Why Would I Have a Toothache with No Cavity?

I went to the dentist two weeks ago and got a clean bill of health, so I’m 100% certain I don’t have a cavity. But, out of nowhere two days ago, I got this raging toothache on my upper right side. I can’t pinpoint the exact area, but it’s killing me. I can’t eat or sleep or anything. I haven’t made an emergency dental appointment because I was so certain this would just go away on its own. There’s literally no reason why anything should be bothering me right now. But, as the days are going by and it’s not going back to normal, I’m starting to wonder if maybe I should go in. Is there any reason I would have a real toothache without a cavity?


Dear Javi,

To be clear, if you’re in pain, you have a “real toothache.” The only question is what’s causing it. And, yes, your tooth might need treatment even if it doesn’t have a cavity.

Why Teeth Hurt When There’s No Cavity

Trauma: Teeth can become traumatized under all sorts of circumstances. Sometimes it’s an accident, fall, or blow to the face, other times, it could be something seemingly benign, like banging your teeth on a mug when you take a sip or biting down on something that’s abnormally hard. Sometimes, trauma only irritates the nerve and makes the tooth angry for a while, but when extreme pain occurs like you’re describing, it usually means the nerve is dead or dying. If left untreated, it will continue to hurt and will develop an infection at some point.

Sensitivity: Occasionally people have habits like brushing hard or have medical conditions that contribute to enamel wear. When this happens, the thin enamel allows for more temperature transference. Teeth can be sensitive to foods, drinks, and air. It often feels more like a dull ache or is triggered by specific actions though. This usually requires treatment too.

Referred Pain: Nerves travel throughout your face and body. Sometimes one tooth hurts when another is really the culprit or sinus and jaw issues can refer pain to a tooth. Due to the way the nerves work, a toothache can even be a warning sign of a heart attack. Because of this, it’s always a good idea to get a diagnosis right away. Even if it isn’t the tooth causing the problem, you need to identify what is. Pain should never be ignored.

TMJ Issues: People who clench and grind and those who have had accidents or have malformed jaws and bites are said to have temporomandibular joint (TMJ) dysfunction. That usually manifests as jaw pain, but nerves can send the pain elsewhere. Plus, if teeth are coming together wrong, some teeth may receive more of the biting force than others, resulting in trauma.

Missed Cavities: Dentists are pretty awesome, but they can sometimes miss things. It’s more common when the tooth already has a restoration because that can obfuscate the problem. If you didn’t get x-rays the last time around either, then the dentist was relying on visual cues to detect issues and sometimes trouble can brew below the surface. It’s not abnormal to have x-rays once every year or so because cavities don’t usually appear overnight, but the dentist has a clearer picture of what’s happening when he has fresh ones to work with.

Book Your Emergency Dental Appointment

While toothaches can occasionally be transient and go on their own, they’re usually a big warning sign that something is wrong—cavity or not. Get in with your dentist as soon as you can to get this diagnosed and addressed.

This blog is sponsored by Dr. Steve Sirin, an Elgin dentist offering same-day emergency visits.

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