Why toothache without cavity?

Dr. Shah: Hi Jennifer, welcome to ask the doctor section. Please feel free to ask me questions.

Jennifer (Patient): Hi doctor, my question today is why does my tooth hurt if I don’t have a cavity?

Dr. Shah: Thank you for asking that question, Jennifer. There are several different reasons the tooth may be hurting. It’s not a cavity. The only reason it should hurt. So let me explain to you and it may not apply to your case, because we need to do a thorough examination with x-rays and clinical examination to find out, and sometimes if a general dentist cannot figure it out, we may have to refer to a specialist. So, let’s find out the most common cause of any tooth which has pain and there is nothing visible, no cavity, no fillings, nothing. It’s called crack tooth syndrome. If the tooth has a crack, which is not visible because it’s a microscopic crack. It’s a very small crack, so it’s not visible either with our eyes or even in an X-ray, then you might have pain because of the crack. Then we usually refer patients to an endodontist. They have a microscope. They have a lot more experience and knowledge in diagnosing the crack. So they can diagnose the crack and then suggest treatment depending on how deep the crack is. So that is the one reason. The second reason can be neurological, meaning some disturbance with the nerve. The third reason may be periodontal, which is not visible. Outside, you might have bone loss and there is an infection inside that bone area under the gums, And then it hurts. Sometimes it’s visible like an abscess, sometimes it is not visible and you may not see any changes and it still hurts. So, all those possibilities have to be diagnosed by the doctor by taking X-rays and asking you lots of different questions and by doing a clinical examination, With the explorer and mirror to check whether you have mobility on the tooth. They tap the tooth in the back of the mirror. It’s called vertical percussion. Then we do the side hitting with the back of the mirrors called horizontal percussion. We can check the depth of the pocket. We can check the X-ray. We can check the 3D X-rays by a CBCT, CT scan or several different ways we can do the diagnosis. Thank you.