Tooth Nerve Pain – Guide

Written & Reviewed by Dr David Chen

Tooth nerve pain is a dental condition in which your tooth feels pain, discomfort or sensitivity that originates from the tooth pulp. What you feel can range from mildly irritating to unbearably painful where you can’t even get a wink of sleep.

tooth abscess

There can be a variety of causes and present with a plethora or symptoms. However, what remains consistent is that this condition will force you to seek treatment whether professionally or with home remedies.

This is a guide for everything that you need to know about nerve pain stemming from the tooth and what you need to do about it.


The symptoms for tooth nerve pain are many since there is an immense amount of etiologies. A common theme among them is an unpleasantly discomforting sensation.

Signs and symptoms:

  • Temperature sensitivity (hot or cold)
  • Sensitivity to acidic foods or beverages (spicy, sour, sweet)
  • Sharp pain in one tooth
  • Dull ache along gum line
  • Throbbing pain like a heart beat
  • Pain that comes and goes
  • Constant dull toothache
  • Unbearable that feels like it may kill you
  • Spontaneous tooth pain
  • Pain that wakes you up at night
  • Lingering toothache
  • Discomfort only while eating or drinking

There can be more signs but a tell tale sign is if NONE of your home remedies are working for your toothache.


The etiologies of tooth nerve pain are many but we’ll attempt to list them all.

  • Tooth decay (cavities)
  • Dental abscess or infection
  • Exposed dentin
  • Exposed tooth nerve
  • Exposed tooth root
  • Receding gum line
  • Defective restoration (worn filling or broken crown)
  • Chipped, cracked, or broken teeth
  • Enamel erosion
  • Recent dental work (fillings or crowns)
  • Use of teeth whitening
  • Brushing teeth too hard
  • Pressure from clenching or grinding your teeth

All of these causes in some way shape or form affect the nerve of your tooth.


The reason you’re having pain in the tooth nerve is because the pulp is inflamed and that is called pulpitis (nerve inflammation). However, there are two types of pulpitis.

  • Reversible pulpitis. The nerve inflammation or pain is only triggered when a stimulus is present. In other words, if you’re not doing anything it shouldn’t bother you.
  • Irreversible pulpitis. The nerve inflammation or pain can be triggered regardless of whether or not a stimulus is present. The best description would be spontaneous.

How your dentist diagnoses it

It is important to get the diagnosis right because it dictates the type of treatment that you will need. Your dentist uses a comprehensive oral examination to arrive at the diagnosis.

Endo Ice
cold test for vitality

How it gets diagnosed:

  • Clinical history by patient’s recount
  • Visual exam
  • Palpation – response to touch
  • Percussion – response to tapping
  • Vitality test – cold test or electric pulp test
  • Take an x-ray (PA and bitewing)

Taking into consideration the results from all of the above tests, your dentist will be able to tell you which type of pulpitis that you have. Consequently, it will determine the treatment that you need.


If your tooth nerve pain is due to irreversible pulpitis, only professional treatment can resolve your toothache. On the other hand, pain in the tooth nerve stemming from reversible pulpitis can be temporarily relieved with home remedies. However for permanent treatment it would still require your dentist’s assistance.


Treatment for tooth nerve pain depends on which layers of your tooth has been compromised. There is the enamel, dentin, and pulp but you also have the gums covering the root surface The etiology of the pain is typically a result of one or more of the layers becoming compromised.

Tooth Anatomy - Mouthhealthy
Credit: Mouthhealthy – ADA

Treatment for each affected layer:

  • Enamel treatments – dental fillings or bondings to repair and restore the enamel.
  • Dentin treatments – dentin can be restored with dental fillings (small defects) or with crowns for medium-large defects.
  • Pulp treatments – an affected nerve can only be treated with root canals or extractions.
  • Gum treatments – gum recession can be fixed by regrowing the gum with gum grafting.

Home remedies

The purported home remedies are too numerous to list but they encompass using willow bark, clove oil, and even painkillers. Essentially if they can be purchased and used at home they will qualify.

We’ve compiled a comprehensive list of home remedies for toothaches, where we rate their effectiveness based on three properties. However, you should know that even if they can alleviate your tooth pain, relief is only temporary in nature. For a permanent fix, you should seek out professional dental treatment with the dentist.


As long as you’ve the correct diagnosis, your dentist will be able to provide you the correct treatment. Complications are not expected.

However, complications can arise if the diagnosis was wrong which means that the treatments were all wrong. Put another way, they will be ineffective if you’re treating the wrong condition. What you’ll find is continued pain or a toothache that doesn’t go away.

The most common complication is the patient insisting on reversible pulpitis treatment when they have irreversible pulpitis. Typically the latter requires a root canal (endodontic treatment) or an extraction but they don’t want to go through with it. We often get asked, “But doc, can’t you just put a filling in it?”

Sure, we can put a filling in it but you’ll still be in pain.


Sometimes this condition can be inevitable but you can do your best to minimize the chances of it happening by practicing good oral habits.

  • Brush twice a day with a remineralizing toothpaste (fluoride or hydroxyapatite).
  • Floss and use mouthwash.
  • Routine dental check ups to catch problems while they’re small.
  • Avoid sugary and acidic foods.

If you manage to do all of the above, you can potentially prevent tooth nerve pain. If you’ve ever experienced the condition before, it can be excruciatingly painful.


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Long Island City, NY 11101

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Our purpose at afterva, is to encourage you to seek in person care with a doctor. It's not meant to be a substitute for medical advice.

A lot of nuances cannot be detected without an in-person clinical exam, which means it is near impossible to diagnose and treat virtually.

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