Dental pain and warning signs: a Sheffield dentist’s guide

When you ring us, reception asks a handful of questions before you have finished describing the tooth. Is the pain sharp or dull? Does it come on its own or only when something touches it? Does hot or cold set it off, and how long does it last afterwards? Does it wake you? Can you point to one tooth, or is it a whole side of the face? Those answers narrow the diagnosis to two or three possibilities before you have parked the car.

The reason is anatomy. A tooth has a nerve in a sealed chamber, a ligament around its root, bone around that, and gum over the top. Each tissue produces a different sort of pain, and each fails in a predictable order. Sharp, short pain is a live nerve complaining. Long, throbbing pain is a nerve that is dying or dead. Pain when you bite is the ligament, or a crack. A swelling means infection has escaped the tooth into the bone or gum.

Cold that hurts for a few seconds and stops is a healthy but irritated nerve. Cold or hot that keeps hurting for more than 10 to 30 seconds after the drink has gone is the single most useful sign of irreversible pulpitis. Heat that hurts while cold relieves it is a late sign: the nerve is dying, and patients sometimes arrive holding a bottle of cold water against the cheek.

Pain on biting, especially on letting go of the bite, points to a crack. Pain on biting with a constant ache points to an abscess. Pain that only comes at night, or wakes you at 3am, is nearly always the pulp: lying flat raises the pressure inside the tooth. Pain spreading into the ear, temple or jaw on one side is usually referred from a back tooth, though jaw pain can also be the joint or clenching.

Start with severe toothache if the pain is constant and painkillers are not touching it. If it is short and sharp with cold, tooth sensitivity explains the difference between worn enamel and early decay. Sharp, shooting tooth pain covers the electric jolts that come out of nowhere. Pain when biting deals with the cracked-tooth pattern and the filling that is sitting too high. Each guide says what we do at the £30 emergency examination and what the fix is likely to cost.

Pain that starts after dental work has its own guides, because the causes are different: pain after a filling (usually a high bite or a nerve that was already inflamed) and pain after an extraction (a dry socket typically starts on day two to five, not day one). Jaw pain separates tooth pain from joint and muscle pain. Headache from a dental infection explains how an upper molar can pass itself off as sinusitis or a migraine.

Once you have a likely symptom, the conditions guides explain what is happening underneath and the treatments guides set out what we do about it and what it costs.