Acute dental pain
Diagnose the source and provide definitive treatment when feasible. Analgesia supports care; antibiotics are not a substitute for local measures.
Understand
Toothache may be pulpal, periapical, periodontal, cracked-tooth or non-odontogenic. Symptom relief should be tied to an accurate diagnosis and a plan for definitive care.
Assess
Map pain triggers and duration, examine teeth and soft tissues, test likely sources and look for systemic signs or a swelling. Do not assume the tooth named by the patient is the source.
Apply
Provide appropriate local treatment, analgesic advice and follow-up or referral. Antibiotics are generally not indicated for uncomplicated dental pain without spreading or systemic infection.
Key distinctions
The first priority is to distinguish urgent red flags from a local dental source. A painful tooth may need pulpal treatment, extraction or drainage; analgesia alone is a bridge, not the endpoint. Non-odontogenic pain can imitate dental pain, so tests and examination should support any irreversible treatment. Give specific advice about which change should prompt urgent reassessment.
Think through a case
A patient describes severe tooth pain but has no swelling or fever. A focused pulpal assessment and local definitive plan is more useful than an antibiotic request.
The distinction to remember
Do not use symptom intensity as a proxy for bacterial spread or as an indication for antibiotics.
Test your recall
What should be examined before treating “toothache”?
Show answer
The tooth, soft tissues, occlusion and relevant differential diagnoses.