Not All Toothaches Are a Toothache

You have a toothache, so naturally you go to the dentist. The problem, however, may not be with your tooth. Some patients become impatient when the dentist is evaluating a tooth problem. Though it appears obvious a tooth, that hurts when you touch it, needs to be fixed, a dentist has to consider the possibility that another tooth or problem in the area maybe contributing to the pain. The dentist wants to avoid a scenario where the apparent tooth is treated and the patient returns the next day still in pain. It is best if the patient understands all of the possible explanations for their pain–especially when it seems obvious.

It is difficult for a patient to determine exactly which tooth is causing the pain. But once the patient thinks they have identified the problem tooth, they become convinced they are right and are not easily persuaded otherwise. Several times I’ve seen a patient who insists a lower back tooth is the problem, but after an x-ray and closer examination they agree that it is obviously an upper tooth. In some cases we find it is not even a tooth causing the pain. Recently, a patient insisted two teeth were the source of her pain, one of the teeth had been treated twice. When treatment of the other tooth did not help, I urged her to see a specialist, who also found nothing wrong. She eventually saw a neurologist who determined she had an artery pressing on a nerve in her jaw. Since having surgery, she has been fine. As this case points out pressure on a tooth nerve can result in a toothache and that pressure can come from several sources.

Though rare, many other sources of tooth pain need to be considered, including: sinus problems, grinding habits, angina, ear inflammation, or muscle inflammation. Nerve conditions or disorders, such as Bell’s palsy or trigeminal neuralgia could also be the cause of tooth pain. “Tumors” in the bone and probably some syndromes, illnesses and conditions we have not yet identified are also possible sources of tooth pain. It is very important for you to become involved in the diagnosis of a problem and not assume the treatment will be obvious. Report all symptoms and any problems to your dentist early, and have patience but be persistent if no solutions are evident right away. Your dentist will do everything he or she can to identify the source of your pain and treat it, but sometimes that will mean sending you to see another doctor or specialist.