Editing Toothache (section)

===Investigations===
Any tooth that is identified, in either the history of pain or base clinical exam, as a source for toothache may undergo further testing for vitality of the dental pulp, infection, fractures, or periodontitis.  These tests may include:<ref name=Hargreaves2011 />{{rp|10–19}}

* Pulp sensitivity tests, usually carried out with a cotton wool [[wikt:pledget|pledget]] sprayed with [[ethyl chloride]] to serve as a cold stimulus, or with an [[electric pulp test]]er. The air spray from a three-in-one syringe may also be used to demonstrate areas of dentin hypersensitivity. Heat tests can also be applied with hot [[Gutta-percha]].  A healthy tooth will feel the cold but the pain will be mild and disappear once the stimulus is removed.  The accuracy of these tests has been reported as 86% for cold testing, 81% for electric pulp testing, and 71% for heat testing.  Because of the lack of [[test sensitivity]], a second symptom should be present or a positive test before making a diagnosis.
* [[Radiograph]]s utilized to find dental caries and bone loss laterally or at the apex.
* Assessment of biting on individual teeth (which sometimes helps to localize the problem) or the separate cusps (may help to detect cracked cusp syndrome).

Less commonly used tests might include trans-illumination (to detect congestion of the maxillary sinus or to highlight a crack in a tooth), dyes (to help visualize a crack), a test cavity<!-- need to explain -->, selective anaesthesia and [[Laser Doppler velocimetry|laser doppler flowmetry]].
<gallery mode="packed" heights="110">
File:Cold test with ethyl chloride.jpg|Pulp sensibility test using ethyl chloride (cold stimulus)
File:Electric-pulp-testing.gif|Electric pulp tester
File:Tooth sleuth.jpg|Plastic wedge to identify pain on biting from a fractured tooth
File:Transillumination of tooth marked.jpg|Transillumination demonstrating fracture
File:Tooth decay and abscess xray.png|Decay (green) with apical abscess (blue)
File:Sinugram abscessed tooth.jpg|Gutta-percha point indicating abscess origin
</gallery>

Establishing a diagnosis of nondental toothache is initially done by careful questioning about the site, nature, aggravating and relieving factors, and referral of the pain, then ruling out any dental causes.  There are no specific treatments for nondental pain (each treatment is directed at the cause of the pain, rather than the toothache itself), but a dentist can assist in offering potential sources of the pain and direct the patient to appropriate care. The most critical nondental source is the radiation of [[angina pectoris]] into the lower teeth and the potential need for urgent cardiac care.<ref name=Hargreaves2011 />{{rp|68}}