Nerve issues are the most common toothache causes.  When you have a severe toothache, it normally means there is nerve involvement with one of your teeth. The nerve of the tooth is in the center of the tooth, normally protected by the outer layers of tooth (i.e, enamel, dentin) and some sort of stimuli, most commonly either  cavity or fracture, has reached it.  This usually means the tooth either needs a root canal or to be extracted.

The most common symptoms are:

Spontaneous pain, that wakes you up at night or when you are just sitting around it starts to hurt.  Or lingering pain, if you for example get cold water on it and it starts hurting, when when you take the cold away, the tooth still hurts.

Toothache During Pregnancy?

toothache causes

The nerve is analogous to the pulp, and when the nerve gets irritated or inflamed, it is called a PULPITIS.

Reversible Pulpitis:

If the pain not bad, is only illicited by certain stimuli, and goes away when the stimuli is removed, sometimes the tooth may get better.  An example of this is if a tooth has a cavity, if the cavity isn't too deep, removing the cavity and filling it may make the sensitivity go away.

Irreversible Pulpitis:

If you have a severe toothache that arises out of the blue, or pain that keeps you up all night, or persists when the stimuli is removed, this is called spontaneous pain, and referred to as irreversible pulpitis.  If your toothache has been getting more painful over a course of time, this is another common sign of an irreversible pulpitis.  This means that even if the stimulus is removed, such as a large cavity or fracture, the nerve will still need to be removed from the tooth.

When this happens, you will need either a ROOT CANAL or an EXTRACTION.


This is one of the most common toothache causes. When decay is left untreated or occurs under existing fillings, often times it will progress towards the nerve. If the bacteria from the decay progresses into the nerve area, often a severe toothache will follow. When this happens, there are two choices. ROOT CANAL or EXTRACTION.


If the disease is allowed to progress, the tooth will likely become loose.  If you are having pain from a tooth that is loose, it may need to be removed.


Fractures are very common toothache causes, and sometimes difficult to treat. They are not always visible to the naked eye, and are usually diagnosed by testing (we’ll get to testing later).  One of the most common symptoms is biting sensitivity.  Sometimes the fractured part of the tooth can be removed and a filling placed over it, but most likely you will need a crown.  

If the fracture progresses into the nerve chamber, you will need a root canal.

If the fracture is into the roots, you will need to have the tooth removed

There are ways to replace missing teeth, such as with implants, bridges, or removable prosthetics.

Read more about tooth fractures here.

toothache caused by tooth fracture


There are a variety of tests that dentists use to diagnose the toothache causes and the condition of the tooth.

The most common…



This is used to check for cavities, and infections around the root of the tooth. They are also very helpful to check on the condition of existing fillings and the supporting bone.


The dentist will tap on your teeth. This is another way to check if the tooth is infected around the root of the tooth. If it’s sore when tapped, this is a sign that the area around the root of the tooth is inflamed or infected, and may need a ROOT CANAL or EXTRACTION.  Because the nerve of the tooth exits the tooth through the end of the root, this area is a common area for signs and symptoms to arise.


The dentist will also feel around your gums. This is yet another way to check if the tooth is infected. It is also possible to check for any swelling of the gums. If your gums are tender to the touch, there is a good chance that you will need either a ROOT CANAL or EXTRACTION.


Same story as the previous two. This is also a way to check for a vertical root fracture. They are untreatable, and your tooth will be removed.  


If your tooth is loose, either it’s infected or you have advanced periodontal disease. You know how infections are treated, and if the tooth has severe periodontal disease, it will likely be extracted.


This is like a bite stick that your dentist will have you bite on in various places to check for fractures. If it hurts in one spot consistently, you likely have a fracture.


This is usually tested by putting a cold stimulus on the tooth, or using an ELECTRIC PULP TESTER. Both of these methods are used to see if the nerve is still alive, or vital. If your dentist puts the cold on that tooth and you don’t feel a thing, this means that the nerve is necrotic, and you’re looking at a root canal. A normal response is one that feels the cold quickly, and then dissipates as the cold is removed.

If your tooth is extremely sensitive to the cold, and the sensation lingers for more than a few seconds or even aches, your tooth likely has irreversible pulpitis and will likely need a root canal.

Like with the sensitivity, there are many other toothache causes, but those are the basics and the main tests that are usually run.



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