A toothache that fades by itself has not always healed. Sometimes the irritation behind it has settled, but sometimes the pain stops because the nerve inside the tooth has died, and a dead nerve can go on to cause an infection at the root tip that gives little or no pain for a while. If the pain came on by itself, lingered after hot or cold, lasted more than a couple of days or needed regular pain relief, it is worth having the tooth checked even though it feels fine now.
Pain can stop for quite different reasons
The inside of a tooth holds the pulp, a soft core of nerves and blood vessels. When the pulp becomes inflamed, usually because of decay, an injury or repeated fillings, the condition is called pulpitis, and its main symptom is pain. The MSD Manual describes two broad forms. In reversible pulpitis the inflammation is limited and the tooth can usually be saved with a filling. In irreversible pulpitis, swelling inside the rigid walls of the tooth compromises the pulp's circulation and the pulp dies. Our guide to reversible and irreversible pulpitis explains the difference in more detail.
| Why the pain eased | What it can mean | What usually needs to happen |
|---|---|---|
| The irritation settled, for example short-lived sensitivity that faded | The pulp may have recovered | A check to find and treat the cause, such as decay, before it flares again |
| The nerve inside the tooth died | The tooth is quiet, but the dead pulp can become infected | Root canal treatment or removal of the tooth |
| Pain relief or antibiotics are masking it | The cause is still there | A dental assessment once the medicine wears off, or sooner |
Why a dying nerve can feel like getting better
When the pulp dies, the nerve fibres that were sending pain signals stop working. The MSD Manual notes that pain from irreversible pulpitis "may then cease for several days because of pulpal necrosis", and that once the pulp has fully died the tooth no longer responds to hot or cold, although it often becomes tender to tapping. So a tooth that used to ache with cold drinks and now feels nothing at all is not necessarily a good sign.
A nerve can also die without much pain. Michaelson and Holland (International Endodontic Journal, 2002) went through the records of 2,202 upper front teeth that had root canal treatment at the University of Michigan, looking at teeth that did not respond to pulp tests and had a dark area at the root tip on the X-ray. About 40% of these teeth had no history of spontaneous pain or of prolonged pain with hot or cold. The authors concluded that many teeth appear to reach this stage without the person having pain from the nerve.
Infection at the root tip is often silent
Bacteria in a dead pulp can spread out through the end of the root and cause inflammation in the bone around it, called apical periodontitis. A 2021 systematic review in the International Endodontic Journal (Tibúrcio-Machado and colleagues, 114 studies) described it as frequently a chronic disease without symptoms, which needs X-rays as well as an examination to diagnose. The same review estimated that about half of adults worldwide have at least one affected tooth, although the studies varied widely.
Because it is often quiet, the first sign may be one of these rather than a return of the original ache:
- the tooth feels tender when you bite or when it is tapped
- a bad taste in the mouth
- swelling of the gum, cheek or jaw
Healthdirect lists pain when biting, a bad taste and cheek or jaw swelling among the reasons to see a dentist.
Painkillers and antibiotics do not fix the tooth
Paracetamol or ibuprofen can make the wait more comfortable, and our article on ibuprofen and paracetamol for tooth pain covers using them safely. They do not treat the cause, so pain that seems to have gone while you are taking them may simply be controlled.
Antibiotics are a different question. A Cochrane review (Agnihotry and colleagues, 2019) found only one small trial and concluded there was not enough evidence to say whether antibiotics reduce pain from irreversible pulpitis. Healthdirect notes that antibiotics are usually not used for a toothache unless there is a clear infection, and the MSD Manual lists root canal treatment (with a crown) or extraction as the treatment for irreversible pulpitis.
What a dentist or OHT checks
At the appointment you will be asked when the pain started, what set it off, how long each episode lasted and when it stopped. The tooth is then examined and tested:
- Cold or electric pulp tests. These show whether the pulp still responds. They are useful but not perfect: a 2018 meta-analysis in the Journal of Endodontics (Mainkar and Kim) found the cold test had an adjusted accuracy of about 84%, and the MSD Manual notes that an electric tester shows whether the pulp is alive, not whether it is healthy.
- Tapping and biting. Tenderness here can point to inflammation around the root.
- X-rays. These can show whether inflammation has spread beyond the root tip. Lumi has an Orthophos 3D X-ray unit for panoramic and 3D scans when a standard X-ray is not enough.
No single test settles it, so the findings are read together. If you are unsure which tooth was hurting in the first place, our guide to pain you cannot pin to one tooth explains how it is narrowed down.
What happens next depends on the pulp
If the pulp is still healthy enough to recover, removing decay and placing a filling may be all that is needed. If the pulp has died or cannot recover, the choice is usually between root canal treatment, which cleans out the inside of the tooth so it can be kept, and taking the tooth out. Our comparison of root canal treatment and extraction sets out how that decision is made.
When to get help straight away
Get emergency medical care, by calling 000 or going to a hospital emergency department, if a toothache or gum swelling is causing problems with breathing or speaking, or swelling around your eye or neck. See a dentist as soon as possible if a toothache lasts more than 2 days or does not improve with pain relief, and see a dentist if it comes with a fever (a temperature over 38°C), trouble swallowing, pain when you bite, a bad taste or swelling in your cheek or jaw. If you are unsure how urgent it is, the healthdirect helpline on 1800 022 222 can advise. Our page on when to go to hospital for a dental problem has more detail.
Questions about a toothache that has gone quiet
Will the pain come back?
It may. When infection spreads beyond the root tip, the tooth can become very sensitive to biting and tapping, and may feel high when you bite down. It can also stay quiet for a long time, which is why an X-ray is part of the check.
The pain only lasted a day. Do I still need to come in?
A brief twinge with cold that settled quickly is usually less concerning than pain that came on by itself or lingered for minutes. Even so, something set it off, and decay or a crack is usually simpler to treat early. Our guide to how long a dental problem can wait may help you decide how soon.
Can a tooth with a dead nerve be kept?
Often, yes. Root canal treatment removes the dead tissue from inside the tooth, which can then be restored. Whether it suits a particular tooth depends partly on how much sound tooth is left.
Having a quiet tooth checked
If a toothache has stopped and you are not sure why, the team at Lumi Dental in Melrose Park can examine and test the tooth and take an X-ray if needed. We keep emergency appointments and are open Monday to Saturday, until 9pm on Thursdays, with Sunday appointments by arrangement. Visit our emergency dentist page or book online.
Sources
- Hennessy BJ. Pulpitis. MSD Manual Professional Version, reviewed August 2026. MSD Manual
- Michaelson PL, Holland GR. Is pulpitis painful? Int Endod J. 2002;35(10):829-32. PubMed 12406376
- Tibúrcio-Machado CS, Michelon C, Zanatta FB, et al. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. 2021;54(5):712-735. PubMed 33378579
- Agnihotry A, Thompson W, Fedorowicz Z, et al. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2019;5:CD004969. PubMed 31145805
- Mainkar A, Kim SG. Diagnostic accuracy of 5 dental pulp tests: a systematic review and meta-analysis. J Endod. 2018;44(5):694-702. PubMed 29571914
- Healthdirect Australia. Toothache and gum swelling, reviewed February 2026. healthdirect.gov.au
This article is general information only and is not a substitute for advice about your own situation from a dentist or doctor.
