Intermittent tooth pain, unlike a constant ache, is a common and unsettling experience. It often presents as fleeting sensitivity or a dull throb that appears and disappears. Understanding the reasons behind this fluctuating pain is the first step toward relief and oral health.
Pain Triggered by Specific Stimuli
Tooth sensitivity is a frequent cause of pain that arises with external triggers and subsides once the stimulus is removed. This occurs when dentin, the layer beneath tooth enamel, is exposed by receding gums or enamel erosion. Contact with hot, cold, sweet, or acidic foods and drinks transmits signals through tiny tubules in the dentin to the tooth’s nerve, causing sharp, temporary pain. Aggressive brushing can also contribute to this exposure.
Early to moderate cavities can also lead to intermittent pain. As decay progresses, it can create openings that allow external stimuli, such as sugary or temperature-extreme foods, to reach the tooth’s sensitive inner structures, causing discomfort that resolves once the food is gone. Cracked Tooth Syndrome (CTS) often causes pain when biting, chewing, or upon releasing pressure. Small, sometimes invisible, cracks open under pressure, irritating internal tissues, with pain subsiding when pressure is removed. Additionally, compromised or worn fillings can allow similar stimuli to reach the underlying sensitive tooth structures, leading to transient pain.
Pain Linked to Pressure and Movement
Mechanical forces on teeth and the jaw can cause fluctuating pain. Bruxism, which involves habitual teeth grinding or clenching, often occurs unconsciously, especially during sleep. The sustained pressure from bruxism can lead to generalized tooth soreness, jaw pain, and headaches that may be worse in the morning or after periods of clenching, then ease throughout the day. This constant force can also cause teeth to become flattened, chipped, or fractured, exposing sensitive areas.
Temporomandibular joint (TMJ) issues can cause referred pain to the teeth. Chewing, talking, or opening the mouth widely can exacerbate TMJ pain, which may manifest as intermittent tooth discomfort or a dull ache in the jaw. An uneven or high dental filling or crown can also place excessive pressure on a specific tooth when biting down. This localized pressure causes pain during chewing that alleviates once the bite is released. Furthermore, the eruption or impaction of wisdom teeth can exert pressure on adjacent teeth or the jawbone, leading to pain that comes and goes, particularly during growth spurts or when inflammation is present.
Pain from Underlying Infection or Inflammation
Internal dental issues, like pulp inflammation or early-stage infections, can cause fluctuating pain. Reversible pulpitis involves inflammation of the tooth’s pulp, often due to deep decay or trauma. Pain is triggered by stimuli like cold or sweet substances and subsides quickly once the stimulus is removed, indicating that the pulp can recover if the cause is addressed. As the inflammation progresses to irreversible pulpitis, the pain may become more severe, lingering for longer periods after a stimulus, or even occurring spontaneously. While the pain in early irreversible pulpitis might still fluctuate, it indicates more significant damage to the pulp that often requires advanced dental treatment.
An early-stage dental abscess, an infection at the root tip, can cause intermittent pressure and throbbing pain. This discomfort may fluctuate before becoming persistent as pus accumulates and pressure builds. Gum disease, or periodontitis, involves inflammation and infection of the gums and supporting bone around the teeth. Inflamed gums can cause teeth to feel sore or loose, leading to intermittent discomfort, especially during chewing or brushing, as the supporting structures are compromised.
Referred Pain from Non-Dental Sources
Sometimes, tooth pain originates from other body parts, a phenomenon known as referred pain. Sinusitis, an inflammation or infection of the maxillary sinuses located above the upper back teeth, is a common non-dental cause of tooth pain. The pressure from inflamed sinuses can manifest as a dull ache or sensitivity in the upper teeth, often fluctuating with head movements or changes in congestion. This pain typically affects multiple upper teeth rather than a single one.
Ear infections can also cause pain that radiates to the jaw and teeth, particularly the upper back teeth, due to the close proximity of nerves in these areas. This intermittent discomfort can be confusing, as the issue is in the ear, not the tooth. Trigeminal neuralgia, a condition affecting the trigeminal nerve, can cause sudden, severe, electric-shock-like pain in the face, including the jaw, teeth, or gums. These pain attacks are inherently intermittent, lasting from seconds to a couple of minutes, and can be triggered by light touch or everyday activities like brushing or eating. Though rare, certain heart conditions like angina can cause referred pain to the jaw or lower teeth, which may be intermittent and often related to physical exertion.
When to Seek Dental Consultation
Any unexplained or recurring tooth pain warrants professional dental attention for accurate diagnosis. It is advisable to seek dental care if the pain lasts longer than a day or two, or if it recurs frequently. Consult a dentist if the pain is severe, interferes with eating or sleeping, or is accompanied by other symptoms such as swelling in the face or jaw, fever, or difficulty opening the mouth.
Pain consistently triggered by hot or cold temperatures, chewing, or pressure also indicates a need for evaluation. Early diagnosis prevents more serious issues and ensures appropriate treatment. A dental professional is best equipped to pinpoint the exact cause of intermittent tooth pain and recommend the necessary steps for relief and long-term oral health.