80% of an accurate emergency diagnosis comes from the patient’s story. Get an accurate story — find the right questions to ask.
Tooth or area?
Bilateral symptoms point away from a single culprit tooth — widen your differential before testing.
Investigate myofacial pain.
Sharp, or dull / throbby / achy?
Bilateral symptoms point away from a single culprit tooth — widen your differential before testing.
What makes the pain worse?
Must reproduce the same sensitivity after establishing a baseline on a healthy tooth.
Cold Sensitivity
Sweet sensitivity
Usually exposed dentin under a restoration. If not obvious, test with air at the margin.
Bite sensitivity
Ranges from bruxism to a vertical fracture — let the pain’s character differentiate.
Pain on release
Cracked tooth syndrome.
Bilateral pain
Likely bruxism, not a single tooth.
Spontaneous pain
Especially at a premolar — likely irreversible pulpitis.
Cold test result (pulpal diagnosis)
What’s the pain level, 1–10?
How long have you been in pain?
Treat it as a true emergency if either is true
Pain started within the last 48 hours, or the patient will come in at any availability.
Remember: nerves don’t hurt after they die.
Clinical judgement still wins
Use it whenever your tests disagree. Accuracy depends on the quality of your questions and tests — not every test is appropriate for every tooth.
Next steps
Once the patient is out of pain, move to a comprehensive evaluation: how does treating this tooth affect the rest of the mouth? Emergency treatment is not the definitive fix.
