Pain when you push on a tooth is a distinct symptom, often indicating an issue beyond a simple cavity or surface sensitivity. This specific discomfort, known medically as percussion sensitivity, occurs when force applied to the tooth sends a signal of pain. Unlike the sharp, brief jolt from temperature sensitivity, pain from pressure points toward inflammation near the root. This reaction is a sign that a problem has extended beyond the tooth’s inner chamber to affect the surrounding bone and tissue. Investigating this symptom promptly is important because it can be an early indicator of serious underlying issues like infection or mechanical damage.
Understanding Pain Upon Pressure
The root of every tooth is anchored to the jawbone by a thin, complex network of fibers called the periodontal ligament (PDL). This ligament acts as a natural shock absorber, cushioning the tooth from the forces of biting and chewing. The PDL is richly supplied with nerve endings, giving it the ability to sense pressure and transmit signals. When the PDL becomes inflamed, a condition known as periodontitis, its cushioning ability is compromised. Any force transmitted through the tooth compresses this swollen and irritated tissue against the rigid bone. This compression triggers a sharp, localized pain response. Therefore, pain upon percussion is usually the inflamed ligament surrounding the root reacting to the pressure, not the tooth itself.
Internal Causes: Infection, Abscesses, and Nerve Death
The most serious causes of percussion pain originate inside the tooth, where the pulp contains the nerves and blood vessels. Deep decay, a traumatic injury, or a failing restoration can allow bacteria to enter the pulp chamber, leading to inflammation (pulpitis). This inflammation may progress until the pulp tissue dies, a condition called pulp necrosis. Once the pulp is necrotic, the infection can spread out of the root tip into the surrounding jawbone. This causes inflammation of the PDL, known as periapical periodontitis, which is a direct cause of pain upon pressure.
If the body’s immune system attempts to wall off this infection, pus can accumulate at the root tip, forming a periapical abscess. An abscess creates significant pressure within the bone, making the tooth intensely sensitive to any touch or bite. An untreated abscess can lead to severe, throbbing pain, facial swelling, and sometimes a fever. The presence of a periapical infection means the internal tooth structure is damaged beyond its ability to heal. Eliminating the infection and saving the tooth requires root canal therapy, which removes the dead and infected pulp tissue, or extraction.
Structural and Mechanical Causes of Sensitivity
Pain from pressure does not always signal a deep infection; it can also result from mechanical stress or structural compromise.
Cracked Tooth Syndrome
One common cause is Cracked Tooth Syndrome, where a fracture line extends into the tooth structure. When a person bites down, the crack flexes, briefly separating the segments and irritating the pulp or the periodontal ligament. The pain is often described as a sharp, fleeting discomfort that occurs when releasing the biting pressure.
Bruxism and High Restorations
Excessive force on the teeth from habitual grinding or clenching (bruxism) can also cause percussion sensitivity. The constant pressure strains the periodontal ligament, leading to inflammation and soreness, similar to spraining a joint. This pain is often a dull ache that is noticeable upon waking or worsens throughout the day. Recent dental procedures, such as a new filling or crown, can leave the tooth sensitive to pressure if the restoration is slightly “high.” An uneven bite places excessive force on the treated tooth, leading to temporary inflammation of the PDL until the bite is adjusted.
Sinus Issues
Referred pain from non-dental sources can mimic the sensation of pressure-induced tooth pain. The roots of the upper back teeth lie very close to the maxillary sinuses. When a sinus infection causes inflammation and fluid buildup, the resulting pressure can irritate the nerves of those nearby tooth roots. This can cause a generalized ache across several upper teeth, which feels like pressure sensitivity but is actually a symptom of the sinus condition.
Immediate Action and When to See a Dentist
While waiting for a professional diagnosis, managing the pain and preventing further irritation is important. Avoid chewing on the affected side and stick to soft foods to minimize pressure on the inflamed periodontal ligament. Over-the-counter anti-inflammatory medications, such as ibuprofen, can help reduce the swelling that contributes to the pain. Rinsing the mouth with warm salt water several times a day can also provide temporary relief. A dental evaluation is necessary because pain upon pressure is a common symptom for both minor issues, like a high filling, and severe problems, like an abscess. Contact a dentist immediately if the pain is severe, persistent, or not relieved by medication. Seek emergency care if the pain is accompanied by swelling in the face or jaw, a fever, or difficulty swallowing or breathing, as these are signs of a spreading infection that requires urgent medical attention.