So you've been having a toothache or at least you're pretty sure that it is. However when you went in to see your dentist, they told you otherwise. They said that they didn't see anything wrong with your tooth.
Are you wondering how that could be? You're clearly feeling pain and it's definitely not all in your head! Could your dentist possibly be wrong with their assessment?
If you were asking your dentist if there was anything wrong with your teeth, they were probably right that there isn't. In a lot of these cases, that tooth pain which you're having is actually referred pain coming from elsewhere in your body!
Table of contents:
Why your dentist isn't wrong
You came in complaining about tooth pain so your dentist did what they were trained to do. They examined your teeth since they are the teeth specialists. They run a bunch of clinical tests and take a couple of x-rays.
Unfortunately the results from all of those were that there is absolutely nothing wrong with your teeth. Yes, that is correct, they saw nothing wrong with your tooth!
It's not as if your dentist is trying to lie to you. If they visually don't see any issues with your tooth they will tell it as they see it. If nothing suspicious shows up on the x-ray, they'll tell you that the x-ray showed nothing.
Therefore when they say that they don't see anything wrong with your teeth, you better believe it. However that doesn't mean you're crazy because the pain that you're feeling is probably referred pain that isn't coming from your teeth.
The next step is to actually ask your dentist what else the pain could be from... because there are a lot of potential referral sources.
Where the pain could be coming from
If you've a toothache but your dentist says nothing is wrong, it could be the surrounding soft and hard tissues that are referring pain to your teeth. Due to their close proximity, your body may be confused and perceive it as a toothache while it is actually something else.
Sources of referred pain that are perceived as a toothache:
Sinusitis or sinus infection
Severe headaches or migraines
Temporomandibular joint pain
TMJ muscle pain
An ear infection can potentially make you think that you have a toothache. This all becomes clear if you look at the anatomy of the ear canal and its proximity to the facial nerve. They're literally right next to each other. Inflammation in the ear can compress on the nerve.
Once in a while we'll have patients come in complaining about wisdom tooth pain. We'll run all of the tests and find nothing wrong with the tooth. However we're suspicious of an ear infection since they also say that their face feels numb.
Treatment: If the pain is coming from your ear, you would need to schedule an appointment with your ENT for a proper diagnosis. Yes, your dentist can give you antibiotics and clear it up but only your ear nose throat doctor can give you a definitive diagnosis.
Toothaches coming from the upper back molars should always make you suspicious of potential sinus involvement. There could be sinus inflammation or an infection.
The reason why it could be coming from the sinus is because the root tips of the maxillary (upper) molars can be very close to the sinus. If that is the case, your teeth could be sensing the inflammation coming from the sinus.
Treatment: A course of antibiotics will clear up the sinusitis. Although you should still follow up with your ENT especially if you are prone to getting this condition. Studies have even demonstrated that headaches can present itself as a toothache. A hallmark sign would be nothing wrong with the teeth but yet pain persists.
Headaches and migraines
Some people can mistake headaches or migraine pain for a toothache. This type of pain usually spread all over the face and the mouth is no exception.
Treatment: For proper treatment and diagnosis of headaches and migraines, you should see a neurologist. Most people who suffer from this condition, it is usually not a one time occurrence but a recurring chronic problem for them.
Temporomandibular joint pain
The actual joint of the TMJ can potentially cause you pain. It is close enough to your last molars where you may feel like it could be toothache.
Signs and symptoms of TMJ joint pain:
Jaw clicking or popping
Jaw deviates to one side when opening
Pain feels worse in the morning
Treatment: You would have to see a TMJ specialist or a dentist who treats it. There is a chance you may need a combination of specialists such as oral surgeons and physical therapists to fully treat this condition.
TMJ muscle pain
In lieu of the temporomandibular joint, the pain could be referred from the TMJ muscles. There are four prominent muscles which you use to chew with that can be dysfunctional. Overuse of them can lead to muscle knots and trigger points which refer intense pain.
Trigeminal neuralgia is a condition which may result in chronic severe pain to the face. It is very complex and you will need to see a neurologist for it. It would be best for your dentist to refer you to an orofacial pain specialist.
What you should do
Your dentist is most adept at diagnosing tooth pain that is odontogenic in nature. However they are also proficient in treating TMJ disorders. You should rule out all dental problems before you seek a consultation with other medical specialties.
How to rule out TMJ disorders:
Check the temporomandibular joint for any dysfunctions.
Check each of the TMJ muscles (masseter, temporalis, medial pterygoid, lateral pytergoid) for muscle knots.
If the toothache is not coming from the TMJ and its related structures, the next thing you can try is taking antibiotics. This will rule out an ear infection or a sinus infection. Taking a one week dose of amoxicillin could resolve both of those conditions. However the best thing to do would be to see an ENT for it but if you want your dentist to try, they can oblige.
Last but not least, if it is not coming from the TMJ or ear/sinus infection, it can potentially be a nerve problem. In that case you would have no choice but to see a neurologist to check if it is a headache or trigeminal neuralgia. These conditions are completely out of your dentist's field of expertise so the most they can do for you is to give you a referral.
Hopefully, you now know what to do when you've a toothache but your dentist says there's nothing wrong.