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

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?

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.

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