My Child Has a Toothache: What to Do at Home and When to Call

It often starts at bedtime: "Mama, my tooth hurts." A toothache can make a child miserable and leave parents unsure what to do. Most toothaches are not emergencies, but they almost always mean something needs checking. Here is how to help tonight, and when it can't wait.

First steps at home

1. Have a look. Use a phone torch to check for food stuck between teeth, a dark spot or hole, a broken tooth, or a swollen gum.
2. Rinse with warm water. For children old enough to swish and spit, a gentle rinse can wash away trapped food and soothe the area.
3. Floss gently. A popcorn husk or a piece of meat wedged between teeth can cause surprising pain. Slide floss gently around the tooth, without forcing it into the gum.
4. Use a cold compress on the outside of the cheek. Wrap ice or a cold pack in a cloth and hold it against the cheek for 10 to 15 minutes at a time. This can ease pain and swelling.
5. Give pain relief if needed. Paracetamol or ibuprofen made for children can help. Always use the dose for your child's age and weight on the package, or as your pharmacist or doctor advises.
6. Offer soft, lukewarm food and avoid very cold, hot or sweet foods for now. Encourage chewing on the other side.

What to avoid

• Never put aspirin or any painkiller tablet on the gum or tooth. It does not work that way and can burn the soft tissue. Aspirin is also generally not recommended for children.
• No heat on the face. A warm compress can make an infection spread or swell more.
• Don't use numbing gels in young children unless your doctor or pharmacist has advised one. Some are not safe for little ones.
• Don't rely on pain relief alone. The cause is usually still there.

Why children get toothaches

In children, toothache is most often caused by tooth decay. When a cavity reaches the inner part of the tooth (the nerve), it can become painful or infected. Other common causes include:

• Food trapped between teeth or under the gum
• A cracked or chipped tooth after a fall or knock
• Sensitive teeth or worn enamel
• A new adult tooth coming through, especially the six-year molars

The type of pain can give your dentist clues. Pain only when eating sweets or cold drinks often points to early decay or sensitivity. Pain when chewing or biting may mean a cracked tooth or deeper decay. Pain that wakes your child at night or throbs on its own usually means the nerve is involved and the tooth needs to be seen soon.

When to seek urgent care

Go to urgent care or the emergency department straight away, or call 998 in an emergency, if your child has:

• Swelling of the face or jaw, especially if it is spreading
• Swelling near the eye, or the eye is hard to open
• Fever together with tooth pain or swelling
• Trouble swallowing, breathing or opening the mouth
• Seems very unwell, drowsy or unusually irritable

These can be signs of a spreading dental infection, which needs prompt treatment.

When to book a dental visit soon

Call your dentist within a day or two if:

• The pain keeps coming back, or wakes your child at night
• It hurts to chew or bite
• You can see a hole, dark spot or broken tooth
• There is a small pimple-like bump on the gum (a sign of infection)
• The pain started after a fall or injury to the mouth

Book a visit even if the pain stops. A toothache that settles on its own does not always mean the problem has healed. Sometimes the nerve inside the tooth has died, and an infection can develop quietly. Treating a tooth early is usually simpler and more comfortable for your child than waiting.