Tooth pain can be sharp and sudden or dull and chronic. There are an infinite number of causes, but the most puzzling cases involve aches that seem to come and go or even disappear entirely and return a few months later. The body's own healing process is responsible for some of the erratic symptoms, but dentists can also misdiagnose an unrelated condition when it presents with pain in the face that only seems to come from a tooth.
Sometimes, if a toothache comes and goes, it can indicate a problem that is not dental such as a sinus infection, inner ear infection or even angina, according to the Merk Manuals Online Medical Library. Diagnosis of a toothache that disappears and reappears should first be considered by both a doctor and a dentist.
Common Dental Cause
A tooth that is cracked on the inside is difficult to diagnose upon examination, and it doesn't always show up on an X-ray. Initially, a cracked tooth presents with acute pain as the pieces on either side of the fissure move and irritate the pulp inside the tooth. Over time, the pulp degeneration can cause sensitivity to hot and cold temperatures. An untreated crack can begin to hurt on its own without any external stimuli like chewing or sudden temperature changes in the mouth, but this chronic pain can go away suddenly as well depending upon the reaction of the pulp and the degree to which infection develops. The pulp can either die off at the point of intrusion or spontaneously heal, but in a couple months' time, the pain will almost certainly recur.
You can see a periodontal abscess, so there is little mystery about the cause of the pain if that is your problem. It results from an infection in the soft tissues above the tooth that presents with redness and swelling at the gum line. Abscesses can heal, though often the underlying infection doesn't completely go away, so in a few months, you could have another flare up.
Nerve pain in the face is often misdiagnosed as a toothache, and the misdiagnosis can result in unnecessary root canals or even extractions. They are difficult to diagnose, as not even the patient can tell precisely where the pain is coming from. According to the information website Dentistry.com, in a study conducted by Dr. Steven Graff Radford of the UCLA Pain Management Center and published in "The Journal of the American Dental Association," two thirds of the 61 patients complaining of pain in the lower facial area were misdiagnosed with toothaches. The condition results from an irritation to the trigeminal nerve that runs through the face to the brain. The pain associated with it is intense and continuous, but it can disappear for months at a time.
A toothache that goes away is not an indication that the problem is gone forever, according to Brian Quesnell of the American Association of Endodontics. Even when the pain is gone, you should still get checked out by your dentist, and if needed, see an endodontist as well. An endodontist receives advanced training in diagnosing complex dental health problems that may be beyond the reach of a general dentist.