What Pain is Mistaken for Toothache

Diseases and conditions that may be mistaken for dental pain. These are mainly diseases of related areas (sinuses, organs of vision and hearing, pharynx, cervical vertebrae, brain); they can also be caused by diseases of the heart and blood vessels, musculoskeletal system (spine), nervous system, and mental disorders.

Neuralgia of the trigeminal nerve. The trigeminal nerve is responsible for the sensitivity of the face and mouth. When it is affected, the pain is very severe and similar to toothache. Unfortunately, many patients with neuralgia have undergone numerous pulpings and tooth extractions, yet continue to experience pain. Despite the patient’s belief that a tooth is the cause of the pain, the dentist needs to correct the diagnosis and refer the patient to a neurologist. Another possibility is postherpetic neuralgia, which occurs in people who have had herpes zoster (shingles). Therefore, it is important to tell the dentist if itchy blisters on the skin and mucous membranes appeared some time ago, or if this diagnosis was made.


Cluster headache is a syndrome of unclear origin represented by an acute onset of pain. It may be a form of migraine. Cluster headache is more common in men in their 30s and 60s. Many patients note the appearance of pain after drinking alcohol.

In classic cases, there is unilateral pain in the area of the upper jaw, maxillary sinus and behind the eye socket. Cluster headache is often mistaken for acute pulpitis or periodontitis of the maxillary jaw teeth.

Middle ear inflammation (otitis media) is a common disease, especially in children, caused by streptococci. It is well known that with diseases of the chewing teeth, pain can radiate to the ear. Conversely, with middle ear inflammation, the symptoms shift to the back of the upper and lower jaws. After diagnosis, the patient is referred to an otorhinolaryngologist.

Acute maxillary sinusitis (maxillary sinusitis). The roots of the teeth of the upper jaw rest against the bottom of the sinus, so the inflammation often mimics toothache. Most forms of sinusitis are allergic and are characterized by blunt pain in the zygomatic region and the alveolar process of the upper jaw.

In acute maxillary sinusitis, the pain can be stabbing, pressing, throbbing. It often goes to the suborbital area, to the area of the upper jaw teeth. This pain is felt in more than one tooth. It is advisable to see an ENT specialist.

Diseases of the sinuses are often chronic and allergic. They tend to be seasonal, because for most people the allergens are the seeds and pollen of various plants. In countries with a northern climate, the percentage of sinusitis cases increases in the spring and fall. The patient must be referred to an ENT specialist and allergist.

Heart disease. Angina pectoris is pain behind the sternum, which may “recoil” into the left shoulder and along the arm. The pain usually occurs after physical exertion. These symptoms are extremely important because angina pectoris is a precursor to acute myocardial infarction. Sometimes the pain is felt only in the left shoulder and arm, even more rarely in the left corner of the lower jaw.

So, if there are complaints of pain in the posterior part of the lower jaw on the left side and there are no objective reasons from the dental side, you can assume the cardiac nature of the pain. In this case, the dentist will refer the patient for a consultation to a cardiologist or therapist.

Salivary stone disease develops in the duct of one of the salivary glands. For a long time, the only manifestation is dry mouth. When the stone reaches a critical size, it clogs the salivary duct; toothache occurs. Swelling of the submandibular area may occur. Several X-rays are taken to diagnose the problem. Treatment is performed by a dental surgeon, it consists of an incision of the duct and removal of the stone under local anesthesia.

Musculoskeletal pain can be caused by trauma or dysfunction of the muscles of the neck, head, and jaw. Pain may be noted in the area of the teeth, cheek, temple, lateral surface of the neck, and occiput. This group also includes diseases of the temporomandibular joint and the cervical spine. Other joint diseases (rheumatoid arthritis, gout, psoriasis; collagenous diseases, or collagenosis) can cause pain in the maxillofacial region.

Internal temporomandibular joint dysfunction often results in complaints of toothache. Joint dysfunction is caused by displacement of the articular disc, the formation of fusion or due to various forms of arthritis, trauma, yawning, and prolonged opening of the mouth. Manifestations: the mouth does not open fully, the lower jaw shifts to the side when opening it, a clicking or creaking sound in the joint, and pain in front from the earlobe.

The pain is prolonged, dull, muffled, but can become more acute when the mouth is opened wide or when chewing. In some cases, the pain radiates to the temple, cheek, distal parts of the upper and lower jaw. In such cases, the patient may think they are experiencing toothache.

Tumors. The manifestation of malignant tumors in the jaw region is rarely pain. In typical cases, there is tingling or decreased sensation (numbness). Most tumors affect not only the sensory but also the motor nerves.

Atypical pain conditions masquerading as toothache are a group of syndromes that do not correspond to any specific disease. In this case, the patient is usually convinced that the cause of the pain is the teeth” and insists on their treatment or removal. Although the cause is unknown, many experts suggest nervous system involvement. Atypical pain is usually chronic, nagging; patients feel it deep inside the bone and have difficulty localizing it. Sometimes the pain seems to move from one area to another, and there may be complaints of pain throughout the body. Examination should include psychological screening and behavioral disorder tests that assess for depressive, anxious, hostile behavior. It is possible that the primary cause of atypical pain is a psychological disorder. Consultation with a psychologist or psychiatrist is indicated.

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Dr. R.Mammadli (Dental Expert Team)

Bachelor in biotechnical medicine. Author of several medical blogs, author of articles on dentistry and oral health.