Are some dental pains more difficult to diagnose than others?

Sometimes diagnosing the cause of a dental pain can be easy. This is especially true if an x-ray shows a problem and my clinical exam provides supporting evidence. If, for example, the dental radiograph shows a dark radioluscency at the end of a tooth that is bothering the patient then it is almost always means that the patient has a necrotic pulp and will require a root canal.

Unfortunately it is not always so easy. Often patients complaints are vague ,radiographic and clinical findings are not clear, and not all pain is easy to replicate while a patient is in the chair. Sometimes a number of tests and challenges need to be performed and a series of questions need to be asked, in order to come up with an accurate diagnosis.

Complicating the matter is that pain can originate from a number of non tooth related conditions, including heart problems, neuralgia, sinus problems, and muscular pain(associated with TMD). Often if I am not sure which tooth is causing a patent's discomfort I suggest 'watchful waiting' . I am operating under the assumption that either the pain will go away or if not, then a symptom will develop that will make my diagnosis more certain. A tooth that wasn't sensitive to percussion may become so, or the patient may develop a swelling(often the case with dental infections) or new radiographs will better suggest the nature of the problem.

There are times when after I have thoroughly checked out a patient I am not certain of which tooth is causing the pain or even if I have pinpointed the particular tooth, I am not certain as to why it is hurting. Clearly if I am not certain of my diagnosis (if any ) is the problem, then waiting can sometimes be the best option, since treating a particular tooth can be very discouraging to both the patient and their dentist , if their symptoms turn out to be caused by a different tooth.