A toothache is a signal that there is a problem in your mouth and to ignore it is likely to invite future pain and infection. There are essentially two sources of an ache; the tooth itself or the gums around a tooth. A tooth can become painful from decay, a fracture or both while our gums can get infected from a wound or from a damaged tooth. Our teeth are under constant stress not only from eating but also from clenching or grinding. Often a fracture begins next to an older filling and will spread across the tooth. These cracks may not be painful at first but as they spread they tend to go deeper into a tooth and irritate the nerve of the tooth. In severe cases, root canal therapy will be needed to replace the damaged nerve with an internal filling or the tooth may need to be extracted. Sometimes a restoration can relieve a fracture but many times a full crown will be needed to cover the fracture with a single unit that will hold up over time. Note that root canal therapy is not required to have a crown, in fact, the crown is recommended so that root canal therapy can be avoided.