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Tooth Troubles
A sore tooth is one of the most common reasons families go looking for answers. This page explains what tooth pain is, why it happens and what a dentist may do. It does not try to work out what is causing your child’s pain — that needs an examination.
Pain from a tooth usually means something has reached, or is close to reaching, the living tissue inside it. That tissue — the pulp — contains nerves and blood vessels, and it responds to damage, pressure and temperature.
What the pain feels like does not reliably tell you what is wrong. The AAPD’s pulp therapy guidance is built around distinguishing a pulp that is healthy from one that is inflamed or dying, and it treats that as a diagnosis requiring examination and X-rays rather than description. This page will not attempt it.
Teeth have a soft, alive part in the middle that can feel sore, just like the rest of you. Telling a grown-up that it hurts is the most useful thing you can do — the dentist has ways to help.
Pain is information, not a diagnosis. The AAPD classifies pulp health as normal, reversibly inflamed, irreversibly inflamed, or dead — and those distinctions determine treatment. They cannot be told apart from how the pain sounds when described over the phone, which is why the answer to “what is causing this?” is always an appointment.
The AAPD groups the underlying situations broadly. Any of these could be behind pain, and only an examination can say which:
That list is deliberately not a checklist. Matching your child’s symptoms against it will not produce an answer, and may produce a wrong one.
Three things families find useful to know before they ring.
A tooth that stopped hurting has not necessarily got better. The AAPD distinguishes reversible from irreversible pulp inflammation and describes pulp death as a cause of infection — and a dying pulp can become less painful, not more. Pain settling is not a reason to cancel.
A tooth can hurt with nothing obvious to see, and a tooth can look damaged without hurting. The AAPD relies on clinical examination together with radiographs precisely because the outside does not report the inside.
If pain comes with facial swelling, or your child seems unwell rather than just sore, that is a different situation. See Facial swelling and contact your dentist, doctor or emergency services.
Expect an examination and, in most cases, X-rays. The AAPD states that the objectives and type of pulp therapy are based on the health status of the pulp tissue, which is why establishing that comes before deciding anything.
Ring your dentist and describe what you have noticed — when it started, what makes it worse, whether it wakes your child, whether anything is swollen. They will tell you how soon your child needs to be seen. That triage is theirs to do, not this page’s.
If there is facial swelling, if your child has difficulty breathing or swallowing, or if they seem unwell in themselves rather than sore in one place, contact your dentist, your child’s doctor, or your local emergency services.
The pain has stopped — do we still need to go? Yes, ring anyway and say so. Pain settling can mean the problem resolved, and it can mean the pulp has died. The AAPD treats a necrotic pulp as a cause of infection rather than an end of the matter. Let the dentist decide which it is.
Ask your dentist or pharmacist rather than a website. This page does not recommend medicines, doses or home measures, because doing so safely requires knowing your child. What it can say is that pain relief does not treat the cause, and the AAPD is clear that the underlying problem needs addressing.
Contact your dentist and let them judge. If there is facial swelling, difficulty breathing or swallowing, or your child seems unwell in themselves, contact your local emergency services. See When to seek emergency care.
It could, and it could be several other things. Teething and erupting permanent teeth can both be uncomfortable. Sorting that from decay, infection or injury is what an examination is for. There is more on Teething.
Families often report this and it is a reasonable thing to mention when you call, because it is the kind of detail a dentist finds useful. This page will not offer an explanation, because the explanation depends on the cause and the cause has not been established.
That is your dentist’s judgement after examining it. The AAPD is clear that treatment follows from establishing the health of the pulp, and that assessment cannot be made remotely. What is certain is that pain is a reason to be seen.
Every clinical statement on this page comes from the American Academy of Pediatric Dentistry documents below.
This website is for education only and does not replace care from your dentist, physician, or emergency services.