Endoinfo Toothache

Toothache & Tooth Pain Guide!

What is a Toothache?

“Toothache” is pain typically around a tooth, teeth or jaws. In most instances, toothaches are caused by a dental problem, such as a dental cavity, a cracked or fractured tooth, an exposed tooth root, or gum disease.

Sometimes diseases of the jaw joint (temporomandibular joint), or spasms of the muscles used for chewing can cause toothache like symptoms.

The severity of a toothache can range from chronic and mild to sharp and excruciating. It can be a dull ache or intense. The pain may be aggravated by chewing or by thermal foods and liquids which are cold or hot. A thorough oral examination, proper tooth testing and evaluation, along with appropriate dental x-rays, can help determine the cause. What we want to know is whether the toothache is really coming from a tooth or somewhere else.

Aren’t all toothaches caused by a tooth or several teeth?

Nope. Sometimes, a “toothache” may be caused by a problem not originating from a tooth or the jaw at all. Pain around the teeth and the jaws can be symptoms of diseases of the heart (angina, heart attack), ears (such as inner or external ear infections), and sinuses (air passages of the cheek bones) such as sinusitis (infection of the sinus cavities). For example, the pain of angina is usually located in the chest or the arm. However, in some patients with angina, a toothache or jaw pain are the only symptoms of their heart problem. Infections and diseases of the ears and sinuses can also cause pain around the teeth and jaws. Therefore, evaluations by both dentists and doctors are sometimes necessary to diagnose medical illnesses causing a “toothache.”

Keep in mind, while rare, some chronic toothache like pains are caused by neuralgias and other nerve ailments.

What are some Dental causes of Toothaches?

A dental cavity or decay which has inflamed the pulp. Left untreated this will progress to an abscessed tooth. Sometimes, in spite of the decay removal and restoration the pulp has become so inflamed that it continues to degenerate.

Decay which has progressed to invade the pulp and cause the pulp tissue to become infected resulting in an abscessed tooth

Cracked, Split and Fractured teeth can cause inflammation of the pulp and the tissues around the tooth.

Periodontal disease and receding gums can expose tooth roots making them more sensitive to hot and cold foods. Periodontal disease can cause pulpal inflammation via small canals that extend from the outside of the tooth to the inside called lateral or accessory canals.

Tooth & Oral Pain Symptoms Guide

Information provided in this guide is for educational purposes only. Your specific symptoms may require different actions than provided in this chart. It should not be a substitute for professional Medical and Dental attention, diagnosis, and treatment.

SymptomPotential Problem ActionMomentary sensitivity to hot or cold foods without recent dental work.If the discomfort lasts a fleeting moment to hot and cold foods it may not signal a problem. Unfortunately, it sometimes is a sign of another problem.

The sensitivity may be caused by a loose filling, decay, crack / fracture in the tooth, or by minimal gum recession which exposes small areas of the root surface.

1. Have the tooth / area checked by your dentist or endodontist. It may be nothing important, but consider it could be an early indicator of a problem!

2. Treatment may be needed such as replacement of a loose filling, restoration, or some type of coverage over an exposed root.

3. In some cases, changing your brushing techniques or switching to a toothpaste for sensitive teeth may decrease the problem.

Lingering or prolonged sensitivity / awareness to hot or cold foods without recent dental work.This probably means the pulp has been irreversibly damaged by deep decay, crack/fracture, periodontal disease or trauma.See your dentist or endodontist. You’re probably going to need nonsurgical endodontic therapy or root canal (RCT) to maintain your tooth. Waiting may cause the tooth to be unrepairable or unsalvagable so do it now!Momentary sensitivity to hot or cold foods after recent dental treatment.Dental work may inflame the pulp, inside the tooth, causing temporary sensitivity. This type of sensitivity lasts only a fleeting second and potentially may be quite intense. Fortuantely, the pulp tissue usually recoperates from this trauma and the sensitivity diminishes within a few days to weeks.Wait four to six weeks. If the pain persists or worsens, see your dentist or endodontist.Lingering or prolonged sensitivity / awareness to hot or cold foods after recent dental treatment.Dental work inflamed the pulp such that the tissue inside the tooth is beginning to degenerate. Chances are your tooth is NOT going to repair the problem without intervention. Don’t blame your dentist, most likely you had a cavity near the pulp tissue or was missing a substantial portion of the tooth prior to restoration.See your dentist or endodontist. There is a good chance nonsurgical endodontic therapy or root canal (RCT) is going to need to be performed to maintain your tooth.Dull ache near a tooth &/or Biting sensitivity after recent dental treatmentPotentially an indicator the pulp tissue is inflamed. Because many of these require treatment, such as endodontic therapy to remove inflamed pulp. Occassionaly, if just biting sensitive, it may be related to your bite.A trip to your dentist or endodontist for an endodontic evaluation is warranted. Many of these may require endodontic therapy to eliminate this problem.

Sometimes this can be bite related and may just require and adjustment. Repeated adjustments are a commonly a sign endodontic therapy may be needed.

Sharp pain when biting down on foodThere are a lot of problems which can cause this symptom. Here are a few:

Loose Filling


Cracked or Split tooth

Cuspal Fracture

Vertical Root Fracture

Tooth that needs endodontic treatment

A tooth that has already had endodontic therapy or root canal treatment which is not responding favorably (failing).

You probably guessed the answer already. Go see your dentist or endodontist for an evaluation.

Treatment will depend on the cause of the problem!

Constant and severe pain with pressure, swelling of the gum, and sensitivity to touchA tooth may have become abscessed, causing the surrounding bone to become infected.See your dentist or endodontist for evaluation and treatment to relieve the pain and maintain the tooth. Many times you’re going to require endodontic treatment of some type to maintain the tooth.

If your tooth has already had endodontic threapy, retreatment or endodontic surgery may be needed to maintain your tooth

A tooth hurts when I tap on it with my finger from the side.If this is your only symptom, there are a variety of reasons this might be occurring.

I had a tooth treated once endodontically and it remained sensitive for 6 months like this.

This is a marker that your periodontal ligament is probably inflamed

There are potentially several causes of this. See your dentist or endodontist for an evaluation of the tooth.Gumboil that sprouts and may become tender but then pops and goes away.Either a periodontal (gum) abscess or an endodontic abscessSee your dentist, periodontist, or endodontist for diagnosis and treatment.

If this is caused by an endodontic problem, endodontic therapy will be needed to maintain the tooth.

Dull ache and pressure in upper teeth and jawThe pain of a sinus problem such as sinusitis or infection of the sinuses is often felt in the face and teeth.

Grinding of teeth, a condition known as bruxism, can also cause this type of ache.

If your sinuses seem to be the problem see your physician.

If your muscles around your face or your TMJ (joint that connects your lower jaw to your skull) is sore, see your dentist.

Chronic pain in head, neck, or earSometimes pulp-damaged teeth cause pain in other parts of the head and neck, but other dental or medical problems may be responsible.See your endodontist for evaluation. If the problem is not related to the tooth, your endodontist will refer you to an appropriate dental specialist or a physician.Touching a specific spot in or near your mouth triggers a sharp, jabbing pain lasting a few seconds. Sometimes talking may also cause this to occur.Possibly a neurological condition known as Trigeminal NeuralgiaSee your dentist or endodontist to rule out a possible dental cause. You will most likely be referred to dentist that treats this type of pain or physician such as a neurologist. Neurologists specialize in treatment of nerve problemsClicking or pop is heard when opening your mouth. Opening / Closing your mouth may be painfulPotentially your TMJ (Temperomandibular Joint) which connects your lower jaw to your skull has a problem. It’s also known as TMD for TemperoMandibular DysfunctionSee your dentist. Treatment will vary depending on the symptoms and severity of involvement.

How do you diagnose whether it’s a tooth problem

or something else?

Good Question. Endodontic diagnosis requires a practioneer to be through and knowledgeable of anatomy of the region in addition to pain referral patterns.  We will test your suspect tooth and other teeth in the area with many different tests. We always check if it is temperature sensitive to cold and possibly heat and/or electricity (sounds terrible but it’s not so bad — I have had it done to myself).  Other tests that we routinely complete include: tapping on your tooth to see if inflammation is present, rubbing the gum area near the end of the roots for sensitivity, and measuring your gums to check the periodontal health of the area including the “wigglyness” of your tooth. Sometimes we have you bite on a stick and/or use a fiber optic light to check for cracks or fractures which go through your tooth. Usually we will take x-rays at various angles. Not only are we looking for an abscess but also the anatomy of your tooth. Since you are 3 dimensional and X-rays are 2 dimensional we lose information that we attempt to make this up by taking specialized angles. X-rays alone are not sufficient for diagnosis. Just because there’s nothing on the X-ray’s does not mean there is not a problem. Early stages of pulp degeneration and some small abscess are not visible on the X-rays. Hence, the reason we perform other tests!

How do I make my Toothache Stop?

Back in the 1800’s, individuals had access to this remedy.

We don’t recommend this. Just thought we’d show a little dental history!