney?
An emergency consultation and X-rays at Surry Hills Dental Centre typically cost 80–200, depending on the complexity. Treatment costs vary based on what's needed. We process health fund claims on the spot, so you only pay the gap.
