Is that dental pain an emergency?

Agonizing tooth pain, sharp jaw discomfort, a dull ache in your gums — each one is a sign of dental trouble or something even more serious. Unfortunately, many people put off a call to the dentist — a potentially risky move, since dental problems can be more advanced than you realize.

"As we age, we can feel less pain in our teeth because the nerves inside them shrink, and dentin — a porous material beneath tooth enamel — builds up. So something can fester for a long time and turn into a bigger, more complex problem," says Dr. Lisa Thompson, a geriatric dentistry specialist at the Harvard School of Dental Medicine.

Here's more on what causes dental pain, how to identify it, and when you should call your dentist or even 911.

Tooth pain

Tooth pain can stem from several problems. Perhaps the most common is a cavity, a tiny hole in the tooth. Plaque — a sticky mix of food particles and bacteria covering the outer layer of a tooth, the enamel — creates chemicals that break down the enamel. The deeper the cavity, the more likely the nerve in the tooth will be exposed, resulting in sharp pain and sensitivity to hot or cold foods. Those symptoms can also come from a cracked tooth or a cracked or loose filling, which can expose the nerve.

Tooth pain might also be due to trauma, such as accidentally biting down on a fork. That can bruise the ligament holding your tooth in the jaw, generating an initially sharp and then dull ache in the tooth.

If you experience tooth pressure when you bite down on food, have sinus pressure without nasal congestion, or a have a bad (acidic) taste in your mouth, it could be that a cavity or cracked tooth has led to a painful infection at the root of the tooth, creating a small pocket of pus called an abscess.

Gum pain

Gum pain tends to be an achy soreness rather than a sharp pain. It has many potential causes. It might be as simple as having sensitive gums, brushing your teeth too vigorously, or having irritation from a bit of food (such as a piece of popcorn) stuck in your teeth or in the space between your gum and teeth.

Gum pain can also come from a cut if something poked you (such as a corn chip), irritation from toothpaste that contains sodium laurel sulfate, or canker sores (aphthous ulcers).

Pain in the gums can also be due to dentures or partials that don't fit well or aren't cleaned regularly. "You might see red bumps on the irritated area or have a burning sensation from a fungal infection," Dr. Thompson says.

Another possibility: plaque buildup at the bottom of teeth is irritating the gums and causing gingivitis, an early stage of gum disease marked by swollen, bleeding gums. Untreated gingivitis can progress below the gum line (becoming periodontal disease). It can destroy the ligament holding the tooth in place as well as the bone, leading to gum pain, abscesses, and tooth loss. Signs of an abscess caused by gum disease include a pimple of pus on the gum or facial swelling.

Jaw pain

Jaw pain can be sudden and sharp, or a chronic tenderness that gradually increases over time.

Dull, chronic jaw pain usually comes from a problem with the temporomandibular joint, where the jaw bone meets the skull on either side of your head. Trouble related to this joint is called a temporomandibular disorder, or TMD.

"You can get TMD from injury such as joint dislocation or from problems related to muscles, stress, arthritis, and even behaviors you aren't even aware of. Maybe you grind your teeth at night, chew gum, or bite on a pen," Dr. Thompson says.

Be especially vigilant about a pain that suddenly affects your neck and lower jaw. That can be a form of the pain called angina caused by narrowed heart arteries — or it could even be a symptom of a heart attack. Heart-related jaw pain can occur without the more common heart attack symptoms such as chest pain and shortness of breath.

What you should do

Sudden neck and lower jaw pain can signal an emergency. Call 911, especially if you have known heart problems.

All other tooth, gum, and jaw pain should trigger a call to your dentist — as soon as possible if you suspect a cracked filling or tooth, gum disease, or an abscess.

"Bacteria from the abscess can get into the bloodstream, and can travel to other spaces in your body, such as your brain or heart. It can be life-threatening. If your dentist can't see you immediately, go to an emergency department, although there's not much they can do but give you antibiotics until you can get to a dentist," Dr. Thompson says. "And if you suspect that your diet, behavior, or brushing habits might be causing pain, go ahead and experiment: get a soft toothbrush, use a Waterpik, switch toothpastes. And keep brushing and flossing your teeth every day."

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