Dental pain and diagnosis?

 Patients often present with dental pain and would like to get a diagnosis and appropriate dental treatment. They often complain of a tooth ache, which is not very specific, since There can be a number of causes for tooth pain and there are many differential causes.  Often my residients and students try diagnosing using the dental radiographs as their primary tool. Dental radiographs are just one of the items in our tool box. For me , the first thing I do is ask the patients a bunch of questions... When do you have pain? do you have pain on biting, pain after eating, hot or cold sensitivity  or prolonged pain. The answers to these questions have a lot to do with narrowing down why the patient is having pain.  I definitely look at the radiographs to see if their is an obvious problem in the quadrant they are feeling pain( perapical radiolucency or a large carious lesion). 

If a tooth is sensitive to cold it means that it is vital and any teeth with root canals in the area can not be the source of cold sensitivity. Swelling usually means the presence of an infection and the swelling should be palpated to see where it is located intraorally. Pain on biting is a often one of the symptoms and I often will have my patient bite on the wooden part of a cotton tip applicator so they may better localize which tooth is the culprit. Pain on biting can indicate a cracked filling, a large carious lesion or or an infection due to an irreversible pulpitis or necrotic pulp that is causing an infection.

Coming up with a differential diagnosis can be complicated and should involve a trip to a knowledgable dentist. Relying on xrays alone is usually a bad idea. Its best best to have you dentist interview you and check you out in person so that he or she can come up with a more accurate assessment of what type of dental problem is causing your pain.