The age of five often marks a significant transition in a child’s mouth, making it a common time for complaints of tooth pain. At this stage, the mouth enters a phase known as mixed dentition, where primary (baby) teeth and permanent (adult) teeth coexist. This biological process involves the simultaneous loss of some teeth and the eruption of others, which causes many dental aches and discomforts. Understanding whether the pain originates from a natural developmental event or a pathological issue, like infection, is the first step in providing appropriate care.
Pain Related to Tooth Loss and Eruption
The most frequent source of discomfort at this age stems from two developmental shifts occurring in the jaw. The first is primary tooth exfoliation, commonly known as having a “wobbly” tooth, which typically begins with the lower front incisors around age six but can start earlier. As the root of the baby tooth dissolves to make way for the permanent successor, the tooth becomes loose, causing mild, localized soreness in the gums.
The second, and often more painful, event is the eruption of the first permanent molars, often called the “six-year molars.” These large molars push through the gum tissue behind the last baby teeth, usually between ages five and seven, without replacing any existing tooth. This causes pressure, inflammation, and a dull, generalized ache in the back of the jaw. The discomfort can last for about a week as the crown breaks through the gum line.
To manage the soreness from these natural events, parents can offer cold compresses applied to the outside of the cheek near the site of pain. Soft, cool foods like yogurt and smoothies can also help. A gentle massage of the gums with a clean finger or damp gauze can alleviate pressure, and warm saltwater rinses are effective for reducing gum inflammation.
Identifying Tooth Decay and Infections
While developmental changes are common, tooth pain can also signal dental caries, or cavities, which represent a more serious cause of discomfort. Decay occurs when bacteria produce acid that erodes the enamel and dentin layers of the primary tooth. If the decay progresses deep enough, it reaches the dental pulp—the inner chamber containing nerves and blood vessels—leading to inflammation known as pulpitis.
Initial, or reversible, pulpitis may present as intermittent, sharp pain or heightened sensitivity to cold temperatures or sweet foods that subsides immediately once the stimulus is removed. If the inflammation becomes irreversible, the symptoms intensify to include spontaneous, persistent, throbbing pain that may keep the child awake at night. In this advanced stage, the pain may linger for more than 30 seconds after exposure to a cold stimulus.
An untreated infection can spread beyond the tooth root, resulting in a dental abscess. Signs of an abscess include swelling in the face or gums, or the appearance of a small, pus-filled bump, called a fistula, on the gum line near the affected tooth. Treating decay in primary teeth is important because an infection left unaddressed can harm the developing permanent tooth bud located beneath the infected baby tooth.
Non-Decay Causes of Dental Pain
Not all tooth pain is related to new teeth or decay; physical trauma is a frequent cause in active children. A fall or impact can result in a chipped, cracked, or loosened tooth, which may expose sensitive inner layers and cause immediate pain. Even if the injury seems minor, a full dental assessment is necessary to check for cracks extending below the gum line or internal damage.
Generalized mouth pain can sometimes be “referred pain,” meaning the source is not the tooth itself. For example, the roots of the upper back teeth are close to the sinus cavities. Therefore, a sinus infection or severe cold can cause pressure and aching that is mistakenly felt as tooth pain, often accompanied by nasal congestion or discharge.
Other mechanical factors, such as teeth grinding or clenching (bruxism), can cause jaw and tooth soreness. Brushing too aggressively can also wear down the enamel or cause gum recession, leading to sensitivity to temperature changes even without decay.
When Immediate Dental Care is Necessary
Certain symptoms act as “red flags” and indicate a need for immediate professional dental attention. Any tooth pain accompanied by facial or gum swelling suggests a spreading infection and requires urgent care. A fever that occurs alongside a toothache is also a sign of a serious infection that needs prompt diagnosis.
Any pain that is so severe it prevents the child from sleeping, eating, or focusing should be treated as an emergency. If the child has experienced trauma resulting in a knocked-out tooth, visible bleeding that will not stop, or a tooth broken or chipped with a noticeable pink or red center, contact a dentist right away. While waiting for professional help, parents can administer an appropriate dose of children’s acetaminophen or ibuprofen to manage the pain, and apply a cold compress to the cheek to reduce swelling.