Truth About "Phantom" Toothaches | 医療法人社団EPSDC

I am Hiroshi Miyashita, Director of The Tokyo International Dental Clinic Roppongi.

In our practice, we are dedicated to safeguarding the “health assets” of executives and high-performing professionals. Our philosophy is rooted in the world-class standards of the University of Gothenburg, Sweden, where I mastered the art of clinical diagnostics. We believe that the most valuable service we provide is not the treatment itself, but the rigorous diagnostic process that precedes it.

Have you ever been told “there is nothing wrong with your teeth,” yet the pain persists? Or perhaps you have undergone repeated treatments only to find the discomfort remains? If you are losing valuable time and mental energy to “unidentified pain,” the culprit may not be your teeth at all.

Today, I wish to share a critical perspective on Orofacial Pain—knowledge that is essential for effective risk management of your physical well-being.

1. The Neuroscience of “The Great Pain”

In medical science, dental pain is ranked alongside kidney stones and childbirth as one of the most intense agonies a human can experience.

This intensity is caused by a dense concentration of A$\delta$ (delta) and C-fibers within the dental pulp. When stimulated, these nerves send high-voltage signals directly to the brain’s emotional centers. On the Numerical Rating Scale (NRS), this pain often reaches a “9” out of 10, which can impair rational decision-making. In desperation, many patients plead, “I don’t care what it is, just pull the tooth.” However, performing irreversible (irreparable) procedures without a definitive cause is one of the greatest risks in modern dentistry.

2. Chasing “Ghosts”: The Trap of Non-Odontogenic Pain

Approximately 5% of patients seeking dental care suffer from “Non-Odontogenic Toothache.” This is a phenomenon where the Site (where you feel pain) and the Source (where the pain originates) are completely different.

While many clinics focus solely on the “site”—the tooth—we invest heavily in identifying the “source.” Without this distinction, a patient risks a “cascade of misdiagnosis,” leading to unnecessary root canals or extractions of perfectly healthy teeth.

3. Myofascial Pain: When Facial “Stiffness” Mimics a Cavity

The most common cause of non-odontogenic pain is referred pain from the masticatory muscles (the masseter and temporalis). Just as a stiff neck can cause a tension headache, “trigger points” in your jaw muscles can project sharp or dull pain into your teeth.

The 5-Second Executive Self-Check:

Press firmly on your cheek muscle (below the cheekbone) or your temple with your fingertips (apply about 1kg of pressure).
Hold for 5 seconds. If this pressure reproduces or radiates your “usual toothache,” the problem lies in muscle hyper-tension, not your dental structure.

4. TCH: The Hidden Cost of High Performance

The “8020 Movement” has successfully allowed more people to retain their natural teeth into their 80s. However, this success has a modern side effect: “Tooth Contacting Habit” (TCH).

Normally, upper and lower teeth should only touch for about 17 minutes a day during eating and speaking. Under the stress of high-level management or deep concentration, many unconsciously keep their teeth in contact for hours. This constant loading exhausts the supporting tissues, creating a phantom ache. True performance requires the strategic ability to “disengage”—both mentally and physically.

5. Life-Threatening Signals Hidden as Toothaches

Rarely, a “toothache” is the only warning sign of a serious systemic condition:

Cardiac Issues: Angina or myocardial infarction can manifest as radiating pain in the lower left jaw.
Malignancy: Roughly 36% of maxillary sinus cancers initially present as pain in the upper molars.
Cluster Headaches: Known as “suicide headaches,” 16% of these patients undergo unnecessary extractions due to misdiagnosis.

6. Burning Mouth Syndrome (BMS): Nociplastic Pain

For those who feel a “scalding” or “stinging” sensation on the tongue despite no visible sores, you may be experiencing BMS. We treat this not as a psychological issue, but as Nociplastic Pain—a change in how the central nervous system processes sensory information.

Conclusion: Resolution Begins with Structured Diagnostics

Orofacial pain is a complex puzzle that often transcends the boundaries of traditional dentistry. To solve it, our clinic utilizes a 12-item “Structured Interview” to profile the quality, duration, and aggravating factors of your pain with clinical precision.

We also employ a multidisciplinary approach, collaborating with neurosurgeons and internal medicine specialists when necessary. Being told “your teeth are fine” is not a dead-end; it is the opening of a new door toward a definitive solution.

Protect your natural teeth. Protect your quality of life. We are here to provide the “Power of Diagnosis” cultivated at the University of Gothenburg to restore your refined, pain-free daily life.

Reference

大野由香　小長谷光　歯科医師が語る口腔顔面痛診療　日本ペインクリニック学会誌　Vol.33 No.3 43-50, 2026

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