Pain that only shows up when you chew is one of the most diagnostic patterns in dentistry. There are really only three serious possibilities, and the way the pain feels usually tells you which one.
Most likely: Cracked tooth syndrome
The classic 'rebound' pain of a cracked tooth — the crack flexes under load, irritates the nerve, then closes when you release. Often hard to localize. Diagnosed under a microscope and with a bite-stick test.
What to do: See a specialist for evaluation within 1–2 weeks. Cracks only get worse.
Read: Cracked tooth symptomsMost likely: Apical periodontitis (root-tip inflammation)
The nerve inside the tooth is dying or already dead, and inflammation has spread to the bone around the root tip. The tooth feels 'taller' or 'high' on bite and is tender to tapping. Often follows a previous deep filling, prior root canal, or trauma months or years ago.
What to do: Needs a root canal (or, if previously treated, retreatment or apicoectomy).
Read: Root canal treatmentMost likely: High filling or crown — bite is slightly off
If a new filling, crown, or onlay was placed in the last few weeks and the tooth feels sore on biting, the most likely cause is that the restoration is hitting first when you close — overloading that one tooth. The fix is a 30-second polish to lower the high spot.
What to do: Call your general dentist who placed the restoration; this is usually a quick adjustment, not an endodontic problem.
A specialist bite-pain workup takes about 20 minutes and walks through three core tests:
Microscope examination, transillumination, and (for difficult cases) a CBCT 3D scan fill in any remaining gaps.
Pain that's only triggered by chewing pressure narrows the differential to a small set of conditions: a cracked tooth, root-tip inflammation (apical periodontitis), a high filling/crown, or a sinus issue affecting the upper molars. The pattern of the pain — sharp vs. dull, brief vs. lingering, with or without temperature sensitivity — usually identifies which one.
We use a 'bite stick' (Tooth Slooth) — a small plastic wedge applied to one cusp at a time. A cracked tooth produces sharp pain when you bite on the cracked cusp specifically, and the pain disappears the instant you let go. A nerve problem (apical periodontitis) produces a dull, focused soreness on tapping, regardless of which cusp. The two patterns are distinct.
Usually not. The most common cause of post-crown bite pain is that the new crown is sitting just slightly too tall — even 50 microns of extra height overloads the tooth on every bite. A two-minute polish to mark and reduce the high spot resolves it. If the pain persists after the bite is adjusted, then deeper evaluation is warranted.
For a tooth that hurts on bite shortly after a recent restoration, start with the dentist who did the work — it's almost always a high-spot adjustment. For a tooth where the pain has come on without recent dental work, especially if it's sharp/snapping or you can't bite confidently, an endodontist's microscope and bite-stick exam will sort it out faster.
Not usually — bite pain alone, without swelling or fever, can typically wait a few days for an appointment. But if the pain is sharp enough to make you avoid eating on that side, or has been getting steadily worse for more than 5–7 days, schedule sooner rather than later. Cracks especially get worse with every chewing cycle.
This is more common than people realize — about 1 in 5 patients we see for unclear bite pain have already seen one or more dentists who couldn't pinpoint it. Microscopic examination, transillumination, CBCT 3D imaging, and selective anesthesia testing usually find the answer within one specialist visit.
Diagnostic dead ends are common with bite pain. A 30-minute specialist consultation usually finds the answer.
