Toothache in a child: what to do straight away, what causes it and when to go to the dentist or to the emergency department

Toothache in a child: what should you do at home straight away?

When a child has toothache, first relieve the pain in safe ways and book a dental appointment, because home remedies do not remove the cause. The list below is based on advice from the UK’s National Health Service (NHS) and the US Food and Drug Administration (FDA); the specific medicine and dose are decided by a doctor or pharmacist.

Home remedies are only meant to bridge the time until the visit. If the pain keeps coming back despite the medicine, or swelling appears, the visit should not wait for the next free appointment in a few weeks’ time.

• Give a painkiller intended for children, following the leaflet for the child’s age and weight, and if in doubt ask a pharmacist.
• Do not give aspirin: the NHS reminds parents that it is not used in children under 16.
• Do not rub a small child’s gums with lidocaine or benzocaine gels: the FDA warns that benzocaine is not used under the age of 2, and lidocaine can cause serious harm.
• Offer soft food, such as yoghurt, and avoid very cold, very hot and sweet foods, which can make the pain worse.
• Keep brushing the teeth, including around the painful tooth, gently and with a soft toothbrush.
• Do not use salt-water rinses for a child: the NHS lists them as a home remedy but points out that children should not try them.
• Note when the pain started, what makes it worse and whether it wakes the child at night; this information helps the dentist reach a diagnosis.

What causes toothache in a child, and how urgent is the visit?

Toothache in a child may result from decay that has reached close to the pulp, the nerve of the tooth, or from an infection that has spread from dead pulp to the tissues around the root. According to the most recent nationwide survey (2016 to 2019), 41.1% of three-year-olds and 76.8% of five-year-olds have decay, and in Podlaskie province the proportion of children with decay rises from 32.0% at the age of 3 to 98.0% at the age of 18.

Other causes are a dental injury, teething in the youngest children and an irritated gum. The table helps to judge how quickly help is needed; it does not replace an examination, because similar symptoms can have different causes. The urgency ratings are based on criteria of the American Association of Endodontists (AAE), the American Academy of Pediatric Dentistry (AAPD) and the NHS.

Toothache in a child at night: what does it mean, and where can you find help?

Toothache at night that comes on without a trigger, lasts a long time and gets worse on lying down points to irreversible pulpitis. This is how the AAE describes the condition, adding that over-the-counter painkillers usually work poorly on such pain, which is why the tooth needs treatment.

At night and at weekends help comes from the NFZ emergency dental service: on working days from 19:00 to 7:00, and on Saturdays, Sundays and public holidays round the clock. According to the Podlaskie regional branch of the NFZ, there is 1 such service point in the province, in Białystok (as of 24 October 2026); its address, hours and phone number are given in the article on finding a dentist at night and at weekends in Białystok. The free NFZ helpline 800 190 590 will also tell you where the nearest point is.

Toothache on its own, even severe, is not a reason to go to the hospital emergency department (SOR). The SOR is for a child with the warning signs described in the next part.

Tooth abscess and swelling in a child: when is it an emergency?

A tooth abscess in a child is a collection of pus in the tissues around the root of a tooth whose pulp has died; it causes swelling of the gum or cheek, pain on biting or a spot on the gum, called a fistula. The International Association of Dental Traumatology (IADT), in its guidelines on milk teeth, points out that a child may not complain of pain even though infection is already present, which is why swelling of the gum always needs a visit.

According to the AAPD, a child with facial swelling of dental origin should see a dentist quickly, and general symptoms such as fever, feeling unwell, facial asymmetry, inability to open the mouth (trismus) or difficulty swallowing require emergency treatment. In Białystok the hospital emergency department for children is at the Ludwik Zamenhof University Children’s Clinical Hospital (Uniwersytecki Dziecięcy Szpital Kliniczny im. Ludwika Zamenhofa), ul. Jerzego Waszyngtona 17 (as of 24 October 2026). Abscesses are described in detail in a separate article on tooth abscess.

• Swelling that spreads to the area around the eye, the eyelid or the neck: the NHS then directs you to the emergency department.
• Difficulty breathing, swallowing or speaking: call 112.
• The child cannot open their mouth or has a clearly asymmetrical face.
• Fever together with facial swelling, marked weakness or feeling unwell.
• Swelling that grows from hour to hour despite a painkiller.

What will the dentist do when a child has toothache?

The dentist first establishes the cause of the pain: asks about the symptoms, looks at the teeth and gums and, when needed, takes an X-ray. For acute pulpitis the AAPD recommends treating the tooth itself: pulp amputation (pulpotomy), root canal treatment of the milk tooth (pulpectomy) or extraction.

An antibiotic does not treat toothache. According to the AAPD it is neither indicated nor effective when the infection is confined to the tooth and its immediate surroundings and the child has no fever or facial swelling; even with a spreading infection an antibiotic is an addition to removing the source, not a substitute for treatment. Whether the tooth can be saved depends on the extent of the damage and how long it still has to stay in the arch; the principles are described in the article on treating milk teeth.

When a child is unable to cooperate and treatment is urgent, the dentist discusses inhalation sedation or general anaesthesia. Since 1 January 2026 the NFZ has funded general anaesthesia for, among others, children and young people up to the age of 18 who need immediate treatment of an acute inflammation of dental origin in the maxillofacial region (legal status as of 24 October 2026). Entitlement is checked at the dental and anaesthesiology qualification.

How can toothache in children be prevented?

Toothache in children is prevented above all by what protects against decay: brushing with fluoride toothpaste, limiting sweet drinks and snacks, and regular check-ups at which the dentist picks up cavities before they start to hurt. A cavity in a milk tooth that does not hurt yet also needs a treatment plan.

• Brush your child’s teeth twice a day with fluoride toothpaste in an amount suited to their age; Polish experts recommend that parents do this up to the age of 8.
• After the evening brush, give your child only water to drink.
• Limit sweet drinks and snacking between meals, because frequent contact of the teeth with sugar encourages decay.
• Come for check-ups from the first year of life, usually every 6 months, and more often when the dentist judges the risk of decay to be high.
• Make use of sealing of the permanent molars, which the NFZ funds once up to the age of 8 for the first molars and once up to the age of 14 for the second molars.

Toothache in a child at DentalBlue

DentalBlue at ul. Kazimierza Pułaskiego 35 in Białystok is open Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00. In the clinic’s price list, a “Wizyta z bólem” (visit in pain) includes a panoramic X-ray, a consultation, an examination and pain relief, and costs 340 zł. The clinic’s own radiology unit also takes intraoral X-rays. The clinic offers inhalation sedation with nitrous oxide. Treatment under general anaesthesia takes place in the clinic’s own anaesthesiology department, after a joint qualifying consultation, among others for children who cannot cooperate and when inflammation is too acute for local anaesthesia to work; entitlement to NFZ funding is confirmed at qualification. The final scope and cost are set by the dentist after the examination, and prices may change. Reception phone: 85 748 00 50.