Most times when a patient comes in complaining of a toothache, they do have an actual tooth related problem, but on occasion a patient presents with pain masquerading as tooth pain. At different points in my career, patients have showed up convinced that they had a significant tooth problem when in fact after a thorough investigation it turned out that their problem was not tooth related. Some of the diagnosis’s turned out to be, maxillary sinusitis, tmj problems, trigeminal neuralgia, oral herpes and shingles. At times, these conditions can fool the patient (and their dentist) into believing that they have a tooth that needs a emergency treatment.
If a patient does come in with reported tooth pain a dentist should do a thorough clinical exam of the quadrant involved including taking need x-rays and if no pathology is apparent, a detailed history of the present problem should be discussed with the patient. Sometimes during an examination several alternative diagnosis’s are possible and I explain them to the patient. It can be difficult for a patient to hear that I am not certain what their problem is caused by, but that is preferable to performing an unnecessary treatment. Sometimes when I am not be sure what is the cause of a patients pain, I ask them to wait a week to see if the situation resolves or changes. If a patient has a actual dental infection, waiting a week may allow a more clear diagnosis of the infection since either the pain will be more localized , visualized more clearly on a radiograph or they may develop an additional symptom that will make the diagnosis more obvious.