Some Causes of Toothache
Cause | Suggestive Findings | Diagnostic Approach* |
|---|---|---|
Periapical abscess | Constant pain that worsens when chewing or biting Normally precise identification of the involved tooth by the patient Tooth tender to percussion (tapping with a metal probe or tongue blade) Sometimes visible fluctuant swelling of mucosa over the affected root, painful swelling of the adjacent cheek and/or lip | Dental evaluation |
Apical periodontitis | Symptoms and findings similar to those of apical abscess but less severe and without swelling over the root | Dental evaluation |
Caries (dentinal sensitivity) | Pain after stimulation (eg, heat, cold, sweet food or drink, brushing) Pain is isolated to a single tooth and usually stops when stimulus is removed Usually a visible carious lesion or a root surface exposed by gum recession or abrasion | Dental evaluation |
Incomplete fracture of the crown of a vital tooth | Sharp pain on release from a chewing stroke Marked sensitivity to cold | Dental evaluation |
Irreversible pulpitis | Pain without stimulation, lingering pain after stimulation, or both Sometimes difficulty identifying the involved tooth | Dental evaluation |
Pericoronitis caused by eruption or partial impaction of a third molar (wisdom tooth) | Constant dull pain, especially with chewing Inflammation around the mandibular wisdom tooth, sometimes with purulent drainage Trismus may occur and limit opening | Dental evaluation |
Pulp damage caused by trauma | Tooth discoloration (may be delayed up to many years after injury) Can result in an apical abscess | Dental evaluation |
Reversible pulpitis | Similar to caries but with difficulty identifying the involved tooth | Dental evaluation |
Many maxillary posterior teeth (eg, molars, premolars) sensitive when chewing and to percussion Pain during positional changes, especially lowering the head (eg, tying shoe laces) Often nasal discharge and tenderness to percussion over the affected sinus | Sinus CT Dental evaluation if no sinusitis detected | |
Teething | Discomfort and fussiness during tooth eruption in young children Drooling common, chewing on things (eg, crib rail) | Clinical evaluation |
Vertical root fracture | Tooth that is mobile and exquisitely sensitive to touch Isolated deep periodontal probing depth Characteristic “J” appearance on x-ray | Dental evaluation |
* Dental evaluation entails referral to a dentist for examination and usually dental x-rays. | ||