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Diagnosing Tooth Pain

Specific Causes: A list

Tooth Ache Pain Anatomy

Toothache usually refers to pain around the jaws or teeth. Most commonly, toothaches are caused by tooth or jaw problems, such as a dental cavity, an exposed tooth root, a cracked tooth, gum disease, disease of the jaw joint (temporo- mandibular joint), or spasms of the muscles used for chewing.

The severity of a toothache can range from chronic and mild to sharp and excruciating. Pain may be aggravated by chewing or by changes in temperature. A comprehensive examination, including xrays, can help determine the cause, whether the toothache is coming from a tooth or jaw problem.

Unusual Pain Events

Some patients experience persistent toothaches without having an apparent dental problem, such as tooth decay, that could explain their pain. These patients may visit several dentists and specialists in the search for a solution, and may have root canal therapy, dental extractions and other procedures without relief.

Non Dental Structural Pain

Thus, toothaches of non-dental origin encompasses a group of conditions in which pain is due to problems in structures other than a tooth. Since the pain still feels like a toothache, the cause can be difficult to identify and puzzling for the dentist and patient.

Pain Perception Differences

Dull vs Sharp

The pain from a toothache of non-dental origin can manifest in many different ways. Some patients have a low-grade, bothersome ache and others experience an excruciating pain, described as throbbing, sharp or shooting.

Pain Migration

The pain can be present all the time or come and go. It is usually felt in the teeth or in the surrounding areas such as the gums and bone. Unexpectedly, the pain can migrate from one tooth to another and even change sides of the mouth.


The pain may be present from weeks to several years. The similarity to a classical toothache will cause some patients to undergo dental treatments in multiple teeth before a diagnosis is established. It is important to exercise caution in having irreversible procedures performed, such as a root canal or an extraction, in these situations.

Disorders that Cause Persistent Tooth Pain

A toothache of non-dental origin can have several different causes for the pain. Previously, when the cause of persistent toothache was unknown, it was often labeled as atypical tooth pain or atypical odontalgia.

To determine the source of persistent tooth pain, several conditions have to be considered. These include conditions that are due to dental problems and frequently go unnoticed, as well as conditions due to non-dental problems.

These can include:
  1. Muscle pain
  2. Headache
  3. Trigeminal Neuralgia (TN)
  4. Nerve damage pain
  5. Heart attack
  6. Sinus pain
  7. Tumors
  8. Salivary gland dysfunction

Summary: Diagnosing Tooth Ache Pain

If the tooth is healthy, identifying the non-dental source of the pain is the next step.

There are some symptoms that suggest the cause for your pain might not be in your teeth. These include: pain in several teeth, pain that moves from one tooth to another, pain that is tingling or burning quality or intensity), occurs intermittently without provocation or is related to other non-dental complaints.

If pain perception does not disappear when the dental structures are anesthetized or if you have had one or more reasonable dental treatments and the pain still persists, it is possible that the source of your problem is not in your teeth.

It is recommended the problem be evaluated by a knowledgeable orofacial pain dentist.

Joseph Cohen, D.D.S., F.A.C.D.
Southwest Pain Management Associates
14861 N Cave Creek Road
Phoenix, AZ 85032
(602) 992-1486

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