Deep decay reaching the nerve
When a cavity breaks through the dentine into the pulp, bacteria inflame the nerve inside a rigid chamber with nowhere to expand. The result is a pressure-type ache that builds in the evening and reacts sharply to heat.
Wimpole Street opens 1 October 2026. For a dental emergency today, call South Kensington 020 7183 2362 (open 7 days) or St Paul's 020 7183 3709 (Mon–Fri).
South Kensington
Open seven days a week
St Paul's, City of London
Open Monday to Friday
Emergency dentistry · Wimpole Street, Marylebone
Severe toothache: emergency relief in Marylebone
A tooth that throbs through the night, wakes you at three in the morning or will not let you chew on one side has usually moved past the stage where a filling alone will settle it. Our emergency visit is built around finding the offending tooth quickly, numbing it, and dealing with the source of the pain rather than sending you away with painkillers alone. From 1 October 2026 that care will run from 22 Wimpole Street; until then, the same dentists see toothache cases daily at South Kensington and St Paul’s.
Before you are seen
Right now: what to do
- 01
Take an over-the-counter painkiller as directed on the pack. Ibuprofen is often more useful for dental pain than paracetamol, and the two can be alternated if the pharmacist confirms both are suitable for you.
- 02
Rinse with warm salt water (a teaspoon in a glass) and let it sit on the sore side for thirty seconds. This clears debris from any cavity and eases inflamed gum.
- 03
Floss gently around the tooth. A trapped fibre of food or a popcorn husk wedged under the gum can mimic a serious toothache and disappears the moment it is removed.
- 04
Sleep with your head raised on an extra pillow. Lying flat increases blood pressure in the head and often makes a pulpal toothache pound harder.
- 05
Avoid anything very hot, very cold or sugary on that side. Note which one sets the pain off and how long it lingers; that detail helps the dentist reach a diagnosis faster.
- 06
Do not put aspirin, clove oil or anything else directly on the gum. Aspirin burns soft tissue and the resulting ulcer adds a second problem to the first.
Take any painkiller only as directed on the pack, never place aspirin against the gum, and ask a pharmacist if you already take other medicines.
Diagnosis
What's likely causing it
Cracked or fractured tooth
A hairline crack, often in a heavily filled molar, flexes each time you bite and releases as you let go. The classic sign is a sharp jolt on chewing that vanishes instantly, with little or no pain at rest.
Abscess at the root tip
Once the nerve has died, infection collects around the end of the root. The tooth feels raised in its socket, hurts to touch and may be accompanied by a gum swelling or a bad taste.
Failing filling or crown
Leaking margins under an old restoration let fluid and bacteria reach the dentine. Sensitivity to cold that lingers for a minute or more suggests the nerve underneath is struggling.
Gum infection or food impaction
A pocket of infected gum beside a tooth, or something trapped between two teeth, causes a dull, localised ache that eases dramatically once the area is cleaned out.
Referred pain
Sinus congestion, jaw joint strain and clenching can all masquerade as toothache, particularly in upper back teeth. Part of the emergency visit is ruling these out before any tooth is touched.
At the clinic
How the emergency visit runs
- Step 1
History
We ask what triggers the pain, how long it lasts and what it feels like. Those three answers usually narrow the field before we look in your mouth.
- Step 2
Examination and X-ray
Each suspect tooth is tested for tenderness, mobility and response to cold; a digital X-ray shows decay, cracks and infection at the root.
- Step 3
Numb the area
Local anaesthetic goes in as soon as the tooth is identified, so the rest of the appointment is comfortable and you leave with the pain switched off.
- Step 4
Deal with the source
That may mean removing decay and placing a dressing, opening the tooth to relieve pressure, starting root canal treatment or, if it cannot be saved, an extraction.
- Step 5
Plan the follow-up
You leave with a written plan and price for anything that still needs finishing, plus clear advice on what to do if the pain changes overnight.
Fees
Emergency fees
Toothache costs vary more than almost any other emergency because the fix ranges from a simple dressing to a molar root canal and crown. The assessment fee covers finding out which you need.
| Item | Fee |
|---|---|
Emergency assessment New-patient rate (usual fee £95). Includes examination and diagnosis. | £30 |
Digital X-ray Per image, where clinically needed. | £20 |
Sedative dressing or temporary filling Stabilises the tooth until definitive treatment. | from £95 |
Composite filling Where decay has not reached the nerve. | from £185 |
Root canal treatment Front tooth from £695, premolar from £795, molar from £895. | £695–£895 |
Extraction Simple from £250; surgical from £650. | £250–£650 |
Crown after root canal Recommended for most back teeth once treated. | from £995 |
Indicative prices for Wimpole Street, identical to our South Kensington and St Paul's clinics. Whatever is recommended is set out in writing, with the cost, before any treatment starts.
Once you are home
Afterwards
- Expect some tenderness for two or three days after a dressing or root canal is started; ibuprofen taken as directed usually keeps it manageable.
- Chew on the other side until the tooth is definitively restored. A dressed or opened tooth is weaker than it looks.
- If antibiotics were prescribed, finish the course even when the pain has gone, and contact us if you develop a rash or diarrhoea.
- Keep the follow-up appointment. A tooth that has stopped hurting after emergency treatment has been quietened, not fixed.
- Ring the clinic if the swelling grows, the pain returns to its original level or your temperature goes up.
- Once settled, book a routine examination so the neighbouring teeth can be checked for the same problem.
FAQ
Questions patients ask
Lying flat raises the blood pressure inside the head slightly, and an inflamed nerve inside a rigid tooth has no space to accommodate that extra pressure. There are also fewer distractions at night, so the ache feels louder. Propping yourself up on two pillows helps many patients get through until morning.
Wimpole Street is not yet open, so today’s emergencies go to our South Kensington clinic, which keeps emergency slots seven days a week, or St Paul’s on weekdays. Both offer same-day emergency appointments where the diary allows; phone first and we will hold a time for you.
Usually not. Most severe toothaches are caused by an inflamed or dying nerve, and root canal treatment removes the pain while keeping the tooth. Extraction is reserved for teeth that are split below the gum, have lost too much structure to restore, or where you decide against root canal after hearing the options.
Antibiotics cannot reach the inside of a tooth where the infection started, so on their own they buy a few days at most and the pain returns. They are prescribed alongside treatment when there is spreading swelling or you are unwell, not as a substitute for dealing with the tooth.
Not necessarily. When a nerve dies completely the sharp pain often stops, but the dead tissue then becomes a food source for bacteria and an abscess follows, sometimes weeks later. A tooth that hurt badly and then went silent still needs an X-ray.
Tell us when you book. The first visit is mainly about diagnosis and switching off the pain with local anaesthetic; nothing further happens without your agreement. Longer treatments can be scheduled with extra time and, where appropriate, sedation.
Also on this site
Other emergencies we treat
Marylebone, W1
Emergency care at Wimpole Street from 1 October 2026
Register your interest and we will contact you as the Marylebone diary opens. Anything that hurts today should go to South Kensington or St Paul's, where the same clinicians keep emergency slots each day.
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.
Until we open
Need an appointment before 1 October 2026?
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.
South Kensington
- 20 Old Brompton Road, London SW7 3DL
- Open seven days a week
- 020 7183 2362
St Paul's, City of London
- 5 Ave Maria Lane, London EC4M 7AQ
- Open Monday to Friday
- 020 7183 3709
