Experiencing pain when biting down, even without a visible cavity, is a common and often perplexing issue. This discomfort can range from a mild ache to a sharp, sudden sensation, making everyday activities like eating uncomfortable.
Pain Originating from the Tooth
One such cause is cracked tooth syndrome, where microscopic cracks in the tooth enamel or deeper dentin layers may not be visible but cause pain when pressure is applied during biting. These cracks can extend into the pulp, which contains nerves, leading to sensitivity that often intensifies upon releasing the bite.
Inflammation of the tooth pulp, known as pulpitis, can also cause biting pain. This inflammation might result from trauma, deep dental fillings, or even subtle cracks that allow irritants to reach the nerve. The nerve becomes sensitive, reacting to the pressure of biting and sometimes to temperature changes.
Gum and bone conditions can also lead to pain when biting. Gum recession, where gum tissue pulls away and exposes the root surface, can cause dentin hypersensitivity. The exposed dentin contains microscopic tubules that lead to the tooth’s nerve, making it sensitive to pressure. Furthermore, localized gum inflammation (gingivitis) or more advanced periodontal disease can cause soreness and pain when chewing, as the supporting tissues around the tooth become compromised.
Sensitivity after recent dental work, such as fillings or crowns, can manifest as pain when biting. This is a temporary response as the tooth adjusts to the new restoration. If a new filling is too high, it can also cause persistent pain when biting down due to increased pressure on the tooth and its surrounding ligament.
Pain Originating Outside the Tooth
Bruxism, the unconscious habit of grinding or clenching teeth, can strain the jaw muscles and teeth, leading to soreness or specific tooth pain when pressure is applied. This constant force can wear down enamel and even cause subtle cracks in the teeth.
Temporomandibular Joint Dysfunction (TMJD), which affects the jaw joint connecting the jawbone to the skull, can also refer pain to the teeth. Issues with this joint can cause discomfort that feels like a toothache when biting, often accompanied by jaw pain or clicking sounds. The close proximity of nerves in the jaw and ear can make TMJD pain feel like it originates from a tooth.
Sinusitis, an inflammation of the sinuses, especially the maxillary sinuses located above the upper back teeth, can exert pressure on tooth roots. This pressure can result in pain that feels like it’s coming from the upper teeth when biting down or moving the head. Referred pain from other areas, such as ear infections, can also be perceived as tooth pain, even if the tooth is healthy.
Identifying the Source of Discomfort
Diagnosing the cause of pain when biting, especially when no cavity is visible, involves a comprehensive approach. A thorough examination includes visual inspection of the teeth and gums, probing around the gumline, and gently tapping on teeth to check for tenderness.
Dentists often use specific tools, such as a bite stick, to help pinpoint the painful tooth. The patient bites down on this tool, which helps isolate the affected area and can reveal the presence of hairline cracks, especially if pain occurs upon releasing the pressure. Temperature sensitivity tests, using hot or cold stimuli, help assess the health of the tooth pulp. A lingering or intense response to these stimuli can indicate inflammation within the tooth.
Dental X-rays and other imaging techniques are diagnostic tools. While a crack may not always be visible on an X-ray, these images can reveal underlying issues such as bone loss, hidden infections, or deep cracks that are otherwise undetectable. A detailed patient history, including the nature, duration, and triggers of the pain, provides valuable information.
Paths to Relief
Addressing pain when biting down begins with a professional consultation for an accurate diagnosis. A dentist can develop a tailored treatment plan based on the identified cause.
Treatment approaches vary depending on the underlying issue. Conservative management might involve nightguards for bruxism, or desensitizing toothpastes for exposed root surfaces. Restorative procedures, such as bonding or crowns, may be used to reinforce teeth with cracks. If pulp inflammation is irreversible, root canal therapy might be necessary. Periodontal treatments address gum and bone issues that contribute to biting pain.
While awaiting a dental appointment, some temporary measures can offer comfort. Over-the-counter pain relievers, such as ibuprofen, can manage discomfort. Rinsing with warm salt water can also soothe the area and help with inflammation. Avoiding hard or sticky foods can reduce pressure on the affected tooth. Applying a cold compress to the outside of the cheek can reduce swelling and numb the pain.