Toothache in child patients is often caused by decay, food trapped between teeth, an injured tooth or an infection. You can ease discomfort safely at home for a short time, but swelling, fever, repeated night waking or dental trauma needs prompt professional care.
Why does my child have toothache?
The most common reason is tooth decay. A cavity may start with sensitivity to cold or sweet food, then progress to aching, pain while chewing, or pain that starts without any food touching the tooth. If the decay reaches the inner part of the tooth, the pain can become strong and may wake a child from sleep. You can read more about cavities in milk teeth, including why baby teeth still need treatment.
Sometimes the problem is much simpler. A piece of fibrous food, popcorn, meat substitute, seed or other food can become tightly wedged between two teeth and press on the gum. The child may point to a tooth even though the gum between the teeth is actually sore.
A chipped or broken tooth after a fall can also hurt. The tooth may look only slightly damaged, but the nerve inside can still be irritated. An erupting tooth can cause soreness too, especially when a new back tooth is pushing through the gum. In younger children, teething usually causes gum discomfort rather than severe, localised toothache.
An abscess is more serious. This happens when infection develops around a tooth or its root. You may see a gum swelling, a small pimple-like spot, facial swelling, fever, a bad taste, or pain on biting.
Occasionally, pain from the ear or sinuses can feel as if it is coming from a tooth. That is one reason an examination matters when you cannot see an obvious dental cause.
What can I do for child tooth pain at night?
If your child wakes with tooth pain, first stay focused on comfort and on checking for warning signs. A home remedy for child toothache should only be a temporary measure until the cause can be checked.
- Ask your child to point to the sore area. Look for swelling, a broken tooth, a visible cavity or food trapped between the teeth. Gently brush the area and clean between the teeth with floss if you can do so without forcing it. Put a cold compress on the outside of the cheek for short periods. Offer soft food and frequent fluids. For pain relief, use children's paracetamol or ibuprofen only in the dose advised by your doctor or stated on the pack for your child's age and weight.
Do not guess a dose, and do not use an adult painkiller just because you have it at home. If your child is dehydrated, has a medical condition, takes other medicines, or has previously been told not to take ibuprofen, ask a doctor or pharmacist before giving it.
Child tooth pain at night often feels worse because there are fewer distractions and the child is lying down. Repeated waking, however, can also mean the tooth is significantly inflamed. If pain keeps returning through the night, arrange a dental assessment rather than repeatedly treating only the pain.
What should I never put on a child's tooth or gum?
Never place aspirin directly on a child's tooth or gum. It can damage the soft tissues and is not a safe way to treat dental pain.
Do not put clove oil, pain-relief gels meant for adults, crushed tablets, tobacco, alcohol, balm, toothpaste mixtures or other strong pastes directly on the sore area. These can irritate or burn the gum, and they do not remove decay or infection.
Also, do not ignore a toothache simply because it suddenly settles. Sometimes pain becomes quieter after the nerve inside a badly decayed tooth has been damaged. The original problem may still be present and infection can develop later.
When is a child's toothache urgent?
Some toothaches can be seen during normal clinic hours. Others need prompt assessment because infection or injury can spread or affect eating, drinking and the tissues around the face.
| Sign | Likely cause | What to do |
|---|---|---|
| Pain with a visible cavity, but no swelling or fever | Tooth decay | Give age and weight appropriate pain relief and arrange a dental visit soon |
| Pain after food is stuck between teeth | Gum pressure or irritation | Gently floss and clean the area, then get checked if pain continues |
| Swollen cheek, gum swelling or fever | Dental abscess or spreading infection | Seek urgent dental care the same day |
| Swelling near the eye, difficulty opening the mouth, trouble swallowing or breathing | Spreading infection | Seek urgent medical or dental emergency care immediately |
| Tooth broken, pushed-in or knocked-out after a fall | Dental trauma | Contact a dentist urgently for injury-specific advice |
| Repeated night waking because of tooth pain | Deep decay or nerve inflammation | Arrange prompt dental assessment |
A swollen cheek in a child should not be watched for several days to see what happens, especially if there is fever or the swelling is increasing. If your child refuses to drink, seems unusually sleepy, has swelling around the eye, struggles to swallow or breathe, or looks seriously unwell, seek urgent medical help.
A knocked-out or pushed-in tooth after a fall is also a kids dental emergency. Do not try to push a baby tooth back into its socket. If a permanent tooth has been completely knocked out, handle it by the crown rather than the root, avoid scrubbing it, keep it moist, and get urgent dental advice. Our page on dental emergencies explains what to do for common injuries.
What will the dentist do for the toothache?
We start by asking where the pain is, when it began, what triggers it, whether it wakes the child, and whether there has been swelling, fever or an injury. We then examine the teeth, gums and bite. An X-ray may be needed if we suspect deep decay, infection between the teeth, root involvement or trauma that cannot be judged by looking alone.
Treatment depends on the cause. Early decay may be treated with a filling. If decay has reached the nerve of a milk tooth, a nerve treatment for the baby tooth may sometimes allow us to keep it until it is ready to fall naturally. If the tooth cannot be saved, extraction may be recommended. Depending on the child's age and which tooth is removed, a space maintainer may be considered so the neighbouring teeth do not drift into the gap.
If there is an abscess, the infection may need drainage and the source tooth still needs treatment. Antibiotics are not a substitute for treating the tooth itself. They are used when the dentist or doctor believes they are needed because of spreading infection, fever or other clinical signs.
Children usually cope better when the appointment is calm, clear and suited to their age. Our children's dentistry page explains the kind of care we provide, and this guide to choosing a kids' dentist can help if your child is anxious or has never had dental treatment before.
How can I reduce the chance of another toothache?
Brush twice a day with fluoride toothpaste and supervise brushing until your child can clean thoroughly on their own. For children under 3, use a small smear of toothpaste. From 3 to 6 years, a pea-sized amount is usually appropriate, unless your dentist advises differently. Encourage the child to spit out the toothpaste rather than swallow it.
Try to keep sugary snacks, biscuits, sweets, juice and sweet drinks to mealtimes rather than offering them repeatedly between meals. Frequent sugar exposure gives decay more chances to start, even when the total amount does not seem large.
Regular dental check-ups can pick up early decay, weak enamel, erupting teeth and cleaning problems before they turn into an evening emergency. If your child has tooth pain now, especially pain that is waking them, swelling or fever, you can call the clinic to arrange an assessment at our IIM Road clinic in Lucknow.
Frequently Asked Questions
Can my child wait until morning if the toothache starts at night?
If the pain is mild, there is no swelling or fever, your child is drinking normally, and there has been no dental injury, you can usually use age and weight appropriate pain relief and arrange a dental visit the next day. Facial swelling, repeated waking, fever, eye swelling, trouble swallowing or breathing, or a knocked-out tooth needs more urgent help.
What pain medicine can I give for a child's toothache?
Paracetamol or ibuprofen can be used for many children, but only in the dose advised by your doctor or shown on the pack for the child's age and weight. Use a children's formulation and do not guess from an adult tablet. If your child is dehydrated, has other medical problems, or takes regular medicines, check with a doctor or pharmacist first.
Why does my child's tooth hurt more at night?
Tooth pain can seem stronger at night because the child is lying down and there are fewer distractions. Deep decay or inflammation of the nerve inside the tooth can also cause throbbing pain that wakes a child. If the pain repeatedly interrupts sleep, it should be assessed rather than managed with pain medicine night after night.
Can a milk tooth need nerve treatment or extraction?
Yes. A deeply decayed milk tooth may sometimes need nerve treatment so it can stay in place until it is ready to fall naturally. If the tooth cannot be restored, extraction may be the safer option. Depending on the child's age and the tooth involved, the dentist may also discuss a space maintainer after removal.