Common causes include inflammation of the pulp, (usually in response to tooth decay, dental trauma, or other factors), dentin hypersensitivity, apical periodontitis (inflammation of the periodontal ligament and alveolar bone around the root apex), dental abscesses (localized collections of pus), alveolar osteitis ("dry socket", a possible complication of tooth extraction), acute necrotizing ulcerative gingivitis (a gum infection), and temporomandibular disorder.

[6]: 125–135 The majority of pulpal toothache falls into one of the following types; however, other rare causes (which do not always fit neatly into these categories) include galvanic pain and barodontalgia.

Pulpitis (inflammation of the pulp) can be triggered by various stimuli (insults), including mechanical, thermal, chemical, and bacterial irritants, or rarely barometric changes and ionizing radiation.

[15]: 619–627 Dentin hypersensitivity is a sharp, short-lasting dental pain occurring in about 15% of the population,[16] which is triggered by cold (such as liquids or air), sweet or spicy foods, and beverages.

[10]: 225  Bacterial cytotoxins reach the region around the roots of the tooth via the apical foramina and lateral canals, causing vasodilation, sensitization of nerves, osteolysis (bone resorption) and potentially abscess or cyst formation.

[6]: 125–135  The usual cause of food impaction is disruption of the normal interproximal contour or drifting of teeth so that a gap is created (an open contact).

The pain occurs during and after eating, and may slowly disappear before being evoked again at the next meal,[nb 1] or relieved immediately by using a tooth pick or dental floss in the involved area.

[21]: 97–98  This condition is not contagious, but multiple cases may simultaneously occur in populations who share the same risk factors (such as students in a dormitory during a period of examination).

[24] ANUG is treated over several visits, first with debridement of the necrotic gingiva, homecare with hydrogen peroxide mouthwash, analgesics and, when the pain has subsided sufficiently, cleaning below the gumline, both professionally and at home.

Typical signs and symptoms of a pericoronal abscess include severe, throbbing pain, which may radiate to adjacent areas in the head and neck,[21][26]: 122  redness, swelling and tenderness of the gum over the tooth.

[10]: 24  The term is falling into disfavor and has given way to the more generalized description of fractures and cracks of the tooth, which allows for the wide variations in signs, symptoms, and prognosis for traumatized teeth.

Accordingly, there is no single test or combination of symptoms that accurately diagnose a fracture or crack, although when pain can be stimulated by causing separation of the cusps of the tooth, it's highly suggestive of the disorder.

In a toothache, nerves are stimulated by either exogenous sources (for instance, bacterial toxins, metabolic byproducts, chemicals, or trauma) or endogenous factors (such as inflammatory mediators).

[citation needed] Factors indicating infection include movement of fluid in the tissues during palpation (fluctuance), swollen lymph nodes in the neck, and fever with an oral temperature more than 37.7 °C.

[citation needed] Any tooth that is identified, in either the history of pain or base clinical exam, as a source for toothache may undergo further testing for vitality of the dental pulp, infection, fractures, or periodontitis.

Establishing a diagnosis of nondental toothache is initially done by careful questioning about the site, nature, aggravating and relieving factors, and referral of the pain, then ruling out any dental causes.

Since many cases of toothache are inflammatory in nature, over the counter non-steroidal anti-inflammatory drugs (NSAIDs) may help (unless contraindicated, such as with a peptic ulcer).

[48][49] As samples for microbiologic culture and sensitivity are hardly ever carried out in general dental practice, broad-spectrum antibiotics such as amoxicillin are typically used for a short course of about three to seven days.

[48] Antibiotics are seen as a "quick fix" by both dentists, who generally only have a very short time to manage dental emergencies, and by patients, who tend to want to avoid treatments (such as tooth extraction) which are perceived negatively.

[48][49] They are often used inappropriately,[49] in conditions for which they are ineffective, or their risks outweigh the benefits, such as irreversible pulpitis,[50][needs update] apical abscess,[15]: 303  dry socket,[15]: 303  or mild pericoronitis.

[52]: 164  Local measures such as incision and drainage, and removal of the cause of the infection (such as a necrotic tooth pulp) have a greater therapeutic benefit and are much more important.

[51]: 232  Evidence of systemic involvement (such as a fever higher than 38.5 °C, cervical lymphadenopathy, or malaise) also indicates antibiotic therapy, as do rapidly spreading infections, cellulitis, or severe pericoronitis.

[56] For example, hypotheses hold that ancient Egyptians had a lot of tooth wear due to desert sand blown on the wind mixing with the dough of their bread.

[56] The Ebers papyrus (1500 BC) details a recipe to treat "gnawing of the blood in the tooth", which included fruit of the gebu plant, onion, cake, and dough, to be chewed for four days.

[55]: 48–52 Archigenes of Apamea describes use of a mouthwash made by boiling gallnuts and hallicacabum in vinegar, and a mixture of roasted earthworms, spikenard ointment, and crushed spider eggs.

Claudius' physician Scribonius Largus recommends "fumigations made with the seeds of the hyoscyamus scattered on burning charcoal  ... followed by rinsings of the mouth with hot water, in this way  ... small worms are expelled.

"[55]: 48–52 Albucasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) used cautery for toothache, inserting a red-hot needle into the pulp of the tooth.

[55]: 48–52  The medieval surgeon Guy de Chauliac used a camphor, sulfur, myrrh, and asafetida mixture to fill teeth and cure toothworm and toothache.

In Much Ado About Nothing, Act III scene 2, when asked by his companions why he is feeling sad, a character replies that he has toothache so as not to admit the truth that he is in love.

The shrine consists of part of an old tree to which sufferers of toothache nail a rupee coin in order to ask the god to relieve their pain.