Tooth Pain When You Bite Down On It: Causes and Treatments

There are many reasons that you can feel pain in your tooth when you bite down. A range of conditions causes this kind of toothache, including cavities and damage to the teeth, sinus infection, and gum disease.

In addition to causing sharp stabs of pain when chewing or putting pressure on the tooth, these issues can lead to tooth loss and other problems.

This article looks at the conditions that lead to a painful bite, when to get help, and treatment options.

Why Does My Tooth Hurt When I Bite Down?

Most often, pain when you bite down, is caused by complications of poor oral hygiene or damage to the tooth. It can also arise from sinus pressure caused by infection. The following are common causes of tooth pain.

Cavity

The most common causes of a painful bite are cavities (holes in the teeth caused by tooth decay). According to the Centers for Disease Control (CDC), approximately 90% of adults over 20 have had at least one cavity. This issue occurs when the hard outer shell of teeth (tooth enamel) erodes when bacteria in plaque feed on sugars in your mouth.

Cavities can affect any part of the tooth; in cases of gum recession due to gum disease, the roots of the teeth can also be affected. It’s essential to treat cavities as they can progress to more serious issues, including infection and tooth loss.

Cracked Tooth or Other Injury

Tooth pain when you bite down can also arise from physical damage. Loosened or cracked teeth have many causes, including:

• Accidents or falls
• Impact
• Natural wear and tear
• Bruxism (teeth grinding)
• Chewing on ice or very hard foods

Periodontitis

Periodontitis, or periodontal disease, is an advanced form of gingivitis in which the infection causes the gums to pull away from the teeth, and the underlying bone starts to lose mass and weaken. The toothache occurs from loosening teeth and decay that commonly results from this condition.

 Periodontitis is very common, affecting nearly half of American adults over 30. It's a progressive condition and a significant driver of tooth loss.

Malocclusion

When properly aligned, the upper teeth should hang over the lower set, and the molars should interlock. If they aren’t lined up, a condition known as malocclusion, they can become worn down and damaged, and their stability can be affected. This can lead to loosened teeth, cracking, tooth decay, and an increased risk of gingivitis and periodontitis, all of which are associated with tooth pain.

Loose Filling or Crown

Dental fillings to repair cavities or dental crowns—specialized caps placed over damaged teeth—can also be at the root of tooth pain.

If these are loose, poorly fitting, or broken, the underlying structures can be impacted, causing discomfort when biting. This arises due to natural wear and tear, poor fit, dental infection, tooth decay under a crown, or teeth grinding.

Abscessed Tooth

Tooth decay, periodontitis, and damage to the teeth can cause the tooth's pulp to become inflamed and die.

This can lead to the formation of an abscess—a pocket of thicker fluid or pus—where the teeth meet the bone. This painful, serious condition can spread the infection to the bone, teeth, and surrounding tissues if untreated.

Pulp Necrosis

A common result of tooth decay is pulpitis, an infection of the pulp, which is the nerve and blood vessel-filled tissue surrounding the tooth root. This can lead to the death of these tissues, a condition called pulp necrosis.

Pulp necrosis can cause pain upon biting and lead to tooth abscess, among other serious dental issues.  

Treatment For a Tooth That Hurts With Pressure

As with other dental issues, the specific treatment for tooth pain depends on the underlying cause. Dentists, dental specialists, and healthcare providers employ a range of treatments to take care of this issue.

Cavity

The specific treatment for a cavity depends on the scope of the damage and tooth decay. Several treatments may help, including the following:

• Dental fillings: This is the standard approach to typical, unadvanced cavities. The dentist removes decayed tooth enamel and fills the gap with dental cement or composite material.
• Root canal: If the cavity has caused infection of the pulp, the dentist performs a root canal. The affected tissue is removed, and the inside of the tooth is thoroughly cleaned out. Then, a temporary filling is placed, and time is given for recovery before the permanent restoration is put in place.
• Extraction: In severe cases, the tooth's pulp can't be saved, and your dentist may recommend pulling the tooth out. Following a dental extraction, you may need a dental implant or bridge to replace it.   

Cracked Tooth or Other Injury

Dental procedures can be highly successful in repairing cracked or chipped teeth, which can treat toothache and other symptoms. Among the procedures considered are the following:

• Dental bonding: The dentist uses a specialized resin to fill in the crack or chip, repairing damage and restoring the tooth's shape.
• Veneers: In some cases, a thin porcelain or plastic shell (veneer) can be placed over the damaged tooth, permanently restoring it.
• Dental crowns: A crown is a customized cap that can be placed over the remaining parts of damaged or cracked teeth. It's color-matched and shaped to fit in with the surrounding teeth.

Malocclusion

If the alignment of teeth is causing pain or otherwise affecting the health of the teeth, orthodontic treatments can help. The most common approaches include the following:

• Braces or aligners: Your orthodontist may try to use clear or metal braces, brackets wired to put pressure on teeth to fix their alignment. Retainers, or other types of wearable aligners, may also be used.
• Tooth removal: If the malocclusion is due to overcrowding of the teeth, tooth extraction may be considered. Once the tooth is removed, surrounding teeth migrate to fill up the space, which can fix the alignment issues.
• Reshaping teeth: In some cases, the cosmetic dentist can file down, cap, or reshape teeth to fix their alignment. Veneers or dental crowns may also be used to support this work.
• Jaw surgery: Very rarely, the position of the teeth needs to be adjusted by shortening, lengthening, or otherwise altering the shape of the jaw. The bone must sometimes be reinforced with a screw, wire, or plate. 

Periodontitis

More advanced gum disease, periodontitis, is progressive and irreversible. This condition is linked to tartar—a hardened, calcified plaque on the teeth—which can only be removed through dental procedures.

Chief among these is scaling and root planing, also known as deep cleaning. Scaling involves physically removing tartar from above and below the gum line, while root planing works to remove pockets of plaque near the tooth root.

Loose Filling or Crown

Generally, loose fillings or crowns can be easily repaired. If a filling becomes loose or falls out, the dentist can often cement it back into place or replace it. However, additional treatments, such as a root canal, may be needed if tooth decay is beneath the filling.

Similarly, dental crowns can be put back in place with a simple procedure if the underlying tooth structure isn’t affected by decay or damage.

Abscessed Tooth

Combatting the infection at the cause of the abscessed tooth is the primary goal of treating this condition. Specific approaches depend on the cause of the issue and can include:

• Taking antibiotics to kill bacteria
• Draining the fluids from the abscess to ease pressure and promote healing
• Scaling and root planing to clean spaces between the gums and teeth
• Root canal if the infection is due to tooth decay or damage

Pulp Necrosis

Endodontists—dentists that specialize in treating pulp—can treat pulp necrosis in several ways, including:

• Fillings: Dental fillings may be needed to treat any cavities at the root of the infection. It can be restored or replaced if a loose filling is at fault.
• Root canal: In a root canal, the dentist removes infected pulp tissues, disinfects, and cleans the tooth out in an initial appointment. In the second one, they fill in and restore the tooth.
• Pulpectomy: This procedure involves removing irreversibly affected pulp through a small hole drilled into the tooth. This may be done alongside a root canal.
• Dental implants: In severe cases, the tooth may need to be extracted and replaced with a prosthetic. This can be a dental implant or bridge.

When To See a Dentist

If you’re experiencing pain when biting down on food, you should have your teeth checked out. Signs that prompt a call to a provider include:

• Pain and symptoms lasting 48 or more hours
• Pain medications aren’t easing the pain
• Fever, bright red gums
• Swelling in the cheek or jaw

If your tooth pain is accompanied by swelling around the eye, neck, or mouth, or you have difficulty breathing, go to the emergency room.

Summary

Pain when biting down is a significant dental issue that requires treatment. It can be caused by tooth decay or damage, gum disease, loose fillings or crowns, and misaligned teeth (malocclusion), among other issues.

Dentists employ a range of treatments, including dental fillings, root canals, crowns, and pulpectomy, to ease pain and treat underlying conditions.

A Word From Verywell

Pain from biting or putting pressure on your tooth is more than an annoyance. It can be a sign of serious dental issues, which can affect your teeth' health and appearance.

If you're experiencing this type of toothache, it's essential to seek out dental care and treatment. As with many aspects of health, the sooner you get help, the better off you—and your smile—will be.