The thing that sets an on-and-off toothache going is often the best clue to its cause. Cold water, biting on one spot, waking up, a head cold and brushing near the gum each point in a different direction. None of these clues replaces an examination, but noting them before your appointment helps a dentist narrow things down quickly.
Whatever the trigger, pain that keeps returning usually means the cause is still there between episodes. Why it is worth acting while the pain is still intermittent is covered in our article on why the quiet spells still matter.
Cold, hot or sweet sets it off
A sharp twinge with a cold drink, ice cream or something sweet that fades once the food is gone often means dentine is exposed. That may be through early decay, a chipped or worn edge, or a filling that has started to leak. When the pain begins to linger for a minute or more, or a hot drink starts to cause a long ache, the nerve may be more inflamed, and it is worth being seen sooner.
It hurts when you bite on one spot
Pain that flashes when you bite on something firm, or as you let go, and is gone a moment later is typical of a cracked tooth. Fine cracks can be hard to see, even on X-rays, and may only cause pain when chewing flexes them. Dentists use bite tests on individual cusps, magnification and sometimes dye to find them. A high new filling or crown can also make one tooth sore on biting, usually soon after the work was done.
Short, sharp pain near the gum line
Brief stings with cold air, cold drinks or brushing close to the gum often come from exposed root surfaces where the gum has receded. Roots are covered by a thinner, softer layer than enamel and react more readily. Recession can be linked to gum disease, firm brushing or the natural position of the teeth.
Thinning enamel and on-and-off sensitivity
Acid from food, drink or reflux, and brushing too hard with a firm brush, can wear enamel down until the more sensitive dentine shows through. This tends to cause sensitivity that comes and goes with cold or sweet foods rather than a steady ache, often across several teeth.
The ache is worst first thing in the morning
Sore teeth or a tight jaw on waking that eases over the day is a common pattern with grinding or clenching during sleep. The discomfort is often spread across several teeth and the jaw muscles. Our article on bruxism in adults covers what tends to be behind it and what can help.
Several upper back teeth ache during a cold
The roots of the upper back teeth sit close to the floor of the maxillary sinus. A blocked or inflamed sinus from a cold or allergies can make those teeth ache, often several at once, and the ache may change when you bend forward or lie down. It usually fades as the sinus clears. If one tooth stays sore after the cold has gone, the tooth itself needs checking.
Triggers and their likely causes
This is a general guide only. Several causes can overlap in the same mouth.
| When the pain appears | A likely cause to check |
|---|---|
| Cold or sweet, fading within seconds | Early decay, a worn edge or exposed dentine |
| Hot or cold, lingering for a minute or more | An inflamed nerve; see a dentist soon |
| Biting on one spot, or releasing the bite | A cracked tooth or a high filling |
| Cold air or brushing near the gum | Gum recession and exposed root |
| On waking, easing through the day | Night-time grinding or clenching |
| Several upper back teeth during a cold | Sinus pressure |
Signs that mean seek care straight away
- swelling of the face, jaw, cheek or under the eye
- fever alongside the tooth pain
- severe pain that suddenly stops, which can mean the nerve has died
- difficulty swallowing or breathing, which needs a hospital emergency department
If the pain has been building gradually rather than stopping, our guide on how long a tooth abscess takes to form explains how infection develops. If you are wondering whether a badly damaged tooth can be kept, read is my tooth savable.
Questions we are often asked
Why does my tooth hurt only some of the time?
Most intermittent pain needs a trigger, such as temperature, biting pressure or lying down, and settles once the trigger is gone. The cause behind it, whether decay, a crack or exposed root, usually remains between episodes.
Can sinus problems really make teeth hurt?
Yes. Sinus pressure can be felt in the upper back teeth because their roots sit so close to the sinus. The ache normally eases as the sinus settles.
Should I keep a pain diary?
A few notes help: which tooth or side, what set it off, how long it lasted and whether it woke you. It saves time at the appointment and can point to the right tests.
Have a returning toothache checked
If tooth pain keeps coming back, it is worth having it looked at before it becomes harder to treat. Book with the team through Lumi Dental's general dentistry page, or see our current deals.
This article is general information and does not replace an individual dental assessment. If you have facial swelling, fever, or difficulty swallowing or breathing, seek urgent care immediately.
