You have a toothache without a cavity. What could it mean?

Orofacial pain is a common condition affecting 21.7% of the population in the United States.
Toothache is the primary cause, triggered most often by tooth decay.
However, your tooth may hurt without noticing any sign of cavities. Instead, you may have another condition that can mimic a toothache, making things more frustrating.
Find out in this article what may cause your toothache besides cavities.

How do we feel oral pain?

The pain that comes from your mouth involves a complex mechanism. First, you need to know that pain signals from teeth and jaws are transmitted by the same nerve called the trigeminal nerve.

When you have an injury or inflammation caused by a cavity or gum disease, receptors in the nerve endings will be stimulated. All the pain signals gather in the trigeminal nerve, which sends them to the brain.

The convergence of pain signals to a single nerve makes the mechanism more complex. As a result, you may perceive pain at a different site from its origin.

For instance, you may have an affected tooth from the lower jaw and believe that pain is coming from a healthy upper tooth.

There is also what is called neurogenic pain. This pain type is not triggered by a visible injury or inflammation but by nerve damage. When a nerve is damaged, it can disrupt how the nerves communicate with each other in your body, which means that signals may be sent incorrectly or exacerbated.

Sometimes the pain can involve different mechanisms, making diagnosis even more challenging.

What are the causes besides cavities that can cause tooth pain?

In addition to cavities, many other factors can be the cause of your toothache, including:

1. Gum disease

Gum disease (otherwise known as periodontal disease) is one of the most common diseases in the world. In addition to damaging the bone and gums that support your teeth, it can result in tooth sensitivity.

Dentin is a hard mineralized tissue composed of many tiny canals called dentinal tubules. They go through its entire width and communicate with the tooth nerve.

At the tooth root, dentin is covered by a thin and softer layer called cementum.

When your gums recede, they expose the root to the oral environment. The cementum, being less resistant, will quickly wear away, exposing the dentin.

At this stage, eating or drinking will stimulate the tooth nerve through the dentinal tubules, resulting in pain.

Sometimes the gums between your teeth can be irritated due to the accumulation of food in this area. This can lead to intense, radiating pain that worsens with meals.

2. Dental wear

Tooth wear is the process by which the hard tissue covering the tooth thins out, thus reducing the barrier that protects the tooth's nerve. It can be caused by habits such as teeth grinding, aggressive brushing, acid reflux, or poor oral hygiene.

This condition will expose the underlying structures of the tooth, increasing sensitivity.

3. Dental Fracture

Tooth fractures can be tricky to spot and lead to symptoms ranging from mild pain when chewing to severe pain. It most often occurs due to the weakening of tooth structure or following trauma.

Bacteria and residue from the mouth will enter the nerves through the fracture line and result in pain.

4. Toothache that doesn't come from the tooth itself

Sometimes, toothache may not be related to the tooth itself. The pain may occur at a distance from its site of origin.

Sinuses are bony cavities located on either side of your cheekbones. Inflammation in this area leads to a condition called sinusitis.
Symptoms include facial pain, swelling, nasal congestion, and sensitivity to touch.
Pain that comes from sinusitis can spread to the upper back teeth area, leading to sinus toothache.

Another typical example is muscle pain, also known as myofascial pain syndrome. It is considered one of the most common causes of non-dental tooth pain.
When the masticatory muscles are affected, they cause hypersensitive spots to appear on your jaws. Pressing these points causes deep, constant pain that can spread to the teeth and mimic a toothache. You may also feel pain when you open your mouth or chew.
This syndrome often occurs following an injury or overusing the chewing muscles due to teeth grinding or poor jaw posture.
Other psychological factors have also been associated, such as stress, anxiety, and depression.

Another rare condition that occurs on a seemingly healthy tooth is atypical odontalgia or phantom tooth pain. It causes continuous and persistent pain that can last for months or years.
The most frustrating part is that the tooth looks healthy, and your dentist's checkups show that everything is fine.
In 83% of cases, atypical odontalgia occurs after a dental procedure such as root canal treatment or extraction. But the exact cause is not yet known. However, many agree on the involvement of nerve damage, leading to disturbances in pain perception.

Should you see your dentist?

If you have a toothache but don't notice any cavities, that's reason enough to see your dentist. As you've learned, some conditions or injuries can go unnoticed and manifest as a toothache.

Your dentist will examine your entire mouth for any potential cause of your pain. He will use special equipment, including x-rays, and a loupe with a light source, to perform exams thoroughly and safely.

Your dentist will also check your temporomandibular joints, chewing muscles, and lymph nodes to look for pathologies. If in doubt, he may refer you to a specialist.

After detecting lesions and infections, he will suggest you the appropriate treatment.