Everything you’ve ever been told says cold is the enemy of a sore tooth. Yet here you are, swilling cold water round your mouth every few minutes because it’s the only thing that works, with a glass by the bed and a bottle that goes everywhere with you like an oxygen tank. It feels backwards. It isn’t. It’s a well-known pattern, it’s in the dental textbooks, and I can often spot it from across the waiting room: you’re the one sipping ice water.
The short answer, and I’d rather be straight with you: toothache that’s eased by cold and made worse by heat usually means the nerve inside the tooth is badly inflamed. The cold is turning the pressure down for a minute or two. It isn’t fixing anything, and in my experience this is one of the patterns that never settles by waiting. So please treat this as your cue to ring a dentist today rather than to buy more ice. My emergency dentist team sees urgent patients in Harlow and Enfield. If we’re closed or you’re not local, call NHS 111.
Living on sips of cold water? Call your nearest Minti practice and tell reception it’s urgent. I keep same-day appointments for pain and swelling wherever I can.
- Nuffield Dental Practice, Harlow: 01279 424 038
- Church Langley Dental, Harlow: 01279 306 690
- Enfield Smiles, Enfield: 020 8804 4320
Evening, weekend, or nowhere near us? Call NHS 111 and they’ll find you an urgent dental appointment. If you’re struggling to breathe or swallow, or swelling is spreading to your eye or neck, that’s 999 or A&E.
Why would cold water relieve toothache instead of causing it?
Because there are two quite different kinds of tooth pain, and they behave in opposite ways.
The one everybody knows is the sharp zing when ice cream hits a sensitive tooth. It’s fast, it’s startling, and it’s gone in a second or two. That’s a healthy-ish nerve doing its job and complaining about a stimulus.
Yours is the other kind: a deep, dull, throbbing ache that’s there whether you do anything or not. That pain isn’t coming from a stimulus. It’s coming from pressure, and pressure responds to temperature the way you’ve discovered. Warm things up and it builds. Cool things down and it eases. You haven’t found a loophole in dentistry. You’ve accidentally run one of my diagnostic tests.
What is happening inside the tooth?
In the middle of every tooth is the pulp, the soft tissue with the nerve and blood supply. When decay, a crack or a deep filling lets bacteria irritate it, it becomes inflamed. We call that pulpitis.
Anywhere else in your body, inflamed tissue swells. Sprain your ankle and it balloons outwards. The pulp can’t do that, because it’s sealed inside solid tooth. So the swelling has nowhere to go, and the pressure builds in a rigid little box with the nerve trapped inside it. Think of a pressure cooker with the lid clamped on. That trapped pressure is the throb.
The textbook explanation for your cold water trick is simple plumbing. Cold makes the blood vessels in the pulp narrow, which lowers the pressure for a moment, and the nerve gets a breather. Then your mouth warms back up, the pressure climbs again, and you reach for the glass. You’re turning the hob down. Nobody has turned the gas off.
Why might hot drinks make it worse?
Same mechanism in reverse. Heat widens the blood vessels and expands whatever is inside that sealed chamber, so the pressure goes up, and with it the pain. In a badly inflamed tooth, heat is typically the worst trigger of all, and the ache it sets off doesn’t stop when the tea does. It can hang on for minutes, sometimes much longer.
It’s the same reason this sort of toothache often gets worse when you lie down or bend over. Anything that nudges the pressure in your head upwards gets passed straight on to a nerve with no room to spare. It’s also why people with this pattern tend to have terrible nights.
So for now: let hot drinks cool right down, and skip the soup straight off the hob.
Does temporary relief mean the tooth is getting better?
I wish it did. No. The cold is managing the symptom, not the cause, and a nerve that has reached this stage doesn’t recover without treatment. I’ll be plain about that because the alternative is you spending a week hoping, and I’d rather you didn’t.
There’s a second trap, and it catches a lot of people. After days of this, the pain may suddenly stop altogether. Bliss. Except that it usually means the nerve has died, not healed. A dead nerve can’t send pain signals, so everything goes quiet, sometimes for weeks. Meanwhile the infection carries on down at the root, and the next chapter is typically a tooth that hurts when you tap it or bite on it, or an abscess. If your toothache has gone from unbearable to nothing without anyone treating it, still get it checked.
Could this mean the nerve is inflamed?
Yes, that’s the usual meaning, though I can’t diagnose your tooth from a blog and wouldn’t try. Dentists divide pulpitis into two sorts. In the reversible sort, the nerve is irritated but can recover once the cause is dealt with: cold or sweet things hurt, but the pain is gone within a second or two. In the irreversible sort, the nerve is too inflamed to heal. The hallmarks are pain that starts by itself, pain that lingers long after hot or cold, throbbing that ruins your sleep, and painkillers that barely touch it. Heat making it worse and cold making it better sits firmly in that second group, usually towards the later end.
You might also find you can’t tell exactly which tooth it is, or even whether it’s top or bottom. That’s normal with this kind of pain, and working it out is my job, not yours.
As for what happens next, I’ll test the teeth, take an X-ray and confirm which one it is before doing anything. If the nerve can’t be saved, the usual options are root canal treatment, which removes the inflamed nerve and keeps the tooth, or taking the tooth out. Which is right depends on the tooth and on you, and it’s a conversation, not a verdict. Two things are worth knowing before you come in. Antibiotics don’t fix this kind of toothache, because the problem is pressure inside the tooth, not something a tablet can reach, so I keep them for infection that’s spreading. And whichever treatment you have is done with you properly numb. The whole aim of that first appointment is to get you out of pain.
When should you seek urgent dental care?
With this pattern, now. The NHS advice is to see a dentist if toothache lasts more than two days, or sooner if painkillers aren’t helping. If you’re rationing sips of cold water to get through the day, in my view you’re past that point. Ring a dentist today and use the word “urgent”. You’re not making a fuss. This is exactly what urgent appointments are for.
Make it the same day if you also have a swollen gum, cheek or jaw, a high temperature, or a bad taste in your mouth.
Call 999 or go to A&E, not a dentist, if:
- you’re finding it hard to breathe, swallow or speak
- swelling is spreading towards your eye or down into your neck
- you can’t open your mouth properly because of the swelling
Until you’re seen, take ibuprofen or paracetamol as per the packet and never more than the stated dose, however tempting at 3am. Eat soft food, chew on the other side and keep hot things away from that tooth. The general advice for toothache is to avoid very cold things as well, but your tooth has clearly rewritten that rule, so use the cold water to get you to the appointment. Just not instead of one.
If you’re near Harlow or Enfield, I’d much rather see you today than have you spend another night setting alarms for your next sip. Ring your nearest Minti practice, and tell reception that cold water is the only thing easing it. The numbers are at the top of this page and on my emergency dentist page. Anywhere else, or out of hours, call NHS 111. Either way, make the call.
This article is general information, not a diagnosis. Tooth pain needs examining in person to find the cause.
