What causes a toothache? It is estimated that nine out of ten people will think that it is caused by problems with the teeth or their nearby oral tissues. But did you know? Toothaches can actually be caused by other problems. For example, inflammation of the throat and even cardiogenic pain can cause toothache. Zeng Bo recently felt pain when biting, thought it was a tooth problem, but after the dental examination, the results were: no decay, no defective teeth and no hidden fracture, no redness or swelling of periodontal mucosa, and no abnormality was found in the dental photos. What is going on here? Finally, after consultation with doctors, it was found that Zeng Bo was suffering from maxillary sinusitis, and the symptoms were relieved after treatment by ENT department. The cause of toothache is divided into odontogenic and non-odontogenic When toothache occurs, it is natural to go to the dentist first, but some toothache is not caused by dental problems. Dr. Weng Zhiqiang, chief physician of the Second Hospital of Guangzhou Medical University, introduced that the causes of toothache include odontogenic and non-odontogenic causes. While odontogenic causes are certainly caused by the teeth, non-odontogenic causes often involve lesions in tissues outside the mouth. “Many diseases of the oral cavity can cause toothache, commonly including caries, endodontic disease, periapical disease, periodontal disease, pericoronitis, etc., which are generally easy to diagnose clearly. However, toothache caused by non-oral diseases should be carefully identified based on the patient’s symptoms, combined with the patient’s general condition and relevant examinations.” Weng said that non-dental toothache includes toothache symptoms caused by lesions of the maxillary sinus, temporomandibular joint, eye, ear, nose, salivary gland and other adjacent organs; neuropathic pain, such as trigeminal neuralgia, pterygopalatine neuralgia and linguopharyngeal neuralgia; and systemic diseases, such as toothache caused by diabetes, heart disease and hysteria. In general, the clinical characteristics of non-dental toothache, such as spontaneous toothache, but insensitive to hot and cold stimuli; regional toothache, which does not involve the whole mouth; persistent and periodic toothache, and constant in nature. Especially when clinical examination cannot find the focal tooth and conventional dental treatment cannot relieve the pain, it can be considered whether the toothache is of non-dental origin. Toothache of different etiologies have their own “pain” characteristics Weng Zhiqiang said that odontogenic pain usually has typical symptoms and is easily diagnosed. Non-odontogenic toothache is diverse and often atypical, so it is easy to miss and misdiagnose. So, let the experts teach you how to initially identify – [odontogenic pain] Pulpitis pain: the typical pain symptom of acute attack is spontaneous nocturnal pain, with paroxysmal attacks, and the pain will increase when encountering hot or cold stimulation, and because the pain cannot be localized, it often cannot accurately point out the location of the diseased tooth by itself. Periapical pain: acute attacks are spontaneous, persistent pain, which is aggravated by the stimulation of occlusion, and the diseased tooth can be clearly localized. Painful occult fissure: mainly manifested as a sudden, transient soreness when the tooth bites something, the tooth feels weak when biting something, but the crown appearance is intact, the tooth problem is not easily visible to the naked eye, the fissure needs to be detected with the help of special light irradiation and staining. Wisdom tooth pericoronitis pain: the onset is mostly in young people, often induced after staying up late, drinking, and fatigue. The pain is mainly felt around the back teeth and can also affect mouth opening and swallowing. Periodontal abscess pain: Sudden onset of periodontal swelling and pustules, also accompanied by bad breath, pain is persistent, severe cases may have fever. Non-dental toothache】 Temporomandibular joint disorder: Individual cases may present with symptoms similar to toothache, accompanied by dull pain and local pressure pain in the muscles around the joint. Facial myofascial pain syndrome: resembles both toothache and muscle pain, and in many cases the exact site of pain cannot be pointed out, and dental examination is often abnormal. Inflammation of the pharynx: If there is inflammation of the pharynx with toothache, it may not be a dental problem that is causing the problem. This involvement pain may radiate to the ear, worsen when swallowing, and is mostly dull. At this time, the oral mucosa is often diffusely congested and the lymphatic follicles in the posterior pharyngeal wall are hyperplastic. Trigeminal neuralgia: It has special electric shock-like characteristics, lasts for several seconds, and the pain decreases or disappears at night, independent of temperature stimulation. At this time, dental examination does not reveal any problem, and even tooth extraction cannot solve the pain. Cardiogenic pain: It is mainly manifested as toothache symptoms that do not match with oral examination, and mostly occurs after intense exercise or exertion. The pain is insensitive to stimulation and is periodic, and the pain can radiate to the back of the shoulder and arm. If it is not detected in time, it will affect the rescue, and can be seen in myocardial ischemia, angina pectoris, aortic coarctation and other diseases. Oral and maxillofacial herpes zoster: clinically, it can also show symptoms of toothache, and often it cannot determine which tooth hurts by itself, and oral examination cannot identify the diseased tooth, which mostly shows burning-like and pinprick-like pain. Examination reveals clusters of small blister-like lesions or vesicular surfaces on the oral mucosa and facial skin, with a band-like distribution along the nerve course. The pain that remains after the rash is pinprick-like pain that can last for months or longer. Weng reminds that toothache symptoms can be caused by a variety of reasons and require a thorough examination by a medical professional to make a correct diagnosis to avoid misdiagnosis and missed diagnosis. Therefore, while developing toothache and receiving local treatment in dentistry, it is important to provide the doctor with a general health condition to facilitate the timely detection of non-dental diseases.