It is late, the tooth is throbbing, and A&E is starting to look like the only door in town with its lights on. Here is the kind answer first: toothache is treated by a dentist, getting to one is simpler than it feels right now, and A&E is kept for a short list of things that are rarely what is happening in your mouth.
So let’s sit with this together for a few minutes. By the end you will know what the hospital is there for, why a tooth gets fixed in a dental chair, and exactly which door is yours, tonight and tomorrow.
Can I go to A&E with a tooth problem?
For a few tooth problems, yes, and A&E is exactly the right place for them. The short list is coming in a moment. For toothache on its own, nhs.uk points you to a dentist instead, and the reason is a kind one: a dentist is the person who can make it stop.
The NHS toothache page says it plainly. It tells you to see a dentist, and gives the why in the next breath: “They can treat the cause of the pain and stop any problems getting worse.” That is the whole thing, really. A painkiller turns the volume down. A dentist goes into the tooth and switches the noise off where it starts.
There is a line about your GP on the same page, and it is worth knowing before you ring the surgery in the morning: “Do not go to your GP as they will not be able to give you dental treatment.”
Now, here is the part that surprises people. Even severe pain is a dentist’s job, as far as the NHS is concerned. Its page on emergency dental care says to “ask for an urgent or emergency dental appointment or get advice from NHS 111 now” if “you have severe tooth or mouth pain that’s affecting your sleep or daily activities, and is not helped by painkillers like paracetamol or ibuprofen”. Read that again with your own tooth in mind. If the pain is keeping you up and the tablets are barely touching it, the NHS has already answered your question, and its answer is a dental chair.
Why is a toothache fixed in a dental chair?
You see, a toothache bad enough to send you searching at night usually starts inside the tooth. Right in the middle of every tooth is a soft core of nerve and blood vessels, sealed inside a hard shell. When that core gets inflamed, or an infection sets up at the root, it swells. Picture a sprained ankle, only this ankle is laced inside a ski boot: there is nowhere for the swelling to go, so it presses on the nerve, and that pressure is what you feel.
So the fix is letting the pressure out, and that means working on the tooth itself. A dentist numbs it first. Then the inflamed nerve is dressed or removed, which is the first stage of a root canal. If there is an abscess, it is drained, so the infection has a way out. The NHS website describes the abscess part in two short sentences: “Dental abscesses are usually treated by a dentist. The dentist will drain away the pus.” And it adds the line most people want to hear before anything else: “You’ll be given a local anaesthetic so you do not feel any pain.”
All of that happens in a dental chair, with the tooth numbed, lit, and x-rayed if it needs to be. That is why the NHS sends toothache to a dentist. A hospital is set up for a different job.
If part of you was hoping someone would simply hand over antibiotics, nhs.uk’s abscess page is clear about it: an abscess “needs urgent treatment by a dentist” and “will not go away on its own”. Antibiotics do appear on that page, as something you “may also be given”, and the full story of how long an abscess lasts with antibiotics, and what fixes it has its own page here.
When is A&E the right place for a tooth?
Here is the short list, and it really is short. On our own emergency page, under “Go to A&E or call 999 instead”, we name three things: a swelling of the face that is closing an eye, or making it hard to breathe or swallow; bleeding that will not stop after twenty minutes of firm pressure on a clean, folded cloth; and a blow to the face where the jaw may be broken, or where you were knocked out.
The NHS toothache page draws the same line for a swelling. It says “Go to A&E if you have toothache and” one of two things is true: “the area around your eye or your neck is swollen”, or “swelling in your mouth or neck is making it difficult for you to breathe, swallow or speak”.
Notice what all of those have in common. How much the tooth hurts appears nowhere on the list. Every one of them is about what is happening around the tooth, and that is what hospital care is for; the dental treatment comes afterwards, here or elsewhere.
Think of a breakdown on the motorway. If you have stopped somewhere dangerous, the recovery truck comes first and gets you safe, and the garage mends the engine later. A&E is the recovery truck for those few cases. An ordinary toothache, however fierce, has not left you on the hard shoulder, so you can drive straight to the garage.
And if you honestly cannot tell which side of the line you are on, nhs.uk has a sentence for that too: “If you’re not sure if you should go to A&E, call 111 or use 111 online to find out what to do.” You do not have to make that call on your own at two in the morning.
Where does tooth pain get treated, then?
With a dentist, and the doors are wider open than most people expect, because you do not need to be anybody’s patient first. The NHS puts the choice in one sentence: “If you need emergency or urgent dental care you can get advice from NHS 111 or contact a dentist and ask for an appointment.”
The first door is a dentist, and in Solihull that can be us. Designer Smiles is at 4 Manor Square in the middle of the town. In practice hours (Monday to Friday, 9am to 5pm) we set out to see anyone with a dental emergency the same day, and you do not need to have been here before. The emergency appointment is £27.90, the same figure as the NHS urgent charge, and it covers the examination and getting you out of pain. Ring 0121 709 3821 as early in the day as you can, because the earlier you ring, the sooner the slot. Nobody will ask you to justify why you are calling.
What happens in the chair comes in the order you would want. The tooth is numbed first, then the abscess is drained or the nerve dressed, and only then does anyone talk about the repair. Dressing or removing the nerve is £76.60 on our fee guide. You are not talked into treatment while you are in pain; you are given the plan to take away, with the fee guide’s price for each part, in writing. The permanent repair is booked for another day, usually within the fortnight. Whichever of our dentists is free first sees you, and all of them do the whole of general dentistry, so the repair is planned by the person who saw you in pain. How the same-day emergency appointment runs, step by step and with the prices beside it, is set out on our emergency page.
If you want the wider picture, how to be seen today in Solihull, the NHS route included, has its own page, and so does what an emergency visit and the treatment after it cost.
The second door is NHS 111, by phone or online, for when you do not have a dentist or cannot get an appointment. The NHS page on 111 opens with the sentence you want to hear at midnight: “NHS 111 can help if you think you need medical help right now.” Outside our hours, 111 can direct you to an NHS urgent dental service, and our own out-of-hours emergency appointment is £150. The evening and weekend options in Solihull are laid out on their own page.
What do I do tonight if the pain is unbearable?
Well, first of all, trust what your tooth is telling you. The NHS treats severe pain that is spoiling your sleep and not settling with painkillers as a reason to get help now, so you are not making a fuss. Ring a dentist as soon as one is open, and until then, NHS 111 is the way in.
While you wait, a pharmacist is a lovely person to know. The NHS website says: “If you’re in pain while waiting for a dental appointment, you can ask a pharmacist for advice on taking painkillers, such as paracetamol or ibuprofen.” Do what the pharmacist suggests and what the packet says, even at the worst moment of the night, because nhs.uk’s abscess page is firm on this one: “do not take more than the recommended dose of any painkiller”.
Small kindnesses to the tooth help too. The toothache page on nhs.uk suggests soft foods, “like yoghurt or scrambled eggs”, and says “do not eat foods that are sweet, very hot or very cold”. If you are lying awake with it, why toothache gets worse at night, and what helps you through it, is the next thing worth reading.
So here is the whole map in one breath. A&E is there for the few times a swelling, a bleed or a blow is about more than the tooth. Everything else that hurts, however much it hurts, is a dentist’s job: ring us on 0121 709 3821 and in practice hours we set out to see you the same day for £27.90, or use NHS 111 outside our hours. Getting you out of pain is exactly what that first appointment is for.
