What Can Cause Tooth Pain On Biting?

Here is a non-inclusive list of conditions that can cause a person to have pain or discomfort during biting on a tooth:

• Irreversible pulpitis
• Pulpal necrosis
• Sinusitis/sinus infection
• Malocclusion; occlusal trauma; excursive interference
• Bruxism
• Fractured and displaced restoration
• Fractured cusp
• Cracked tooth
• Split tooth
• Vertical root fracture
• Periodontal abscess

Dentists should avoid the temptation to simply treat a symptom. A diagnosis should be made, and then the diagnosed condition can be properly treated. To differentiate between these conditions, a meticulous clinical work-up should be performed, which might include:

• Medical history
  • Recent changes in health
  • Recent lifestyle changes
  • Recent trauma
  • Hayfever, allergies, sinusitis, sinus infections
• Dental history
  • Recent dental work
  • Recent tooth trauma
  • Date of last check-up
  • Date of last x-rays
• History of chief complaint
  • When pain started
  • How frequently symptoms are present
  • How long pain lasts when initiated
  • Precisely what causes the pain to start
  • What makes the pain get better
  • Medications taken for the pain
  • Can pain be pinpointed to a specific tooth
• Clinical exam
  • Visual findings
    • Caries
    • Craze lines vs. crack vs. fracture
    • Fractured tooth structure
    • Factured or failing restorations
    • Abfractions
    • Occlusal wear
    • Swelling
    • Fistula
    • Periodontal appearance
  • Explorer findings
    • Caries
    • Cracks/crazes
    • Fractured tooth structure
    • Factured or failing restorations
  • Periodontal findings
    • Pocket depths
    • Presence of bleeding, purulence
    • Furcation involvement
  • Mobility
  • Percussion tests
  • Palpation of surrounding tissues
  • Pulp vitality tests
    • Ice
    • Heat
    • Response to electric pulp tester
  • Bite tests
  • Transillumination
  • Occlusion
  • TMJ
  • Sinuses
  • Staining
  • Restoration removal
  • Surgical assessment
• X-rays
  • Caries
  • Depth of existing restorations
  • Resorption
  • Root fracture
  • Integrity of existing root canal fill
  • Bone loss
    • Vertical
    • Horizontal
    • Furcation
  • Periapical or periradicular radiolucencies or radioopacitieis
  • PDL integrity
  • Lamina dura integrity
  • Sinuses
  • TMJ

See also:

• Cracked Tooth Syndrome and Insurance
• Craze vs. Crack vs. Fracture

References:

1. AAE publication, "Cracking the Cracked Tooth Code: Detection and Treatment of Various Longitudinal Tooth Fractures" 
2. AAE publication, "Classification of Longitudinal Tooth Fractures" 
3. AAE publication, "Clinical Determination of Cracks and Fractures Based On Location and Separable Segments" 
4. AAE publication, "The Obvious and the Obscure: Steps For Crack Detection and Confirmation"

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