What Could Cause a Toothache if the X-ray Looks Fine?

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I had a severe toothache for three days, so I scheduled an appointment with my dentist. She used my X-rays from June to diagnose the problem. She said the tooth looked fine, but she would prescribe antibiotics in case the tooth is infected. If the toothache decreases after I finish the antibiotics, I don’t need to return to the office. What could be wrong with the tooth if the X-ray doesn’t show a problem? Thanks. Ravi from Cleveland, OH

Ravi,

You had X-rays four months ago, but pain developed afterward, which means the situation has changed. The earlier images likely showed only the tooth crowns. What you need now is a periapical x-ray that includes the root tips. That image will show if an infection has reached the pulp.

What Tests Help Find the Cause of a Toothache?

Diagram of root canal treatment instead of a dental implant - from Baton Rouge denitst Steven Brooksher, DDS

Root canal process

If your dentist focused only on the filling, she overlooked other possibilities. Diagnosing tooth pain involves several critical but straightforward checks:

  1. Does tapping the tooth increase pain?
  2. How does cold or heat affect it?
  3. Does cold relieve discomfort?
  4. Was an electric pulp test done to see if the nerve is alive?

Skipping these steps can lead to incomplete or incorrect treatment.

Will Antibiotics Get Rid of a Toothache?

Prescribing antibiotics and suggesting no follow-up if the toothache eases is a faulty approach. If antibiotics reduce your pain, they’ve only calmed the infection in the surrounding bone—not inside the tooth. Without root canal treatment and a dental crown, the infection will return once you stop taking them, and the bacteria may become resistant to the same drug.

If this reflects your experience, you need a dentist who listens carefully, investigates thoroughly, and provides the proper treatment to resolve your toothache—not just mask it.

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist, sponsors this post. Read why so many patients view Dr. Brooksher as one of the best dentists in Baton Rouge.

An Untreated Tooth Infection Can Be Fatal

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Are you tempted to treat a tooth infection at home because it’s cheaper, more convenient, or helps you avoid the dentist? Published research on untreated tooth infections that led to fatalities can help you understand how going to a dentist for root canal treatment can be life-saving.

The Journal of Endodontics published results from a study that showed 66 people died from tooth infections from 2000-2008. Additionally, the Sacramento Bee and Fox News reported the case of Californian Vadim Kondratyuk Anatoliyevich, a 26-year-old husband and father of two girls. Vidim was a long-haul truck driver who developed a tooth infection. In January 2017, while driving to New York on a long-haul job, Vadim’s tooth infection worsened, so he stopped in Oklahoma to see a dentist who prescribed antibiotics. As Vadim continued his travel to New York, the toothache got better, then worse, and the side of his face began to swell.

Vadim made his delivery in New York but could not drive home due to the severity of his tooth infection. Vadim’s brother flew to New York to drive him back to California. However, Vadim had difficulty breathing and became pale, so his brother took him to a Utah hospital, where he was placed on oxygen and flown to a Salt Lake City facility.

A diagram of root canal treatment steps including removing the infection, filling the canals, and crowning the tooth

Root canal treatment gets rid of a tooth infection

The infection had spread to Vadim’s blood and lungs. Despite stronger antibiotics and dialysis, the doctors in Salt Lake City could not save him. Vadim’s wife was able to fly to the hospital in Utah to say goodbye before he died.

At-home care is not enough to treat a tooth infection. Antibiotics are insufficient because an infected tooth is dead and does not have blood circulation to transport medication. If you have a toothache, address it by seeing a dentist for root canal treatment—the only way to remove infection from a tooth. By seeing a dentist immediately for root canal treatment, you can avoid a tooth infection that spreads and becomes life-threatening.

 

Baton Rouge accredited cosmetic dentist Dr. Steven Brooksher sponsors this post.

Is a Recent Toothache a Reason for an Extraction?

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Is a recent toothache a reason for an extraction? I moved here from Connecticut in July, so I haven’t had time to search out a dentist like I want thoroughly. I’ve had a lower jaw and toothache on the back left side of my mouth for two weeks. The pain comes and goes. I went to a nearby dentist who took an x-ray. She said that a molar that already has a filling in it has a large cavity. She recommends pulling the tooth and replacing it with a dental implant.

Does this sound right? I had no idea this was happening with the tooth because the pain started only two weeks ago, and it comes and goes. I haven’t had a throbbing toothache or significant discomfort in other ways. Thanks. – Victoria

Victoria – If the pain in your tooth just started, the tooth has only recently become infected. If a dentist cannot save the tooth, it would be more likely that you would have felt pain months ago. The tooth may be badly broken or decayed, and a dentist may think it is unsavable. Or, the dentist may want to remove the tooth rather than try to save it because of its condition and the time it would take to restore it.

Model of a dental implant with the crown, abutment, and root form labeled

A savable tooth may need root canal treatment,  not extraction and a dental implant

It is best to seek a second opinion without telling the second dentist about the diagnosis from the first dentist. Your independent second opinion should include an X-ray to determine the tooth’s condition. A dentist or endodontist may be able to save the tooth with root canal treatment. Otherwise, you may get a recommendation for an extraction and dental implant.

We advise patients to get second opinions before agreeing to significant treatment that is costly or will impact their oral health. For example, a missing tooth can lead to other concerns, including teeth drifting out of place and creating a need for braces to realign them.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Read about his education and training, and learn what he does to provide some of the best dental care in Baton Rouge.