What Causes Toothache? A Short Guide

A guide to toothache?

A toothache can take many forms and vary from an occasional mild discomfort to a severe pain that disturbs your sleep- this is one of those times where taking painkillers and hoping it will simply go away is not advised. By all means take something for the pain, but schedule a visit with us (or another dentist) to get the issue checked out. Delaying can easily lead to more pain, and more extensive and expensive treatments.

We see it everyday: cavities which could have been simply filled if they had been discovered sooner, now have nerve problems and need a root canal or in the worse case scenario – the tooth cannot be restored and has to be removed.

Give us a call today on 02 and let us help you.

Why choose Dr Workman to look after you?

Not only is Dr Workman a very good dentist, he has genuine caring nature and always makes sure you feel truly looked after. This is why he has such a loyal following of, families, young professionals right through to our older generation. With over 12 years experience, he is young, passionate, great at what he does and has an excellent aesthetic eye. If you would like a dental professional you can really trust,  who places your health, happiness and comfort as an absolute priority, then you would be hard pushed to look any further. If you have typed ‘dentist near me’ then our state of the art Maroubra dental practice won’t be far away.

Where is the pain coming from?

Your toothache maybe coming from a tooth, but it may also be related to your gums, your bite, your jaw or even the muscles associated with chewing. You may know exactly which tooth is causing the pain, or you may have no clue as the pain travels from the top jaw to the bottom jaw, maybe even up to your ear!

So, how do we diagnose your toothache?

There are a number of questions we always ask in order to gauge what is actually going on and what’s causing your problem. Think of it rather like clues to a puzzle: we are collecting bits of information in order to determine the issue. Once we have the diagnosis we can discuss the possible treatments; get you fixed you up and alleviate your pain.

Sometimes a diagnosis is simple and obvious such as a chip in a front tooth, maybe because you bit into an olive stone, but on other occasions there’s nothing obvious going on in your mouth and the history of the symptoms that come with the pain is very confusing and unclear.

Our questions can give us clues about the state of the nerve inside a tooth – clues that even imaging cannot tell us. For example, you will experience specific symptoms if the nerve has been damaged beyond the point where simply having a filling will alleviate the problem… by placing a filling, you are likely to continue to feel pain… in these circumstances a root canal would be necessary.

What is the history of your pain?

Dr Jamie has written at length on his patient education site about the questions dentists ask and what they mean in terms of your teeth, mouth and the pain you are experiencing. If you are keen on a bit of self diagnosis- generally not recommended (but being informed is certainly a good thing) click here to read more about toothache symptoms (link)

The clinical examination

During the ‘clinical examination’ we look at your mouth, teeth, jaw and gums for any sign of problems. Our initial diagnosis is further enhanced by questioning – what you tell us and where the problem seems to be originating can be critical in the diagnosis.

We will perform some ‘special tests’ to provide us with extra information to hopefully complete the picture.

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What special tests do we do?

The most common special tests are:

1. X-rays- these allow us to look at the areas of the tooth we cannot see visually- such as in between the teeth, under fillings; it enables us to assess the roots of the tooth, the bone supporting it and the surrounding area. There are different views we take, depending on the situation: these are discussed further in the link to X-rays but more than one view may be necessary.

2. Vitality testing (“pulp testing”)- we will spray cold air on a tooth or apply a cold spray on a cotton pellet to the tooth to check for signs of life. How the tooth responds gives us an indication of how affected the nerve is inside; we can then suggest an appropriate treatment. We have an EPT or electric pulp tester that can also be used to test the state of the nerve.

3. Percussion- you may have had a dentist tap your teeth in the chair; we do this to identify if any teeth are tender to percussion. A susceptible tooth is more likely to be the ‘toothache’ culprit; if the tooth is very painful on tapping, it may suggest an abscess underneath, or, if the pain is not quite so extreme – inflammation is moving to the ligament.

4. Crack finder- we can use an instrument to test different areas of a single tooth to see if a crack is the likely cause of your pain. If you have tooth-pain when eating hard things, a crack is possible. Hard foods can flex the tooth slightly and if there is a crack, send shooting pains into the tooth. The crack finder helps us test this: a crack may be visible, or it may not – there is often a large filling that needs to be removed in order to inspect the tooth fully. The position and extent of the crack will determine how we treat it.

5. Palpation- this is slightly different to percussion and involves us gently pressing the bone and gum around the offending area. We are looking to see if there is any tenderness or swelling which may indicate infection.

6. Mobility- we will also check your teeth for mobility: are the teeth moving more than normal: this could suggest gum disease and associated bone loss, or possibly an abscess that is pushing the tooth up into the socket.

What are the common reasons for dental pain or toothache?

  • Decay or cavity
  • Gum disease
  • Cracked tooth
  • Sensitivity
  • Loose tooth
  • Dental abscess
  • Gum abscess
  • Wisdom tooth pain
  • Chipped or fractured tooth
  • Tooth wear
  • Grinding or clenching
  • Sinusitis

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How do we treat toothache?

How we treat toothache depends on the cause, the importance of the correct diagnosis cannot be overstated. If we get this wrong, you could end up having a filling, root canal or worse an extraction that may have been unnecessary.

On rare occasions we may not be able to diagnose the cause of your problem, though we are likely to be able to rule a number of things out.

In these cases, it may be necessary to see how your symptoms develop over the course of a few days and weeks. We may start with a simple treatment and progress to others depending on how you respond.

To check the treatment for each of the common problems above, please click on the above links.

What is pulpitis?

Pulpitis literally means inflammation of the dental pulp, aka the blood vessel/nerve complex inside the middle of your tooth. A problem with cavities or decay often stimulates this reaction in a tooth…it’s not always so, which is why it’s so important to get regular check ups and X-rays every couple of years: these pick up those hard to see problems early, and minimise the treatment needed.

When the pulp becomes inflamed we categorise it broadly into 2 forms; this gives us an indication as to how the tooth will respond to treatment and which treatment is best.

Reversible pulpitis is a mild inflammation of the pulp. With appropriate treatment, such as a filling and removing any active decay, the tooth will settle down and return to normal.

Irreversible pulpitis is a significant inflammation from which the pulp is not likely to recover. The swelling inside the tooth is such that the tooth will continue to be painful, unless the inside of the tooth is treated: this means removing the nerve and the surrounding tissue with either a root canal or an extraction.

In reality, it’s not always quite so cut and dry; the inflammation represents a spectrum of changes which we need to interpret- nevertheless it serves as a good general guide.

Sometimes we may attempt to save a tooth and maintain its vitality with a filling only for the pain to continue; in these circumstances we end up moving to a root canal in order to save the tooth.

It is important to understand that reversible pulpitis will, if left untreated, progress to irreversible pulpitis – so, if you have symptoms, the earlier you see us for treatment the better.

Summary Box:

Toothache causesDecay | White fillings | Gum disease | Sensitivity | Wisdom tooth pain | Grinding
CostSee treatment page for details

Have a Question?

You can ask Dr Jamie directly:

Alternatively if you would prefer to speak with someone directly or book an appointment, please call our lovely staff at the Maroubra Dental Centre on 02 9133 4005.

Like more information?

Click the below to download our guides to:

Check out:

  1. Dr Jamie’s education site; Jamiethedentist.com where you can hear him speak and read about TOPIC in a lot more detail.
  2. These other excellent resources:


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