Tooth pain and dental infection, what a doctor can and cannot do

It is half eleven at night, the painkillers you took two hours ago have stopped working, and one tooth is throbbing in time with your pulse. Lying down makes it worse. You have already prodded it with your tongue forty times to check it still hurts, and it does. The dentist is shut, and you are wondering whether a doctor can sort this out instead.

Here is the honest answer up front, because it is the most useful thing on this page. A doctor cannot fix a tooth. Drilling out decay, draining an abscess through the tooth, taking it out, root canal treatment, replacing a lost filling: all of that is dentistry, it needs a dentist, and no video consultation changes that.

What a doctor can do is a narrower but genuinely useful list. They can help you manage severe pain while you wait for dental treatment, and where an infection is spreading beyond the tooth into surrounding tissue, they can assess it and prescribe treatment if that is clinically appropriate. Our page on tooth pain and dental infection sets out what that assessment covers. A doctor can also tell you when what you are describing is not dental at all, and when it is urgent enough to get seen today.

Treating the infection is not the same as treating the tooth. Even if antibiotics settle the swelling, the tooth that caused it is still there and still needs a dentist, or the whole thing comes back.

Why a tooth starts hurting

Teeth have a nerve and a blood supply in the middle, in the pulp, with enamel outside protecting it. When something breaches that protection, whether decay working inwards, a crack, a lost filling or a worn surface, the pulp becomes inflamed. Inflamed nerve tissue inside a hard shell that cannot swell is why toothache has its particular quality.

Let that inflammation progress and the pulp can die, at which point bacteria colonise the space and an abscess forms at the root tip. Gum disease creates the same problem from another direction, in the pocket around the tooth rather than inside it. A wisdom tooth pushing through at an angle traps food and bacteria under a flap of gum. Exposed roots give a short, sharp zing with anything cold rather than a constant ache.

One more thing worth knowing: pain in the upper back teeth is sometimes not dental at all. The roots of those teeth sit just under the sinus, so a sinus infection can produce convincing toothache in two or three teeth at once, all on one side, with none individually tender. If your nose is blocked and your cheek feels heavy, read about sinus infection symptoms before assuming the worst about your teeth.

What the pain is telling you

• A short, sharp jolt with cold or sweet things that fades quickly, usually sensitivity or early decay
• A deep, constant throb that keeps you awake and is worse lying flat, pointing to dying pulp
• Pain when you bite on one tooth, or a tooth that suddenly feels higher than its neighbours
• A tooth that is tender to touch, sometimes noticeably loose
• A bad taste, a foul smell, or a sudden salty discharge if an abscess bursts
• A swollen, red, painful gum, or a visible lump beside the tooth
• Pain radiating into the jaw, the ear, or across the temple on the same side

When the infection is spreading

This is the part a doctor is genuinely able to help with. Most dental infections stay put, contained around the root, and a dentist deals with them. Sometimes infection escapes into the soft tissue of the face and neck, and once that starts it can move quickly, because those spaces connect in ways that let it travel.

Signs that infection is no longer confined to the tooth include swelling of the cheek, jaw or under the chin, skin that is red, hot and tight over the swelling, a fever with shivering, feeling unwell all over rather than just in your mouth, difficulty opening your mouth, and swollen glands in the neck. That is the point where this stops being a dental appointment you can book for next week. Our page on skin and soft tissue infections covers the same principle elsewhere in the body.

When to get urgent help

Facial and neck infections are where dental pain becomes an emergency, so do not sit on any of these:

• Swelling of the face or jaw, particularly swelling visibly getting bigger over hours
• Swelling that is closing your eye, or spreading up towards the eye
• Any difficulty swallowing, or difficulty breathing
• A fever alongside spreading swelling
• Swelling under the tongue, or a tongue that feels pushed upwards and forwards
• A voice that has changed or sounds muffled, or drooling because you cannot swallow saliva
• Being unable to open your mouth more than a little way
• Uncontrolled bleeding from the mouth, or a tooth knocked out by an injury

Call 999 for difficulty breathing or swallowing, swelling under the tongue, or swelling that is closing your eye. Those are airway risks, treated as emergencies. For severe pain or swelling outside that category, call 111, which can also point you to an urgent dental service when your dentist is closed.

Getting through the night

None of this treats the cause, and all of it helps you cope until a dentist can. Take a painkiller you know is suitable for you, and ask the pharmacist what you can safely combine, because they can be specific where an article cannot. Sleep propped up rather than flat, since lying down increases the throbbing.

Rinse gently with warm salt water a few times a day. Keep to soft, lukewarm food and avoid anything very hot, cold, sweet or hard. Keep the tooth clean even though it hurts. Never hold a painkiller tablet against the gum, which burns the tissue and leaves an ulcer on top of the toothache. Clove oil numbs briefly for some people and irritates the gum in others. A cold pack against the outside of the cheek for short spells is more reliable.

Ring your dentist first thing regardless of how much better it feels by morning. Pain that stops suddenly is not always good news, and can mean the nerve has died rather than the problem resolving.

How an online consultation works for this

You book a time, explain what has been happening, and speak to a UK registered doctor by video. They will ask when it started, whether there is swelling and whether it is spreading, whether you can open your mouth and swallow normally, and when you can realistically see a dentist. If spreading infection needs treating and an antibiotic is clinically appropriate, the doctor can prescribe. If the problem is the tooth itself with no spread, they will say so plainly and point you to dental care rather than a prescription that would not help. A referral letter is available where onward care is needed.

Read how an appointment works, see the fees in pounds on the prices page, then book a doctor appointment. Take a photo of any swelling in good light beforehand, note the highest temperature recorded, and say clearly if you struggle to open your mouth or swallow, because that changes the urgency. If this turns out to be one sided facial pain with no clear dental cause, our headache and migraine page may fit better.

So the summary is simple. See a dentist for the tooth, because nobody else can fix it. If the pain is severe or an infection looks like it is spreading and you cannot get dental care quickly enough, get a consultation booked and a UK registered doctor will help you manage the infection and the pain meanwhile.