Is It an Ear Infection, Tooth Pain, or Something Else?

Ear pain and tooth pain are easy to con­fuse, because the ears, teeth, and jaw sit close togeth­er and share nerve path­ways. Ear infec­tions usu­al­ly bring deep pres­sure, muf­fled hear­ing, and fever, often after a cold. Tooth pain is usu­al­ly sharp­er, tied to one tooth, and worse with chew­ing or hot and cold foods. Both are treat­able, and a quick exam can tell them apart.

What is the dif­fer­ence between an ear infec­tion and tooth pain?

The main dif­fer­ence is where the pain starts. Ear pain comes from the ear itself, while tooth pain usu­al­ly comes from one spe­cif­ic tooth. In this part of the body, though, pain trav­els. The trigem­i­nal nerve car­ries sen­sa­tion from the teeth, jaw, sinus­es, and parts of the ear along shared path­ways to the brain, which is why an infect­ed molar can make the ear ache and an ear infec­tion can make the back teeth feel sore. That over­lap is the rea­son so many peo­ple guess wrong about the source.

What is an ear infection?

A mid­dle ear infec­tion, called acute oti­tis media, hap­pens in the space between the eardrum and the inner ear. That space is filled with air and the small bones that car­ry vibra­tions inward so you can hear. When flu­id builds up behind the eardrum and becomes infect­ed, the pres­sure caus­es pain.

Ear infec­tions are most­ly a child­hood prob­lem. Five out of six chil­dren have at least one by their third birth­day, and ear infec­tions are the most com­mon rea­son par­ents bring a child to the doc­tor. They are most fre­quent between 6 months and 2 years old and stay com­mon through about age 8. Adults get them too, and they hurt just as much. Both virus­es and bac­te­ria cause them, and they often fol­low a cold or anoth­er upper res­pi­ra­to­ry infec­tion, when germs move into the mid­dle ear.

Not all ear pain is a mid­dle ear infec­tion. Swim­mer’s ear is an infec­tion of the out­er ear canal, and the pain clear­ly wors­ens when the ear­lobe is pulled or the front of the ear is pressed. The two are treat­ed dif­fer­ent­ly, so the dis­tinc­tion matters.

What caus­es tooth pain?

A toothache can occur in or around a tooth and ranges from mild to severe. Some fade on their own, and oth­ers need treat­ment. Com­mon caus­es include:

• Cav­i­ties
• A cracked or frac­tured tooth
• Teeth grind­ing or clench­ing, called bruxism
• Gum dis­ease
• A dam­aged fill­ing, crown, or oth­er den­tal restoration
• An abscess, a pock­et of infec­tion at the root of a tooth or in the gums
• Exposed roots from reced­ing gums, which cause sen­si­tiv­i­ty to hot and cold

Ear infec­tion or tooth pain: which symp­toms do I have?

If you can­not tell where the pain is com­ing from, these pat­terns help nar­row it down:

If your symp­toms land in both columns, that is use­ful infor­ma­tion too. It may point to one of the referred pain con­di­tions described below.

When should I get care right away?

Most ear and tooth pain can wait for a reg­u­lar appoint­ment. A few sit­u­a­tions can­not, because infec­tions in the head and neck can spread quickly.

For pain that is urgent but not an emer­gency, such as a painful ear with fever or a toothache you can­not man­age at home, an imme­di­ate care cen­ter can eval­u­ate you the same day with­out an appointment.

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How is the cause of my pain diagnosed?

For an ear infec­tion, a provider asks about your symp­toms and does a phys­i­cal exam, check­ing for cold symp­toms and look­ing inside the ear with a light­ed instru­ment called an oto­scope. They are look­ing for red­ness, swelling, and flu­id behind the eardrum. They may also use a tym­pa­nome­ter, which mea­sures how the eardrum moves in response to air pres­sure and quick­ly con­firms whether flu­id is trapped in the mid­dle ear.

For tooth pain, diag­no­sis usu­al­ly calls for a den­tist, who exam­ines the teeth and mouth and may take an X‑ray to see beneath the gumline.

When it is not clear which one you are deal­ing with, start­ing with your pri­ma­ry care provider is often the fastest path. Duly Health and Care is a sub­ur­ban based com­pre­hen­sive care orga­ni­za­tion, so the ear, sinus­es, and jaw can all be checked in one vis­it, and if you need an ear, nose, and throat spe­cial­ist or an audi­ol­o­gist, you are referred inside the same net­work rather than start­ing over with a new practice.

How are ear infec­tions and tooth pain treated?

Ear infec­tion treat­ment has changed in ways that sur­prise many par­ents. Most ear infec­tions clear up with­out antibi­otics. For mild cas­es, cur­rent guid­ance sup­ports watch­ful wait­ing, which means observ­ing symp­toms for two to three days to give the immune sys­tem time to fight the infec­tion. Some providers use delayed pre­scrib­ing instead, writ­ing a pre­scrip­tion to fill only if symp­toms do not improve. Both approach­es cut unnec­es­sary antibi­ot­ic use with­out worse out­comes, and man­ag­ing pain with over the counter med­ica­tion is an impor­tant part of care dur­ing that win­dow. Antibi­otics are still the right call for infants, severe cas­es, and infec­tions that do not improve. Chil­dren with repeat­ed infec­tions may ben­e­fit from ear tubes, which let air into the mid­dle ear so flu­id can drain.

For tooth pain, home mea­sures can help while you wait for an appoint­ment. Rinse with salt water, using half a tea­spoon of salt in 8 ounces of warm water, apply a cold com­press to the out­side of the cheek, and take an over the counter pain reliev­er. Do not place aspirin direct­ly against the gum, which can burn the tis­sue. These steps ease symp­toms but do not treat the cause. Depend­ing on what is behind the pain, a den­tist may rec­om­mend a fill­ing, crown, root canal, extrac­tion, treat­ment for gum dis­ease, or a night guard for grinding.

What else could cause pain in my ear and teeth?

If your symp­toms do not match either pat­tern, anoth­er con­di­tion may be responsible:

• Sinus infec­tions, which cause pain in the upper teeth, ears, and face, along with con­ges­tion and pres­sure that wors­ens when you bend forward
• TMJ dis­or­ders, which cause pain in the jaw joint and the mus­cles that move the jaw, often with click­ing, lim­it­ed jaw open­ing, headaches, or a full feel­ing in the ear
• Trigem­i­nal neu­ral­gia, which caus­es sud­den, elec­tric shock like pain on one side of the face
• Neu­rovas­cu­lar oro­fa­cial pain, which resem­bles a migraine and can cause pres­sure and aching in the teeth
• Vis­cer­al toothache, referred pain from the heart or stom­ach, which is the rea­son jaw pain dur­ing exer­tion should be treat­ed as urgent

Can ear infec­tions and tooth pain be prevented?

Not every case is pre­ventable, but a few habits low­er the risk. Stay­ing cur­rent on rec­om­mend­ed vac­cines, includ­ing the pneu­mo­coc­cal and flu vac­cines, reduces ear infec­tions in chil­dren. Avoid­ing sec­ond­hand smoke helps as well. Dry­ing the ears after swim­ming low­ers the chance of swim­mer’s ear. For teeth, brush­ing twice dai­ly with flu­o­ride tooth­paste, floss­ing, lim­it­ing sug­ary drinks, and keep­ing reg­u­lar den­tal vis­its pre­vent most cav­i­ties and gum dis­ease. Treat­ing grind­ing ear­ly, often with a night guard, pre­vents cracked teeth and the jaw pain that comes with them.

Who treats ear and tooth pain?

The right start­ing point depends on the symp­toms. A pri­ma­ry care provider can eval­u­ate ear pain, diag­nose an infec­tion, treat it, and sort out whether the source is the ear, the sinus­es, or the jaw. An imme­di­ate care cen­ter han­dles the same eval­u­a­tion on evenings and week­ends, or when you need to be seen the same day. An ear, nose, and throat spe­cial­ist steps in for repeat­ed infec­tions, hear­ing loss, or ear pain that does not resolve, and an audi­ol­o­gist tests hear­ing when infec­tions have affect­ed it. Tooth pain is treat­ed by a den­tist, and jaw joint pain is often man­aged joint­ly by a den­tist and a med­ical provider.

At Duly Health and Care, those med­ical pieces are con­nect­ed. Pri­ma­ry care, imme­di­ate care, ENT, and audi­ol­o­gy work across the same net­work of clin­ics through­out the Chica­go sub­urbs, so an ear eval­u­at­ed at a walk-in vis­it can move to a spe­cial­ist with­out repeat­ing your his­to­ry or wait­ing weeks for a first appoint­ment. If pain turns out to be den­tal, you will be told clear­ly, so you are not left guess­ing about the next step.

Fre­quent­ly asked questions

How do I know if my ear pain is from my tooth?

Look at what trig­gers the pain. Pain that spikes when you chew, bite down, or drink some­thing hot or cold usu­al­ly starts in a tooth, even when it is felt in the ear. Pain that is worse lying down, comes with muf­fled hear­ing or a plugged feel­ing, or fol­lows a cold points to the ear. If the pain is sharp and trace­able to one spot in the mouth, a tooth is the like­ly source.

Can a tooth infec­tion cause an earache?

Yes. The teeth, jaw, and ear share nerve path­ways through the trigem­i­nal nerve, so an infect­ed or abscessed molar often caus­es aching in the ear on the same side. The ear itself is healthy in these cas­es, which is why an ear exam comes back nor­mal. Treat­ing the tooth resolves the ear pain.

Do ear infec­tions always need antibiotics?

No. Most ear infec­tions clear on their own, and cur­rent guid­ance sup­ports watch­ful wait­ing for mild cas­es, mean­ing symp­toms are watched for two to three days before antibi­otics are start­ed. Some providers write a pre­scrip­tion to fill only if things do not improve. Antibi­otics are still rec­om­mend­ed for infants, severe infec­tions, and cas­es that are not get­ting better.

Can adults get ear infections?

Yes, though they are far less com­mon than in chil­dren. Adult ear infec­tions usu­al­ly fol­low a cold or sinus infec­tion and can be just as painful. Because they are less com­mon, ear pain in an adult is more like­ly to have anoth­er cause, such as a TMJ dis­or­der, a den­tal prob­lem, or swim­mer’s ear, so an exam is worthwhile.

When is a toothache an emergency?

Go to the emer­gency room for swelling of the face, jaw, neck, or floor of the mouth, trou­ble breath­ing or swal­low­ing, or a high fever with severe tooth pain. These can mean a den­tal infec­tion is spread­ing, which is a med­ical emer­gency. Jaw or tooth pain that appears dur­ing exer­tion or comes with chest dis­com­fort also needs emer­gency eval­u­a­tion, since it can sig­nal a heart problem.

Should I go to imme­di­ate care or a den­tist for tooth pain?

A den­tist treats the tooth itself, includ­ing fill­ings, root canals, and extrac­tions. Imme­di­ate care is the right choice when a den­tist is not avail­able and you have sig­nif­i­cant pain, signs of spread­ing infec­tion such as facial swelling or fever, or you are not sure whether the source is your tooth or your ear. Imme­di­ate care can eval­u­ate the infec­tion, man­age pain, and direct you to the right follow-up.

Where can I get ear pain checked in the Chica­go suburbs?

Duly Health and Care offers pri­ma­ry care and imme­di­ate care loca­tions across the Chica­go sub­urbs where ear pain can be eval­u­at­ed the same day, with ENT and audi­ol­o­gy avail­able in the same net­work if you need spe­cial­ty care. For facial swelling, trou­ble breath­ing or swal­low­ing, or sud­den hear­ing loss, go to the near­est emer­gency room instead.

Care at Duly Health and Care

Ear and tooth pain are mis­er­able, and guess­ing at the cause tends to delay relief. Duly Health and Care brings pri­ma­ry care, imme­di­ate care, ENT, and audi­ol­o­gy togeth­er across the Chica­go sub­urbs, so you can be seen quick­ly, get a clear answer about where the pain is com­ing from, and move to the right treat­ment with­out repeat­ing the process at a new prac­tice. Most caus­es of ear and tooth pain respond well to treat­ment, and the soon­er the source is iden­ti­fied, the soon­er you feel better.

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