The four usual causes

A crack. Sharp pain when you bite down or, more often, when you let go. The tooth flexes and the crack opens. Found with a bite test on each cusp.

A high filling or crown. A new restoration that hits first when you close makes that tooth sore to chew on. Found by checking your bite with marking paper and fixed with a small adjustment.

A cavity between teeth. Food packs into it when you chew and presses on the gum or the nerve. Found on an X-ray, because it hides where you cannot see it.

Sinus pressure. The roots of the upper back teeth sit under the sinus. A cold or allergies can make several teeth ache at once, worse when you bend over. Found by tapping the teeth and asking the right questions.

What I check, in order

This takes about ten minutes and usually points to one answer.

• Which tooth, or teeth, and whether the pain is on biting or releasing
• Bite test on each cusp to reproduce the pain and locate a crack
• Marking paper to see if a filling or crown is high
• X-ray for decay between teeth or at the root
• Cold test to see how the nerve is responding
• Gum measurements, since a pocket beside the tooth can ache on chewing

Same-day or scheduled?

Call for same-day time if the pain is sharp, getting worse, waking you up, or comes with swelling or a bad taste. Cracks and deep cavities only move in one direction.

A scheduled visit this week is fine for mild soreness on a new filling, or an ache that came with a cold and is already easing. Say what you are feeling when you call and we will tell you which.

What happens next

A high spot gets adjusted in the chair. A cavity between teeth gets a small filling. A crack gets a bond, an onlay or a crown depending on how far it runs. Sinus pain gets a note for your physician and a recheck once the congestion clears. You see the finding and the cost before anything starts.