Hello doctor, my tooth has really been hurting me, and I know which one it is,” says the patient.
“How long has the tooth been hurting, and what makes the pain worse?” the dentist asks.
“The tooth has been sore for about a week, especially when I eat hot and cold food.
Sometimes it feels like every tooth on my right side of my mouth hurts, but this is the tooth that has the problem,” states the patient, pointing to an upper molar on the right side of her mouth.
The dentist has his assistant take an x-ray, carefully examines the tooth, uses hot and cold stimulus to test the area, and then lightly taps on the tooth. The patient has no abnormal reaction. “I’m sorry, but the tooth you are pointing to is just fine. I’ll need to examine the rest of the mouth to find out which tooth is infected.” The dentist examines the rest of the teeth and soon finds out that a different tooth, a premolar, is where the pain was coming from.
The premolar is two teeth in front of the tooth that the patient pointed to.
The patient looks at the dentist with surprise. She was sure it was the molar. It had a big black filling and seemed to be in the exact location of the pain. The dentist explains to her that she will require a root canal on the premolar, and that will take care of her problem. It may surprise you to know that the above scenario is very common. The reason for the patient’s confusion is a phenomenon called referred pain.
Pain from an infected tooth can travel from tooth to tooth on the same side of the jaw, and sometimes to the ear. In fact, pain from an infected tooth on the upper jaw can even travel to the lower jaw on the same side of the mouth, and vice-versa.
Referred pain does not, however, cross the middle of the mouth (midline), i.e. pain will not travel from the right side to the left side of the mouth. It is important to note that it is only the sensation of pain that travels, not the infection itself.
Treatment of the infected tooth is the only way to stop the pattern of referred pain. One surprising pattern of referred pain has nothing to do with an infection of the teeth. It occurs when a person is having a heart attack, and pain is referred to the jaw and teeth. Usually, the pain is referred to teeth on the left side of the mouth. People with a history of heart disease and angina need to be aware of this possible referral pattern, especially if they are in good dental health.