Many of us have toothache in our life, and we also have the old saying “toothache is not a disease, but a pain that kills you”. Most toothaches are caused by dental diseases, such as pulpitis, periapical infection and periodontitis, which often cause severe toothaches. However, there are many people who have recurring toothache, and after the medication and injection do not work, they pull out their own teeth according to the principle of “treating toothache and headache”, and some patients can even pull out half of their teeth, but the toothache is still not solved. Therefore, when it comes to stubborn toothache, we need to change our thinking and identify it carefully. The knowledge of Chinese and Western medicine is extensive, from which we can identify the real cause of toothache and take targeted treatment in order to effectively treat various chronic stubborn toothache: 1. When the branches of the trigeminal nerve distributed in the gums and oral mucosa are subjected to wind and cold or lesions of the nerve itself, it causes severe throbbing pain or paroxysmal stabbing pain in the corresponding side of the teeth, which is similar to toothache. However, the pain is very severe and unbearable, much more severe than ordinary toothache. The most important feature of trigeminal neuralgia is that it has a “trigger point”. Patients can often point out that there is a small area on the face, lips, tongue and gums that cannot be touched, which is as sensitive as the trigger on a gun, and once touched, it will trigger pain. As a result, some patients are often afraid to wash their faces, brush their teeth, rinse their mouths, or even eat. From the viewpoint of TCM, trigeminal neuralgia is caused by phlegm and fire, phlegm and blood internal obstruction, deficiency fire and other reasons, especially many elderly patients, often have hypertension, coronary heart disease and other co-morbidities, the use of minimally invasive, surgical and other treatment methods are often very risky, from the perspective of TCM using dialectical treatment is often a good choice. 2.Coronary heart disease Some patients with coronary heart disease have angina pectoris, but the heart symptoms are not obvious, but there is pain on one side or more teeth up and down at the same time, accompanied by chest pain, and one of the symptoms: pain and paresthesia in the jaw, neck and arm, shortness of breath, vertigo, sweating, often considered as “cardiogenic toothache”. This kind of toothache has two characteristics: – is a severe toothache, but it is difficult to determine which toothache; secondly, taking pain medication is ineffective, and the toothache disappears immediately after taking nitroglycerin. Therefore, patients with coronary heart disease with persistent toothache must first consider whether their original disease is poorly controlled. From the perspective of Chinese medicine, coronary heart disease is a decline in the function of the heart’s main blood vessels, leading to chest pain, and when the disease is long, it will lead to impaired circulation in the distal part of the body, which will lead to persistent toothache, therefore, treatment from the perspective of activating blood in Chinese medicine often has good results. 3, hypertension Patients with hypertension have spasms in the peripheral small arteries sclerosis when blood pressure rises, which can lead to gum ischemia and insufficient nutrition of dental tissue, resulting in toothache, which is characterized by symptoms such as dizziness, head rise, and blinding eyes. This toothache often lasts for a few days and can be relieved on its own, and patients often have better results by using local massage or hot compresses. 4, maxillary sinusitis The maxillary sinus is one of the paranasal sinuses and is located close to the upper teeth. When inflammation occurs, the nerve endings are invaded by inflammation, which can cause paroxysmal throbbing pain in the teeth they innervate. This patient can also be easily misdiagnosed as a migraine and requires a CT of the head, which can often confirm the diagnosis. From the perspective of Chinese medicine, it is due to the unfavorable opening and closing of the upper orifice, and pain is caused by the lack of circulation. 5.Maxillary sinus cancer Maxillary sinus cancer is the most common type of sinus malignant tumor, which only grows in the mucous membrane of sinus in early stage and there is no obvious change in appearance, so it is not easy to be detected. When the symptoms are obvious, the tumor has often damaged the bone wall and invaded out of the sinus, which manifests as nasal obstruction, facial swelling, skin sensation loss and toothache. Among them, toothache is mostly caused by the tumor invading the alveoli. If timely consultation is made at the time of toothache, it is likely to detect the tumor at an early stage and surgically remove it within a small area to avoid the facial depression caused by the removal of the right jaw bone, which affects the appearance. Therefore, when unexplained upper toothache, nasal obstruction, increased nasal exudate and difficulty in opening mouth occur and symptomatic treatment is ineffective, pathological biopsy or maxillary sinus aspiration irrigation and cytological examination should be considered to exclude the possibility of maxillary sinus cancer. Influenza is caused by influenza virus and often invades the respiratory system. If the influenza virus invades the oral mucosa and periodontal tissue, it will cause viral periodontitis or viral oral mucositis, resulting in paroxysmal swelling and pain of teeth. This kind of patients often with the improvement of the flu and toothache to get significant relief. 7, premenstrual toothache A few women in the premenstrual period, the dental pulp and periodontal membrane vascular expansion and congestion, such as the encounter of cold water, cold food, cold air stimulation, can immediately cause pinprick like allergic toothache, external factors removed, the pain quickly disappeared. Since toothache is not always caused by dental disease, when toothache occurs, we should not only think of dental disease, but also be alert to other diseases, and we should not rely on anti-inflammatory, pain-relieving and antipyretic drugs alone to relieve toothache, so as not to miss the time of treatment and cause adverse consequences. It should be noted that most toothaches in adults are caused by fire (neurological). If the toothache still cannot be relieved after excluding the above diseases, you can come to the pain clinic for a comprehensive treatment of your stubborn toothache through a combination of Chinese and Western medicine, dispelling dampness and dispelling cold, removing fire and anti-inflammatory, and acupuncture therapy.