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Please note that Dental pain is poorly localized. Pain may refer to opposing arch but does not cross midline of the face. It is often difficult to identify the offending arch and even more difficult to identify the offending tooth.

Generally speaking Toothaches come in a variety of styles. While it is often difficult to diagnosis the origin of your tooth arch, it is helpful if you note the following:

Is the pain or sensation brought on spontaneously or Only When Stimulated?
i.e. Sensitivity to percussion (50% of the time it is (+) to finger tapping)

Rule Out Non-Dental Origin;
Sinus, pharyngeal, nasal inflammation
Malignancies (Our dental team routinely performs oral cancer screenings)
Cardiac Origin (if there is a history we will check your blood pressure. Please take your medication.)

Please note what stimulus causes your pain

  • Sensitivity to hot & cold (i.e. ice), salt or sugar

What Type Of Pain Are You Experiencing?

  • Dull, throbbing pain
  • sharp pain from pressure with short duration

Please note the duration or how long the pain lasts
(Less Than 30 Seconds) verses (Over 5 Minutes)

In all cases: Even if the tooth has a large carious hole and/or missing filling, it is not advisable for the patient to attempt to place a temporary filling. Bacteria may be sealed in and the patient may delay dental treatment due to false sense of security.

Rinse your mouth with warm water to clean it out. Use dental floss to remove any food that may be trapped between the teeth. Do not put aspirin on the aching tooth or your gum tissues.

  • Rx analgesics (see our recommendation)
  • ASAP to dentist.

Since “Toothache” is potentially the reason for all topics listed on our dental emergency web site, please narrow your search by reviewing the proceeding specific topics related to toothache;

If you don’t feel that any of the proceeding topics are the reason for your toothache, please continue with general topics below to help you with your dental concern.

#1 Hot/Cold – Salt/Sugar Sensitivity

(Also see topic #5 gum recession root surface sensitivity and rule out history of trauma or broken tooth, or tooth grinding)

If the sensitivity only lasts for a few seconds, then it is often related to a small exposure or agitation of dentinal tooth structure. Usually this is a result of an old leaking filling, or initial stages of tooth decay.

How Does Decay Cause Sensitivity?
The knowledge of the healthy tooth layers will help you to better understand sensitivity from tooth caries. The outer chewing surface of your tooth is enamel. Enamel is naturally white in color and is the hardest substance in your body. When the outer protective enamel is broken down by sugar acids, the underlying dentinal tooth structure is exposed (decay creates a hole or cavity into the dentine). Dentine is made up of tubules which are directly connected to the nerve of the tooth.

Please note, dental disease has become know as a “silent disease” and in many cases, it is possible you may not feel a cavity or even a cavity which exposes the tooth nerve. For this reason, if you have a history of sensitivity or are currently experiencing this type of sensitivity, call our office for an appointment and make sure to mention the location at your dental exam.

Home Treatment:
In this case, avoiding hot and cold, and even placing some Vaseline over the area can protect the tooth for a short while until you can get in to have us take a look at it. If the pain persists more that one minute after it is exposed to hot or cold, it often means that the nerve has been infected. This could mean that we will need to do a root canal to save the tooth. Take Advil or Tylenol to control the sensitivity; if this does not work, you should make an appointment sooner since there could be tooth nerve involvement. Never put aspirin on the tissue in your mouth directly. It can easily burn the tissue.

Clinical treatment options at our office.
See: Dental Procedures Offered > No Needle Drill-Less Fillings

#2 Spontaneous Tooth Pain-Throbbing +5 Min Duration

Some untreated dental infections can quickly change course and rapidly spread into dangerous areas of your head or neck. It should be noted that any infection which is rapidly expanding can become live threatening and should be considered a medical emergency.


  • The most common reason is a Large Cavity which has spread into the tooth nerve.
  • Swelling may also be a result of Traumatic Injury which resulted in death of the tooth nerve & subsequent decomposition (rotting tissue). This rotting tissue dissolves into the jaw bone and subsequently an infection forms.
  • Failing Root Canal Therapy or Root Fracture: It should be noted that the success rate for root canal therapy is 93-95%. Another way to interpret these numbers is to realize that a bit more than 1 in 20 root canal treated teeth will result in failure. This 5% failure rate is largely due to the fact that clinically undetectable and expanding vertical root cracks can be present.

You should also consider reviewing:

  • Swelling Pressure Under Your Tooth
  • Common Mouth Sores
  • Gum Tissue Swellings (Periodontal Disease)

Swelling Pressure under Your Tooth which usually originates from your tooth is difficult to differentiate from swelling which originates from Gum tissue Infections – Periodontal Disease or Something Is Stuck or Wedged between Your Teeth.

Possible Symptoms

  • Dull, throbbing, Intense pain
  • Continuous pain
  • The Tooth may be Loose
  • Lingering pain with thermal changes (esp. cold)
  • Percussion sensitivity (tap your finger nail on each tooth)
  • Slight elevation of the tooth out of the socket
  • Pus drainage around the tooth
  • Grey colored tooth with a history of trauma
  • Intra-oral or extra-oral “pimple-like” draining pump or sore.
  • Possible swollen Lymph nodes
  • Possible low-grade


  • Warm packs appropriate only if infection is already close to skin and skin drainage is likely.
  • Call our office as soon as you can for an appointment. If the infection is from the tooth you will likely need a Root Canal therapy or an Extraction.

Rx: Analgesics
Rx: Antibiotics

It is not normal to experience night awakening with continuous throbbing tooth pain. It is also not normal to experience continuous throbbing pain which is a result of chewing force and/or cold stimulus. Please note the key words which are; continuous and throbbing pain. If you experience this type of pain please call our office, you may have indirectly damaged the nerve of the tooth and may need root canal therapy to save your tooth.

Often when patients present with pain with a longer duration, initially Dr Landers will try to treat the tooth situation conservatively. He will try to save you from root canal therapy. This is when fiber optic dental handpiece technology is a wonderful advantage and service to our patients. Clinically, the use of fiber optic hand piece illuminates deep areas of your tooth structure. The improved vision not only allows Dr Landers to more accurately remove dental decay, and conserve your tooth structure, but the improved vision helps avoid the nerve of your tooth. The end result is a better chance to avoid Root Canal Therapy if it is not needed.

On the other hand, you may have permanent nerve damage and the tissues of the tooth may have been exposed by decay. Adults with carious nerve exposure will need root canal therapy to prevent possible serious side effects of Jaw bone infections. In this case, fiber optic technology will illuminate and accurately show even small nerve exposures. Additionally fiber optic technology will illuminate deep crack into the tooth nerve which expose the tooth nerve.

#3 Sharp Pain Chewing Short Duration

Description: possible old filling, possible pain from gums (see Gum Swelling)

When you bite down you feel sharp pain.
You avoid certain foods or chew on one side of your mouth.

You may have a cracked tooth.
A crack may appear as a hairline size fracture, possible run­ning vertically towards the root of the tooth. A crack often is not detectable to the visual inspection and may not show on an x-ray, for these reasons diagnosis is diffi­cult. At our office we use fiber optic light technology to illuminate tooth cracks on a computer screen. “See what the doctor sees.”

Please remember, dental pain is poorly localized. Pain may refer to opposing arch but does not cross midline. It is often difficult to identify the offending arch and even more difficult to identify the offending tooth. For this reason, it is useful if you decide to help us determine which tooth may be causing the problem. Our suggestion is to noting when and where you have sensitivity to heat or cold, to sweet, sour or sticky food and approximately where the pain is when you are chewing. Don’t just assume you know the location or tooth! Starting from the last tooth in the back of your mouth, progress forward until you locate the actual teeth for which you sense tenderness or pain. Make a mental note and remember the count from the back of your mouth.

A cracked tooth may hurt because the pres­sure of biting causes the crack to open. When you stop biting, the pres­sure is released and a sharp pain results as the crack quickly closes. This pain upon release of biting pressure is characteristic of “cracked tooth syndrome” and you should let us know if you experience this symptom.

Even though the crack may be microscopic, when the crack opens, the pulp (living tissue) inside the tooth may become irritat­ed. If the crack irri­tates the pulp, the tooth will likely become sensitive to temperature extremes. Subsequently, the pulp may become dam­aged or diseased with invading bacteria. Root canal treatment may be necessary to save the tooth.

Depending on the size and location of the crack, Dr Landers may restore the tooth with bonding, an Onlay, or a crown. A severe­ly cracked tooth may need extraction. Dr Landers will conservatively advise you of the best treatment options.

Tiny cracks are common and usually do not cause problems. Often, Dr Landers will make notes if cracks are around old dental fillings, since these are more likely to cause future problems. Regular dental checkups are important. They allow our dental team to diagnose and treat prob­lems in the early stage. If you continue to have pain, avoid chewing on that side of your mouth and give us a call.

#4 Food Between Teeth- Gum Swelling

First, try using dental floss, very gently and carefully, to remove the object. If you tie a small knot in the middle of the floss and pull that through the contact area, often you can dislodge most small pieces of food or debris. Do not poke between your teeth with a pin or similar sharp, pointy object; it can cut your gums or scratch the tooth surface. If you can’t get the obstruction out, give us a call we will remove the object.

#5 Root Surface Sensitivity

Common Symptoms of Root Surface Sensitivity
Groups of teeth on right and left sides of your mouth are:

  • Sensitive to Air
  • Hot or cold sensitive
  • Sensitive to normal tooth brushing
  • Root surface near the gum line is sensitive to finger nail pressure and/or dental instruments during routine dental cleanings.

Often when other obvious causes for tooth discomfort like cavities, broken teeth, tooth grinding etc. have been considered, root surface sensitivity becomes a part of Dr Landers’ Differential Diagnosis and is considered as a potential cause for your symptoms.

What Causes Root Sensitivity?
The knowledge of the healthy tooth layers or lack there of, will help you to better understand root sensitivity. The outer chewing surface of your tooth is enamel. Enamel is naturally white in color and is the hardest substance in your body. A layer called cementum protects the tooth root under the gum. For various reasons, the gum tissues can recess or the enamel may wear away (i.e. excessive improper Brushing). Subsequently the underlying dentinal tooth structure is exposed. Dentine is made up of tubules which are directly connected to the nerve of the tooth. In many patients, the dentinal tubules when exposed are normally mineralized or occluded by a patient’s saliva. Unfortunately, sensitivity occurs in some patients when the root surface is not completely mineralized by their saliva alone. The result can be hypersensitivity near the gum line.

Grinding And/Or Clinching Verses Root Surface Sensitivity

Grinding and root surface sensitivity commonly occur together. This is due to the fact that the pressure of grinding or clinching often cause bone loss and subsequent root surface exposure. In fact, patients who grind there teeth and have gum disease will loose bone 50% faster then those patients with gum disease alone. Diagnosis of Grinding can be differentiated from the diagnosis of Root Surface sensitivity because grinding will uniquely cause sensitivity and tightness of muscles of the jaw, which may result in jaw joint pain. Grinding often is suspected when a patient presents with tooth pain on opposing top and bottom teeth. In other words, the teeth that meet or occlude during the grinding habit. Also, look for abnormally flat tooth structure.

Note that patients who maintain continuous oral habits such as constant gum chewing and/or Para functional habits like tooth tapping are consider to be subject to the same symptoms as those patient who grind and clinch their teeth.

Root Exposure verses Decay

Dentinal tooth structure is much more soft (verses Enamel) and is therefore more susceptible to the bacteria that cause tooth decay.


Sensitive teeth can be treated conservatively. Dr Landers may initially review your brushing habits to rule out the use of a hard tooth brush, improper brushing technique, or use of an abrasive dentifrice. In addition, you may be instructed to use a desensitizing toothpaste. Desensitizing toothpastes may require several applications and may need to be used from time to time to control and reduce tooth sensitivity.

It the desensitizing toothpaste does not help your discomfort; Dr Landers will prescribe a prescription strength desensitizer or suggest that in office fluoride get applied to the sensitive areas of the teeth, or both. Fluoride strengthens tooth enamel and reduces the transmission of sensations.

If your root is ledged and/or worn, Dr Landers may use an in-office technique such as root repair with a bonding agents. This type of bonding procedure is quite painless. Unless there is decay, there is usually no need for dental anesthetic or tooth removal. The area is simply cleaned and the dental Bonding material is placed on the root surface. At our office, it’s that simple. This procedure can help prevent the decay and decrease the chance that a crown will be needed in the future.

As A Last Result
Rarely, and as a last result, where hypersensitivity is severe and persistent and cannot be treated by other means, Dr Landers may recommend Endodontic treatment to eliminate the problem.

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