Emergency dental symptoms
Severe toothache: what it means and what to do today
A toothache that keeps you awake, throbs on its own or shrugs off painkillers is a tooth telling you its nerve is in trouble. Here is what is going on inside it and what to do next.
Clinically reviewed by Dr Ibraheem Ijaz, Principal Dentist · GDC 301711 · Last reviewed April 2026
Why a toothache gets this bad
Almost every severe toothache comes down to one thing: the nerve inside the tooth is inflamed or has died, and the tissue around the root is reacting. The nerve (the pulp) lives in a rigid chamber of dentine with no room to swell. When decay, a crack or a deep filling irritates it, it swells anyway, and the pressure has nowhere to go. That trapped pressure is the throb you feel with every heartbeat.
The usual causes, roughly from most to least common:
Irreversible pulpitis.
Periapical abscess.
Reversible pulpitis.
Cracked tooth.
Gum abscess, pericoronitis or sinusitis.
A quick way to tell them apart at home: pain that comes and goes in seconds points to a live nerve that can still be saved. Pain that lingers, throbs or wakes you points to a nerve that is dying or dead. Pain mainly on biting, with a tooth that feels tall, points to infection at the root.
How urgent is severe toothache?
Toothache itself will not harm you, but the infection behind it can spread. Use this as a guide:
Call today.
Same day, within hours.
A&E now.
Outside our 8am–8pm hours the emergency line is answered personally by Dr Ijaz, the principal dentist. For general advice out of hours you can also call NHS 111. What you will pay is set out on our emergency dental fees page.
What you can do in the next hour
- Take ibuprofen and paracetamol together if you are able to take both, as directed on the packet. Taken together they work better for dental pain than either alone. Never exceed the packet dose, and skip ibuprofen if you have been told to avoid it.
- Keep your head up. Sleeping propped on two pillows takes some of the pressure out of the throb.
- Rinse with warm salt water (a teaspoon in a glass) to keep the area clean. Avoid very hot or very cold food and drink.
- Do not hold an aspirin against the gum. It burns the tissue and does nothing for the tooth.
More options are in our guide to temporary fixes before your appointment.
What happens at your £30 emergency examination
The emergency examination takes about 15 minutes and costs £30 including any X-rays. You do not need to be registered with us. The aim is to find the tooth causing the pain and get you comfortable that visit.
- We ask what the pain is like: what sets it off, how long it lasts, whether it wakes you. This usually narrows the cause before we have looked.
- We look for decay, cracks, swelling and gum problems, and check any fillings or crowns.
- Cold test. A cold-soaked cotton pellet is held against the suspect tooth and its neighbours. A healthy nerve responds briefly; a dead nerve does not respond at all; an irreversibly inflamed one gives an exaggerated response that lingers.
- Percussion. Tapping each tooth gently with the handle of a mirror. Tenderness points to inflammation around the root tip, which usually means infection.
- Bite test. Biting on a small plastic wedge tooth by tooth, to find a crack.
- Digital X-ray. Shows decay under fillings, a dark area at the root tip, bone loss or a fracture. Included in the £30.
Then we talk through what we found and your options, with fees in writing before anything starts. The treatments that usually follow:
For irreversible pulpitis, the fastest route out of pain is removing the inflamed nerve: an emergency root canal, which is stage 1 of a full root canal, or an emergency extraction. For an abscess the priority is drainage, through the tooth or through the gum. Antibiotics on their own do not fix toothache and are only used when infection is spreading or you are unwell. They cannot reach a dead nerve, because there is no longer a blood supply inside the tooth to carry them there.
| Treatment | Fee (from) |
|---|---|
| Emergency examination including X-rays | £30 |
| Emergency root canal stage 1 (nerve removed, tooth dressed) | £200 |
| Completed root canal treatment | £450 |
| White filling | £150–£220 |
| Extraction | £120–£260 |
What happens if severe toothache is left
Sometimes a raging toothache suddenly stops. That is rarely good news: it usually means the nerve has died. The pain returns weeks or months later as an abscess, and by then the infection has been quietly dissolving the bone around the root. A tooth that could have had a straightforward root canal may by then need taking out.
Left longer, the abscess can track into the face. Upper teeth swell the cheek and can close the eye; lower teeth swell under the jaw and, rarely, the floor of the mouth, which threatens the airway (Ludwig’s angina). The difference between a £30 examination and a night in hospital is usually a few days of hoping it goes away.
When it is more than a dental problem
Call 999 or go to A&E if swelling is spreading quickly, the eye is starting to close, you have difficulty swallowing or breathing, or you have a high fever and feel very unwell. Sudden electric-shock pain on one side of the face set off by touching the skin, with no tooth to blame, can be trigeminal neuralgia and needs your GP. Jaw pain that comes on with exertion and eases with rest needs a 999 call, as it can be coming from the heart.
Questions, answered
Common questions
Why is my toothache worse at night?
Lying flat raises the blood pressure in your head, which raises the pressure inside an already swollen nerve. There is also less to distract you. Night pain is one of the clearest signs the nerve is inflamed beyond recovery.
Will antibiotics get rid of my toothache?
No. Antibiotics do not reach the inside of a tooth and do not treat an inflamed nerve. They are only appropriate when infection is spreading into the face or you have a fever, and even then the tooth still needs drainage, a root canal or an extraction.
Can I wait and see if the toothache goes away?
Short sensitivity to cold can settle. Throbbing, lingering or night pain does not; if it stops suddenly it is usually because the nerve has died, and an abscess follows later. It is worth £30 to know which you have.
Will I need the tooth out?
Not usually. Most severe toothache is treated by root canal, which keeps the tooth. Extraction is the option when the tooth is too broken down or cracked to save, or when you would rather not have root canal treatment.
How much does it cost to be seen for toothache?
The emergency examination is £30 including X-rays. Any treatment is priced separately and agreed with you in writing before it starts. Evening and weekend visits carry an additional out-of-hours charge.
Which painkillers work best for toothache?
Ibuprofen and paracetamol taken together, as directed on the packet, if you can take both. Ibuprofen reduces the inflammation inside the tooth as well as the pain. Do not put aspirin on the gum, and do not exceed the packet dose while you wait to be seen.
In pain? Don’t wait
Same-day emergency appointments, seven days a week.
£30 emergency examination including X-rays. Call now and a real person answers, or grab a slot online.
334 Manchester Road, Deepcar, Sheffield S36 2RH · Free parking