Merck Manual

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Some Causes and Features of Toothache

Some Causes and Features of Toothache


Common Features*


Periapical abscess (a collection of pus around the tooth's root that can cause acute or chronic symptoms)

Pain may have begun recently or be longstanding

Constant pain that worsens when chewing or biting

Normally, the person can precisely identify the involved tooth

Tooth tender when tapped with a metal probe or tongue depressor (percussed) 

Sometimes visible swelling of the gum over the affected root and painful swelling of the adjacent cheek and/or lip

A dentist's examination†

Apical periodontitis (inflammation of tissues around the tooth's root)

Features similar to those of apical abscess but less severe and without swelling over the affected root

A dentist's examination†

Pain that

  • Occurs mainly after brushing or after chewing or swallowing hot, cold, or sweet food or drink

  • Is isolated to a single tooth

  • Usually stops when the stimulus is removed

Usually a visible cavity or a root surface exposed by gum recession or an abrasion

A dentist's examination†

Fracture of a tooth

Sharp pain when chewing

Marked sensitivity to cold

A dentist's examination†

Pericoronitis (usually involving an erupting or partially impacted wisdom tooth)

Constant dull pain, especially when chewing

Visible swelling, redness, and sometimes pus around the affected tooth

Commonly spasms of the chewing muscles (trismus) may occur and limit opening

A dentist's examination†

Pulpitis (inflammation of the tooth pulp)

Pain that occurs without stimulation and/or that lingers for more than a few seconds after stimulation

May have difficulty identifying the affected tooth 

A dentist's examination†

Pain in several upper teeth on one side, especially molars and premolars

Sensitivity when chewing and when the upper teeth are tapped (percussed)

Often a nasal discharge and tenderness when the sinus is tapped

Pain when changing positions, especially lowering the head (as when bending down to tie shoe laces) 

A doctor's examination, sometimes with CT of the sinuses

A dentist’s examination if no sinusitis is detected

Discomfort and fussiness during tooth eruption in young children

Commonly drooling and chewing on things (such as the crib rail)

A doctor's examination

* Features include symptoms and the results of the doctor’s examination. Features mentioned are typical but not always present.

† Dental x-rays are usually taken.

CT = computed tomography.