Toothache - Diagnosis

Authored by Dr Ben Williams, 19 May 2017

Reviewed by:
Dr Hayley Willacy, 19 May 2017

Before starting any treatment your dentist will need to make sure that the source of your pain has been correctly identified. The first step is asking about the history of your toothache.

The questions might include:

  • For how long have you had toothache?
  • How long does each episode of pain last?
  • Describe the pain? Where is it located? Is it a sharp pain or a dull throbbing pain? How painful is it on a scale of 1 to 10?
  • What causes the pain to start? Does anything make it go away? Does the pain start spontaneously by itself?
  • Is the tooth painful to bite or chew with? Is it sensitive to hot or cold food and drinks?
  • Does the pain affect your sleep?
  • Have you taken any painkillers and if so were they effective?

Next, your dentist will examine your teeth and carry out some tests to gather more information.

Percussion testing
This is usually performed by tapping gently on teeth with a dental mirror handle and pushing on various teeth to identify which ones feel normal, a bit tender or very tender.

Vitality testing
This aims to identify if a pulp is healthy, inflamed or dead by placing hot or cold pieces of cotton wool against individual teeth. If a tooth feels the temperature difference, the pulp is alive or vital. An exaggerated response indicates the nerve may have pulpitis. A negative response implies the pulp may be dead. A pen-shaped device called an electric pulp tester can also be used to test if a pulp is alive.

X-rays
These can provide useful information about the presence and extent of tooth decay (dental caries), root fractures, the shape and depth of fillings, the presence of infections or abscesses around the roots of teeth and the proximity of teeth to the sinuses, nerves and other structures.

Testing for cracks
You will be asked to bite down repeatedly on to a plastic wedge-shaped instrument to identify cracks in a tooth that might be too small for the dentist to see directly. Sometimes shining a bright light against the tooth can help to visualise a crack.

Assessing the health of your gums
Your dentist will carefully assess the health of the gums around the painful teeth to check for inflammation, infections and signs of periodontal disease.

When all the relevant information has been gathered, your dentist will discuss the likely causes for your pain and provide you with a list of treatment options.

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