Short answer
Tooth pain that is constant, wakes you up, comes with swelling or a bad taste, or follows a break below the gumline is a sign to be seen the same day. Many of these teeth can still be saved with a root canal and crown, but when a tooth is too broken, too decayed or too loose, removing it is the safest way to stop the pain and infection. Call us during office hours for a same-day emergency visit; go to the ER if swelling spreads to your face or neck or you have trouble breathing or swallowing.
Which kinds of tooth pain are warning signs?
A quick twinge from cold that fades in a second is often minor. The pain that deserves attention is the kind that sticks around, gets worse or changes. Watch for:
- Throbbing pain that lasts for hours or wakes you at night
- Sharp pain every time you bite down
- Sensitivity to hot or cold that lingers long after the food or drink is gone
- Swelling in the gum, cheek or jaw
- A pimple-like bump on the gum, pus or a bad taste
- A tooth that feels loose, or one that cracked or broke off
- Pain that suddenly stops after days of throbbing, which can mean the nerve has died while the infection remains
Painkillers can quiet these symptoms for a while. They do not fix the cause, and the problem usually keeps getting worse underneath.
Does a bad toothache always mean the tooth has to come out?
No. We try to save natural teeth whenever it makes sense. A tooth with an infected nerve can often be treated with root canal therapy and then protected with a crown. A cracked tooth may be repairable if the crack has not gone too deep. If the idea worries you, read why root canals are about relief, not pain.
Removal becomes the better choice when saving the tooth is not realistic or would not last. The table below shows how that decision often goes.
| Situation | Often savable? | Usual treatment |
|---|---|---|
| Deep cavity, nerve inflamed or infected | Usually | Root canal, then a crown |
| Tooth chipped or cracked above the gumline | Usually | Filling, bonding or crown |
| Crack or break that runs below the gumline | Often not | Extraction |
| Decay that has destroyed most of the tooth | Often not | Extraction |
| Tooth very loose from advanced gum disease | Often not | Extraction, then gum treatment |
| Painful, infected wisdom tooth | Depends | Often extraction |
Only an exam and X-rays can tell for sure. We explain the options and costs before anything is done, so you can make the choice that fits you.
Why is waiting risky?
Tooth infections do not clear up on their own. Over days or weeks, the infection can spread into the bone, the gum and the soft tissue of the face. A tooth that could have been saved may break down to the point where it cannot be.
Waiting can also turn a simple visit into a harder one. Severe swelling can make it difficult to numb the area or open your mouth. In rare cases, a spreading dental infection becomes a medical emergency.
What can you do while you wait to be seen?
- Rinse gently with warm salt water to keep the area clean.
- Hold a cold compress on your cheek, 15 to 20 minutes at a time, for swelling.
- Take an over-the-counter pain reliever as the label directs, if it is safe for you.
- Chew on the other side and avoid very hot, cold or sugary foods.
- Do not put aspirin or other tablets directly on the gum; they can burn the tissue.
How do same-day emergency visits work at our Richmond office?
We see same-day emergencies during office hours: Tuesday, Wednesday and Saturday, 9am to 3pm. Call first so we can fit you in. Saturday hours help many families in Richmond and across Fort Bend County who cannot leave work midweek; see our Saturday dentist page.
We do not offer after-hours emergency care. If it is outside our hours, follow the steps above and call when we open, unless you have any ER warning sign below.
Extractions here, including many wisdom teeth, are done with local anesthetic. We do not offer sedation. If your case needs it, we will refer you. For what the visit and healing look like, read when emergency tooth extractions are necessary and what happens next.
When should you go to the ER instead?
Go to the emergency room or call 911 if you have:
- Swelling spreading into your cheek, eye, jaw or neck
- Trouble breathing or swallowing
- A high fever with tooth or jaw pain
- Bleeding you cannot control with firm pressure
- A possible broken jaw after an injury
What does an emergency extraction cost?
The cost depends on how the tooth needs to be removed, whether it is a wisdom tooth and what your insurance covers. We give you a written estimate before treatment. If a root canal is an option instead, ours start at $899, and crowns start at $1,199; see our dental prices. New patients can start with a limited exam and panoramic X-ray for $49.
When to call us
Call us the same day for tooth pain that lasts for hours, swelling in your gum or face, a bad taste or pus, or a tooth that broke or feels loose. We’ll tell you whether to come in right away or head to the ER. Call (832) 612-2831 — we’re open Tuesday, Wednesday and Saturday, 9am–3pm.
Frequently asked questions
Often, yes, if you call during office hours and it is safe to treat that day. Sometimes an infection needs to calm down first, and we will tell you if that is the case.
Keeping your own tooth is usually better when it can be done well. A root canal and crown let you keep chewing on that tooth. Extraction makes more sense when the tooth cannot be restored.
Emergency rooms usually treat pain, swelling and infection but do not typically pull teeth. You will still need to see a dentist for the tooth itself.
Not always, especially for wisdom teeth. For other teeth, replacing them helps keep nearby teeth from shifting. We can talk about implants, bridges or partial dentures once you heal.
Sources
This guide is general information, not a diagnosis. Every mouth is different — the right treatment for you depends on an exam.