Symptoms
Toothache: what to do, signs of infection and when to go to the ER
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Facial swelling spreading up toward the eye or down toward the neck
- Trouble swallowing or breathing, or drooling
- Swelling under the tongue
- High fever or feeling very sick
- Jaw or tooth pain with chest pain, shortness of breath or sweating
Help lines
A toothache usually comes from a cavity or an infection, and a dentist fixes it. Until you get an appointment, the doctor sees you by video, helps with the pain, looks for signs that an infection is spreading and, if appropriate, prescribes. Go to the ER if your face swells toward the eye or neck, or you have trouble swallowing or breathing.
Other names: Tooth pain, Dental pain
Possible causes
Cavity (tooth decay)
Pain with cold, sweets or biting; a dentist treats it
Tooth abscess (infected tooth)
Severe constant pain, fever, swollen gum or jaw
Cracked or worn tooth
After an injury, or from grinding your teeth
Sinusitis
Upper-tooth pain with facial pressure
Ear pain
Pain felt in the jaw or teeth
Heart attack
Jaw or tooth pain with chest pain: call 911
On this page(8)
What causes a toothache?
According to MedlinePlus, the most common causes are cavities and infections. A tooth abscess is a pocket of pus at the root or in the gum, and it causes a severe, constant pain that doesn’t stop. Other causes include a cracked or worn tooth, an injury to the mouth or jaw, sinusitis, or ear pain felt in the teeth.
One cause isn’t in the mouth at all: a heart attack can feel like pain in the jaw, neck or teeth. If the pain comes with chest pain or pressure, shortness of breath or sweating, call 911.
Toothache: what we do by video and what needs a dentist
You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks when the pain started, whether it wakes you at night, whether you have fever or swelling, whether it’s hard to open your mouth or swallow, and what medicines you take. With good light she looks at your mouth, gums and face.
She then helps you control the pain, tells you which over-the-counter pain relievers are safe for you given your other conditions, and looks for signs that an infection is spreading. If she finds signs of an abscess, if appropriate, the doctor prescribes an antibiotic and we send your prescription to your pharmacy. We do not prescribe controlled substances, including opioid painkillers.
The tooth itself needs a dentist. An antibiotic can control the infection for a while, but it doesn’t fix the cavity or the abscess: that takes a root canal, a filling, drainage or an extraction, done by a dentist in person. So we refer you to a dentist and tell you how soon to go. Puerto Rico has 99 dental health professional shortage areas, according to HRSA, so getting an appointment can take time; a video visit helps in the meantime.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer. A flashlight helps show the tooth.
Get your plan.
A plan for the pain and, if appropriate, a prescription we send to your pharmacy. We refer you to a dentist for the tooth.
What a toothache visit costs
A toothache visit is a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. The dentist charges for their treatment separately. See all prices or virtual urgent care.
Signs of an infected tooth
According to MedlinePlus, a tooth abscess can cause:
- Severe, constant pain that doesn’t stop
- Fever
- Swollen gums or a bump (like a pimple) on the gum
- Swelling of the jaw
- A bitter taste in the mouth or bad breath
What to do for a toothache until you see the dentist
MedlinePlus recommends over-the-counter pain relievers if you can’t see a dentist right away, and warm salt-water rinses if there is an abscess. Take pain relievers as the label directs, and ask the doctor first if you have kidney or stomach problems or take blood thinners.
See a dentist soon if the pain is severe, lasts more than a day or two, or comes with fever, ear pain or pain when opening your mouth wide. To prevent cavities: brush with fluoride toothpaste, floss, eat less sugar and keep up with cleanings.
When a toothache is an emergency
For your safety, go to the emergency room or call 911 if you have any of these signs. A tooth infection that spreads to the floor of the mouth and the neck (Ludwig angina) can block the airway, according to MedlinePlus. See when to go to the ER.
- Facial swelling spreading up toward the eye or down toward the neck
- Trouble swallowing or breathing, or drooling
- Swelling under the tongue, or the tongue pushed up
- High fever or feeling very sick
- Jaw or tooth pain with chest pain, shortness of breath or sweating
Frequently asked questions
Can I get an antibiotic for a tooth infection by telehealth?
What can I take for a toothache?
When is a tooth abscess an emergency?
Can a toothache come from the heart?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (5)
- Toothaches (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Tooth abscess (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Ludwig angina (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Heart attack (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- HRSA Fact Sheet FY 2024: Puerto Rico (HRSA) (opens in a new tab) (accessed 2026-10-02)