A Child's Toothache

Have A Dental Exam To Figure Out The Real Cause

Dear Doctor,
What should I do if my child has a toothache?

Dear Jan,
A child's toothache (absent a fever and facial swelling) is not generally a symptom of an emergency. First, try to get your child to show you exactly where the pain is coming from and get a little history about how long it's been hurting and possible causes. Children are notoriously poor historians, so you might have to do a little sleuthing to find out what's wrong.

A dentist should evaluate any tooth pain that keeps a child awake at night or persists into the next day, because it could indicate a dental problem that will only become worse if left untreated. What follows are some helpful hints in the meantime.

The most common cause of dental pain is tooth decay, which is a bacteria-induced infection. Examine the tooth or teeth to see if there are any obvious brown spots or cavities (tiny holes), which will be more easily seen on the biting surfaces or between the teeth. Next, look at the gum surrounding the tooth and the nearby inner areas of the mouth to see if there are any sores or swelling. In the absence of a dental injury, a swelling could mean an abscess as a result of a nerve infection caused by tooth decay. Sometimes a child might mistake pain near a tooth as pain in a tooth, and having a look around might offer some clues that you can mention to your dentist.

If you don't see anything unusual, the next step is to help your child gently floss on either side of the hurting tooth. This may free a food particle or piece of candy that might be stuck, causing uncomfortable pressure. If discomfort is still evident, take steps to relieve your child's symptoms.

Here are some things you can do to ease the pain of a toothache, or any discomfort in the mouth — at least temporarily:

• Ibuprofen or acetaminophen can be given in a dose appropriate to your child's age and weight. If cleaning between the teeth to remove debris and ibuprofen or acetaminophen stops the pain within an hour, then you can wait until the next day to book an appointment with your dentist.
• Apply an ice pack against the jaw, especially if there is swelling. Apply on the outside — on and off for a minute or two at a time, being careful not to burn the cheeks or soft tissues with the ice. If these two measures do not stop the pain, then a dental abscess is likely developing and a dentist should be seen the same day or next morning.

Under no circumstances should you rub aspirin (or any other painkiller) on your child's gum — it is very acidic and can cause burns, creating pain rather than relieving it. Rubbing or rinsing with whiskey or any other type of alcohol is also not appropriate. This Civil War-era remedy is not helpful for adults either; alcohol has no value as a local anesthetic and will not cure an infection in the mouth.

If there is no sign of dental caries (tooth decay) ask your child if there was a recent injury he or she neglected to mention. Look for obvious signs of trauma like chipped teeth or fractures. A blow or injury to a front tooth, for example, may not affect the lips or tongue, but may damage the tooth or nerve inside the tooth. Even if there appears to be nothing wrong, the living pulp tissue inside the tooth can die if traumatized; likewise even if immediate pain is relieved, an infection without symptoms could begin in the pulp.

Check for obvious damage to the soft tissues of the lips and tongue associated with trauma, including minor cuts, scrapes, and bruises that will require pain or milder discomfort control. Don't forget to clean minor wounds and abrasions with mild soap and antiseptic to make sure they're clean. And, of course, the immediate reaction to shock and trauma requires good old-fashioned TLC.

Even if you are successful at relieving a toothache or other pain in the mouth, unless you're absolutely sure that you know what caused it, you need to see your family dentist or a pediatric dentist.

Bottom line: Even if you are successful at relieving a toothache or other pain in the mouth, unless you're absolutely sure that you know what caused it, you need to see your family dentist or a pediatric dentist. A professional look by a trained eye backed by years of study and experience can pinpoint a problem and identify a real solution. This is the only way to both treat the toothache and put your mind at rest. That's why it's important for anyone — adult or child — to see the dentist if tooth pain does not resolve itself within a day. Today's minor cavity can turn into tomorrow's painful abscess.