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Toothache
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===Differential diagnoses=== {| class="wikitable" style="border:1px solid #BBB; font-size:80%; margin:0.46em 0.2em" |- ! Parameter !! Dentin hypersensitivity<ref name=Hargreaves2011 />{{rp|36}} !! Reversible pulpitis<ref name=Hargreaves2011 />{{rp|36}} !! Irreversible pulpitis<ref name=Hargreaves2011 />{{rp|36β37}} !! Pulp necrosis<ref name=Hargreaves2011 />{{rp|37}} !! Apical periodontitis<ref name=Hargreaves2011 />{{rp|37β38}} !! Periodontal abscess !! Pericoronitis!! Myofascial pain !! Maxillary sinusitis |- | '''Site'''||Poorly localized ||Poorly localized || Variable; localized or diffuse || No pain || Well localized || Usually well localized || Well localized, associated with partially impacted tooth || Diffuse, often over many muscles ||Back teeth top jaw |- | '''Onset''' || Gradual || Variable || Variable || From pain of reversible pulpitis to no pain in days || Gradual, typically follows weeks of thermal pain in tooth || Sudden, no episode of thermal sensitivity || Sudden || Very slow; weeks to months ||Sudden |- | '''Character''' || Sharp, quickly reversible || Sharp, shooting || Dull, continuous pain. Can also be sharp || No pain || Dull, continuous throbbing pain || Dull, continuous throbbing pain ||Sharp, with continuous dull || Dull, aching || Dull, aching, occasional thermal sensitivity in back top teeth |- | '''Radiation''' ||Does not cross midline || Does not cross midline || Does not cross midline || N/A || Does not cross midline ||Little, well localized ||Moderate, into jaw/neck || Extensive, neck/temple || Moderate, into other facial sinus areas |- | '''Associated symptoms''' || Patient may complain of receding gums and/or toothbrush abrasion cavities ||Can follow restorative dental work or trauma|| Follows period of pain that does not linger || Follows period of spontaneous pain || Tooth may feel raised in socket ||May follow report of something getting "stuck" in gum || Tooth eruption ("cutting") or impacted tooth || Tension headaches, neck pain, periods of stress or episode of mouth open for long period || Symptoms of [[upper respiratory tract infection|URTI]] |- | '''Time pattern''' || Hypersensitivity as long as stimulus is applied; often worse in cold weather || Pain as long as stimulus is applied || Lingering pain to hot or cold or spontaneous pain || Absence of pain following days or weeks of intense, well localized pain || Pain on biting following constant dull, aching pain development || Dull ache with acute increase in pain when tooth is moved, minimal thermal sensitivity || Constant dull ache without stimulus || Spontaneous, worse with eating, chewing, or movement of jaw || Spontaneous, worse when head is tipped forward |- | '''Exacerbating and relieving factors'''|| Exacerbating: thermal, particularly cold || Exacerbating: thermal, sweet || Simple analgesics have little effect || Prolonged heat may elicit pain|| Same as irreversible pulpitis, or no response to cold, lingering pain to hot, pain with biting or lying down || Tapping tooth makes worse, cleansing area may improve pain || Cleansing area can improve pain || Rest or ice makes pain better, movement and chewing make it worse || Tilting head forward, jarring movements (jumping) make pain worse |- | '''Severity'''|| Less severe than pulpitis || Severe, for short periods || Variable; pain dissipates until periapical tissue affected || Severe || Severe || Severe || Mild to severe || Mild to moderate || Mild to severe |- | '''Effect on sleep''' || None || None usually || Disrupts sleep || None || Disrupts sleep || Variable, can disrupt sleep || If moderate to severe, will disrupt || Unusual || Unusual |} When it becomes extremely painful and decayed the tooth may be known as a [[hot tooth syndrome|hot tooth]].<ref name="endoexperience.com">{{Cite web|url=http://endoexperience.com/documents/HotToothanesthesia.PDF|title = Looking for a File and were Directed Here?}}</ref>
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