Merck Manual

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Some Causes and Features of Toothache

Some Causes and Features of Toothache


Common Features*


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†

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†

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.