Toothache is not a single diagnosis. It is the nerve inside a tooth, or the tissues around it, reporting that something is wrong, and the character of the pain tells us a great deal about what. A brief jolt with cold that vanishes at once means exposed dentine. An ache that starts with cold or sweet and then lingers for a minute or more means the pulp is inflamed and may or may not recover. Pain that arrives on its own, throbs, and is worse lying flat means the pulp is dying or has died. A tooth that hurts to press on, with the surrounding gum tender, means infection has reached the bone at the root tip. Pain only when biting down or letting go points to a crack. And some toothache is not from a tooth at all: sinus congestion, jaw muscle spasm and, rarely, nerve or heart conditions can all be felt in the teeth. Our Wimpole Street dentists take the history seriously before touching anything, because the pattern, more than the X-ray, tells us what will actually stop the pain.
Sharp twinge with cold that stops at once
Exposed dentine or a small early cavity; the nerve is healthy.
Pain with hot or cold that lingers for a minute or more
Reversible or irreversible pulpitis depending on how long it lasts and whether it comes on spontaneously.
Spontaneous throbbing, worse at night or bending forward
Irreversible inflammation or a dying nerve; root canal or extraction will be needed.
Tooth tender to tap or bite, feels taller than the others
Inflammation or infection at the root tip; often a stage after the nerve has died.
Sharp pain on biting that releases suddenly
Cracked tooth, or a filling flexing under load.
Ache across several upper back teeth, worse leaning forward, with a cold
Sinusitis referring pain to the teeth whose roots sit under the sinus.
By far the most common cause. Bacteria advance through dentine and irritate the pulp long before they reach it; once they do, the pulp becomes inflamed inside a rigid chamber with no room to swell, which is why the pain can be so intense.
Cracks let fluid and bacteria into dentine and flex under biting force. The classic story is a sharp pain when biting on something, often on release, in a heavily filled molar, with an X-ray that looks normal.
A restoration that has lost its seal allows decay to develop underneath or cold to reach the dentine. A recently placed filling that is slightly high in the bite causes bruising of the ligament and a tooth that aches every time you chew.
Once the pulp dies, bacteria multiply in the canal and leak into the surrounding bone, producing pressure, tenderness on biting and, if it progresses, swelling. Antibiotics alone do not resolve it.
A periodontal abscess, food wedged deep beside a tooth, or an inflamed gum flap over a partly erupted wisdom tooth all produce pain that patients describe as toothache, although the tooth itself may be healthy.
Sinus infection, jaw muscle spasm from clenching, trigeminal neuralgia and occasionally cardiac pain can be felt in the teeth. When testing cannot find a tooth to account for the symptoms, we look wider rather than treat a healthy tooth.
These are holding measures, not a substitute for an examination. Use any pain relief exactly as directed on the pack and check with a pharmacist if you take other medicines.
We take a detailed history of the pain, test the suspect teeth with cold, tapping and pressure, and X-ray to locate decay, cracks and infection. Pain is settled at the first visit with a dressing, drainage or removing the cause.
About this treatmentDecay that has not yet inflamed the pulp beyond recovery is removed and the tooth restored with bonded composite, which usually ends the pain within days. From £185.
About this treatmentWhen the pulp is irreversibly inflamed or dead, the canals are cleaned, disinfected and sealed. Relief from the throbbing is typically immediate once the inflamed tissue is removed. £695 front tooth, £895 molar.
About this treatmentA cracked tooth, or a tooth that has been root treated, is held together and protected with a laboratory-made restoration. £995.
About this treatmentWhere a tooth is split, has too little structure left or the patient prefers not to save it, removal ends the pain reliably, from £250. Replacement options are discussed once healed.
About this treatmentA new filling or crown that is fractionally high is adjusted in minutes, and the bruised ligament settles over a few days.
About this treatmentAn emergency appointment at Wimpole Street, including X-rays and initial pain relief such as a dressing or drainage, is expected to be around £95. Where the cause is decay with a healthy nerve, a white filling from £185 completes the treatment. Root canal treatment is £695 for a front tooth and £895 for a molar, with a protective crown afterwards at £995 for back teeth.
Extraction is from £250, with surgical removal quoted up to £650. We set out the options for the tooth, including saving versus removing it, with fees and prognosis in writing at the emergency visit, so that the definitive treatment can be booked with a clear picture.
Figures are indicative prices for Wimpole Street and are confirmed in a written plan once a dentist has examined you. Fees match our South Kensington and St Paul's clinics.
Leave your details and we will be in touch when the Marylebone diary opens. If the problem cannot wait, the same clinicians are already seeing patients in South Kensington and at St Paul's.
Related conditions
Opening 1 October 2026
Wimpole Street is not yet seeing patients. Until then, please book or call our South Kensington clinic on 020 7183 2362 or our St Paul's clinic on 020 7183 3709. Questions about the new clinic: wimpolestreet@md.co.uk.
The same clinical team already works from two other Medical & Dental clinics. Book at either one now and, if you prefer, move your ongoing care to Wimpole Street once the doors open.
