Toothaches can be very surprising to get when looking in the mirror and there are no obvious black spots, holes or dark areas. Whilst many believe that tooth decay causes all dental pain, there are many hidden issues that can affect human teeth. The enamel layer is the protective layer of the tooth that covers the sensitive inner parts. If the inner parts of the teeth are under stress, temperature changes or structural damage, nerves will fire off signals to the brain.

Understanding why your teeth are aching without cavities will help keep your mouth healthy. Dental professionals take into account lots of issues when diagnosing your toothache caused by nerve sensitivity, fractured teeth and gum infections.

How Do Sensitivity and Enamel Erosion Cause Toothache?

Whilst enamel is the hardest part of the human body, it can erode over time. Below the enamel is a softer layer called dentine, which has millions of tiny fluid filled tubules. These lead straight to the pulp chamber containing nerves and blood vessels. As the enamel thins, the nerves are stimulated by hot, cold, acidic or sweet items.

Aggressive brushing causes more erosion of the enamel. Using a hard bristle brush or too much pressure while brushing can cause erosion of enamel at the gum line. Acidic foods such as citrus fruits, fizzy drinks, energy drinks and drinking too much coffee can cause erosion of minerals in the enamel. As the dentine does not have enamel to protect it anymore, everyday activities such as drinking cold water will cause sharp pains.

How Can You Detect Micro Cracks in Your Teeth?

Micro cracks can be very hard to spot. They are referred to as cracked tooth syndrome by dentists. This can occur from trauma to the teeth, eating hard foods such as ice or hard candy or biting down on an un popped popcorn kernel.

  • Every time you eat something the broken sections flex.

  • This movement causes irritation to the pulp tissue inside.

  • Bacteria can enter the tiny cracks causing localized inflammation.

  • Sharp, severe pain occurs when pressure is suddenly taken off whilst biting.

Micro fractures can be hard to detect on regular x-rays as the fracture runs parallel to the x-ray beam. Special tools such as trans-illumination devices, diagnostic bite sticks and 3D cone beam CT scans, help dentists detect these fractures.

How Does Bruxism Cause Your Teeth to Ache?

Bruxism is when you unconsciously grind and clench your teeth. Many people suffer from bruxism whilst sleeping due to stress, anxiety or sleep apnoea.

Grinding your teeth every day puts pressure on the periodontal ligament. The periodontal ligament is a small shock absorber attaching your teeth to your jaw bone. If the ligament becomes stressed, it will become inflamed causing a dull ache across several teeth. This causes erosion of enamel, wearing down the cusps used for chewing and micro fractures around the roots. Many patients wake up with aching teeth, tight jaw muscles and tension headaches.

How Can Gum Recession Cause Toothache?

Normally the gums tightly wrap around the bottom of the teeth. Due to periodontal disease, aggressive brushing, hormonal changes or genetic factors the gums can recede from the crown.

The root of the teeth do not have enamel to protect them. They have a very thin layer of soft tissue called cementum. This erodes very easily exposing the dentine tubules. The roots will be highly sensitive to cold air, hot drinks and touch. As the gums have receded, the teeth become more prone to nerve irritation.

Can Sinus Infections Cause Toothache?

Not all toothaches are caused by issues in the mouth. The roots of the upper molars and premolars sit below the maxillary sinuses. If there is a virus or bacterial infection in the sinuses, fluid can build up causing inflammation and pressure. This causes the nerves to be affected.

Usually multiple upper back teeth will be affected by the sinus infection. The pain will increase when leaning forwards, jumping or moving your head quickly. Once the congestion in the sinuses is treated using nasal sprays, staying hydrated or visiting a medical professional, the pressure on the teeth will reduce.

How Does Pulpitis Cause Toothache Without Cavities?

The center of the tooth contains living tissue known as the pulp. This contains nerves, blood vessels and connective tissue. Trauma to the tooth, previous dental work or micro leakage around old fillings can cause irritation to the sensitive nerves.

What Are the Two Types of Pulpitis?

  • Reversible Pulpitis – This causes mild irritation to the nerve. You will feel a brief pain from cold or sweet items. Once the irritation is removed, the nerve will heal completely.

  • Irreversible Pulpitis – This causes severe damage to the nerve. You will feel severe continuous throbbing pain that gets worse when lying down. The nerve cannot heal and needs endodontic treatment.

If the pulpitis is not treated, the nerve in the tooth will die causing a localized infection or abscess at the tip of the root. This causes severe throbbing pain in the bones, swelling and extreme sensitivity.

Can New Fillings, Crowns and Orthodontics Cause Toothache?

It is common to have some discomfort after having new fillings, crowns or orthodontic work. This is because the nerves inside will be irritated from the dental work. This causes sensitivity to temperature changes for a few days/weeks.

If the new filling is slightly high it will hit the opposing tooth before the rest of your bite. This causes all the pressure to be put on one tooth. This causes the shock absorber ligament underneath to become inflamed causing severe pain whilst eating. A quick adjustment from your dentist will redistribute the pressure and relieve the pain.

When Should You Visit a Dentist for Unexplained Toothache?

Trying to diagnose your toothache yourself can cause small issues with your teeth to become an emergency. Dental professionals use advanced diagnostic methods to find the issue quickly.

  • Digital x-rays will show damage between the teeth, root fractures and bone loss.

  • Nerve testing using electric pulp testers and cold sprays.

  • Gum probing will show deep pockets and root exposure.

  • Night guards can be made to protect your teeth.

Visiting a dentist as soon as you start to have un-explainable pain will help keep your natural teeth. Getting medical help early will prevent the nerve from dying, expensive complicated surgery and will make you comfortable again.