Severe Tooth Pain When Chewing: Possible Causes and Solutions

Experiencing pain for several hours after eating or biting something, but not feeling pain when tapping, could indicate a dental issue such as a cavity, cracked tooth, or gum disease. It is advisable to consult a dentist for a thorough examination and appropriate treatment?

It seems to be the right molar.
I can only chew on the right side, and when I bite down, it hurts.
The pain starts as a slight discomfort, then gradually intensifies...
the area of pain spreads (is it conduction??)...
radiating from beneath the tooth to the area under my jaw, and then it also affects my head and right ear.
Once the pain escalates, it lasts for about 3 to 4 hours (it's extremely painful), and then it slowly subsides (actually, neither brushing my teeth nor using cold water to alleviate the pain helps at all)! When I wasn't in pain, I had dental X-rays taken, but the dentist said everything looked fine.
The dentist also tapped on the molar vigorously, and it didn't hurt at all; no matter how hard he tapped, there was no pain.
He tapped several teeth in different areas, and there was no pain (it's quite remarkable).
The dentist gave me a task (??) and said to see which tooth hurts more when the pain occurs.
I tried tapping, but since the area of pain is so large and intense, I really can't tell which tooth would hurt more when tapped.
What could be the issue here?? What direction should I take or how should I go about getting checked?

KUKU, 30~39 year old female. Ask Date: 2015/07/28

Dr. Zeng Guanghui reply Dentistry

The right molar hurts when biting down, and once the pain starts, it intensifies, radiating to the submandibular area and the right ear, lasting for 3-4 hours before gradually subsiding.
However, during examination, X-rays and percussion of the tooth show no abnormalities.
This is more likely to be related to a neurological issue such as trigeminal neuralgia or migraine.
It is advisable to consult an oral surgeon or a neurologist for further evaluation and treatment.

Reply Date: 2015/07/28

More Info

Severe tooth pain, especially when chewing, can be a distressing experience and may stem from various underlying issues. Based on your description, it seems that the pain radiates from the affected tooth to other areas, including your jaw, ear, and head. This type of pain can be indicative of several dental conditions, and understanding the potential causes can help guide you toward appropriate solutions.

Possible Causes of Severe Tooth Pain:
1. Dental Caries (Cavities): Even if X-rays did not show any visible cavities, there could be decay that is not easily detectable. Sometimes, cavities can develop in areas that are difficult to see or access, especially between teeth.

2. Pulpitis: This condition occurs when the dental pulp (the innermost part of the tooth containing nerves and blood vessels) becomes inflamed, often due to untreated decay or trauma. Pulpitis can cause severe pain that may worsen when chewing or applying pressure to the tooth.

3. Periodontal Disease: Gum disease can lead to inflammation and infection around the tooth roots, causing pain that may radiate to other areas. If you have gum inflammation, it could contribute to the discomfort you are experiencing.

4. Cracked Tooth Syndrome: A crack in a tooth may not always be visible on X-rays but can cause significant pain, especially when chewing. The pain may vary depending on how the crack interacts with the surrounding tissues.

5. Temporomandibular Joint (TMJ) Disorders: Given that you experience pain radiating to your jaw and ear, TMJ disorders could be a contributing factor. These disorders can cause pain in the jaw joint and surrounding muscles, leading to discomfort while chewing.

6. Sinusitis: Sometimes, sinus infections can cause referred pain to the upper teeth, particularly the molars. If you have had recent sinus issues, this could be a factor.

Recommended Actions:
1. Seek a Specialist: If your general dentist is unable to identify the cause of your pain, consider seeing an endodontist, a specialist in tooth pain and root canal treatments. They can perform more detailed assessments, including tests for pulp vitality.

2. Further Imaging: If pain persists and is severe, ask for additional imaging, such as a cone beam CT scan, which can provide a more comprehensive view of the tooth and surrounding structures.

3. Pain Management: While waiting for further evaluation, over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. However, consult with your healthcare provider before taking any medication.

4. Avoid Aggravating Factors: If certain foods or activities exacerbate the pain, try to avoid them until you can get a definitive diagnosis.

5. Monitor Symptoms: Keep track of when the pain occurs, its intensity, and any other symptoms (like swelling or fever). This information can be valuable for your dentist or specialist.

6. Consider TMJ Evaluation: If you suspect that your pain may be related to jaw issues, a consultation with a dentist specializing in TMJ disorders may be beneficial. They can assess your jaw function and recommend treatments such as a night guard if bruxism (teeth grinding) is a factor.

Conclusion:
Severe tooth pain when chewing can arise from various dental issues, and it is crucial to identify the underlying cause to determine the appropriate treatment. If your current dentist is unable to provide answers, seeking a second opinion from a specialist can be a wise decision. Remember, timely intervention can prevent further complications and alleviate your discomfort.

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