If you’ve ever experienced it, you know it: a toothache can be the worst pain you’ve ever felt.
Toothache pain, often described as sharp and throbbing, is most often felt in the teeth or gums but can also be felt in the head, ear, and jaw. This sort of pain can seriously disrupt a child’s ability to perform daily activities, including learning.
Of course, toothaches can be a sign of natural dental development:
Chronic toothache can indicate something much more serious than a loose tooth. The impact a toothache can have on school pupils should not be underestimated, as it can impact concentration, academic performance, behaviour, and attendance – with most children missing an average of 3 days of school after a tooth extraction.
In this issue, we look at the most common symptoms of dental discomfort in children and break down two of the most common causes of toothache in children: tooth decay and gum disease.
Schools are not expected to diagnose or treat dental problems, but there are signs that school staff and teachers can look out for that may indicate that a pupil is suffering from a toothache:
Younger pupils may struggle to describe the pain clearly.
Tooth decay can cause severe pain, but it’s an entirely preventable condition.
Nonetheless, in 2025, there were over 56,000 tooth extractions in NHS hospitals in England for 0 to 19-year-olds. This means across England, a child’s tooth is extracted every 15 minutes, sometimes under general anaesthesia.
The highest rates of dental extractions due to tooth decay amongst 0-19 year-olds were in Yorkshire and the Humber, and the lowest rates were in the East Midlands.
Dealing with the unnecessary pain of a preventable condition at an early age may lead to a lifelong avoidance of dental care due to anxiety.
Percentage of tooth extractions that were due to tooth decay by age band. (UK Government)
Well, to put it simply, bacteria feed on built-up food and plaque on the teeth, producing acids. If teeth are not cleaned properly and regularly, these acids can gradually wear off tooth enamel, the hard outer layer of the teeth, and cause cavities. Over time, the decay can cause cavities and reach the deeper layers of the tooth, irritating the nerves and causing pain. If left untreated, the decay can spread to other teeth.
In the early stages, tooth decay may not cause noticeable symptoms. However, if it is left untreated, it can progress and lead to cavities.
If there are signs that indicate a child may be suffering from cavities or tooth decay, taking note of their symptoms may be useful to inform parents and healthcare professionals.
While national reporting and child oral health surveys in England and the UK focus heavily on tooth decay, clinical research shows that gingivitis and early gum inflammation are still common oral health conditions affecting many children.
Like tooth decay, gum disease is a common yet preventable condition. Gum disease develops when plaque builds up along the gumline. If the plaque is not removed through regular flossing and brushing, it may irritate gums and cause inflammation. Although the early stages of gum disease are usually painless, it can still cause discomfort and may affect concentration during lessons.
Contributing factors to gum disease may include irregular tooth brushing, braces and other orthodontics (which can trap foods), hormonal changes, and high-sugar diets.
The most common form of gum disease is gingivitis. The good news is, gingivitis is usually reversible with good oral hygiene. However, if left untreated, it can lead to infection and loosening teeth.
Again, taking note of these symptoms may be helpful to inform caregivers and healthcare professionals.
1. Listen and reassure:
Listen to the child's concerns and reassure them. Avoid dismissing their pain: it could just be a wobbly tooth, but it could also be a more serious issue.
2. Provide comfort measures, where appropriate
👉 Apply a cold compress or an ice pack wrapped in a towel to the outside of the cheek, close to the sore area if appropriate. Cold will cause the blood vessels in the area to constrict, making the pain less severe.
👉 Allow lukewarm water to rinse the mouth (not salt water, which they could ingest).
👉 Offer a quiet place to rest.
👉 Encourage regular brushing and flossing
👉 Advise parents of your concerns
3. Monitor and record to keep parents informed
Using Medical Tracker’s incident recording feature, you can record:
✅ Symtoms reported by the pupil
✅ Any visible symptoms (swelling, for example)
✅ Time and duration of the incident
✅ Any action you’ve taken
Patterns can help patients, carers, and dental professionals monitor the toothache and recognise how the pain is progressing or changing over time.
Parents depend on schools to pass on concerns, share observations, and provide insight into how dental discomfort may have affected their child’s day. Below is some helpful advice on how you and your colleagues can discuss oral health concerns with pupils' parents and carers:
Avoid implying blame around brushing habits. Families may be managing multiple pressures, and some children find oral hygiene challenging for sensory, developmental, or orthodontic reasons.
If helpful, signpost families to trusted information on the NHS website, which explains symptoms of tooth decay, gum disease and when to seek advice.
Use neutral, supportive language and stick to the facts. For example: “We’ve noticed some bleeding from their gums during lunch, and they’ve mentioned soreness. We wanted to let you know in case you’d like to have it checked.”