Reviewed by Dr. Kepa Beitia, DDS Independent dentist providing online second opinions.Reviewed by Dr. Kepa Beitia, DDS Independent dentist providing online second opinions.

Tooth Hurts When Chewing? Here's What It Means (From a Dentist Who Reviews X-Rays Daily)

If your tooth hurts when you bite down or chew, it's usually a sign that something is wrong — but it doesn't automatically mean you need a root canal or crown.If your tooth hurts when you bite down or chew, it's usually a sign that something is wrong — but it doesn't automatically mean you need a root canal or crown.

In fact, chewing pain is one of the most commonly misdiagnosed dental symptoms, and thousands of patients are told they need expensive treatment when the actual problem is much simpler.In fact, chewing pain is one of the most commonly misdiagnosed dental symptoms, and thousands of patients are told they need expensive treatment when the actual problem is much simpler.

This guide explains the real causes of chewing pain, how to know whether it's serious, and when you should get a second opinion before committing to treatment.This guide explains the real causes of chewing pain, how to know whether it's serious, and when you should get a second opinion before committing to treatment.

If your dentist recommended this treatment and you're unsure, an online dental second opinion can help you decide with confidence.

Quick Answer: Most Chewing Pain Is From Bite Problems, Cracks, or Fillings — Not Infections

Chewing pain usually comes from:Chewing pain usually comes from:

• A cracked tooth or cracked filling
• A high bite (after a filling or crown)
• Gum inflammation
• A deep cavity
• Tooth grinding
• Sinus pressure
• A loose crown or filling

Only a small percentage of chewing pain cases require a root canal.Only a small percentage of chewing pain cases require a root canal.

Common Causes of Pain When Chewing

Below are the 7 most common causes — in order of how often dentists see them.Below are the 7 most common causes — in order of how often dentists see them.

1. Cracked Tooth Syndrome (Most Common Cause)

A small crack in the tooth can cause sharp pain when biting.A small crack in the tooth can cause sharp pain when biting.

This is especially true if:This is especially true if:

• The pain feels like an electric shock
• You feel it mostly when releasing pressure
• The pain is inconsistent

Treatment depends on crack depth:Treatment depends on crack depth:

• Shallow crack → filling or onlay
• Moderate crack → crown
• Deep crack → may need extraction

Not all cracks require a crown or root canal. For more information about when a crown is truly necessary, see Do I Really Need a Crown?.

2. High Bite After a Filling or Crown

If a dentist recently worked on your tooth, the filling or crown might sit too high.If a dentist recently worked on your tooth, the filling or crown might sit too high.

Symptoms:Symptoms:

• Pain when biting down on the new filling
• Tooth feels "taller"
• Pain disappears after avoiding chewing on that side

Fix:Fix:

• A simple bite adjustment (2-minute procedure)
• No drilling, no injections, no root canal

This is the most overtreated cause of chewing pain.This is the most overtreated cause of chewing pain.

3. Gum Inflammation (Gingivitis or Localized Swelling)

Swollen or irritated gums can create pressure pain when chewing.Swollen or irritated gums can create pressure pain when chewing.

Causes:Causes:

• Food stuck between teeth
• Early gum disease
• Poor flossing habits

Fix:Fix:

• Warm saltwater rinses
• Proper flossing
• Professional cleaning

No major dental work needed.No major dental work needed.

4. Deep Cavity Reaching Close to the Nerve

A cavity that reaches the inner dentin layer can cause pain with pressure.A cavity that reaches the inner dentin layer can cause pain with pressure.

This does not always require a root canal. A filling is often enough.This does not always require a root canal. A filling is often enough.

But if decay is very deep and close to the nerve, a crown may be recommended.But if decay is very deep and close to the nerve, a crown may be recommended.

5. Loose Filling or Loose Crown

When a filling or crown moves slightly under pressure, it can trigger sharp pain.When a filling or crown moves slightly under pressure, it can trigger sharp pain.

Fix:Fix:

• Re-cement the crown
• Replace the loose filling
• Simple and inexpensive procedure

6. Sinus Pressure (Especially Upper Molars)

Your sinus sits directly above your upper back teeth.Your sinus sits directly above your upper back teeth.

Symptoms:Symptoms:

• Pain in multiple teeth
• Worse when chewing or jumping
• You feel congested or have allergies

Fix:Fix:

• Treat the sinus issue first
• Dental treatment is rarely needed

7. Bruxism (Teeth Grinding or Clenching)

Grinding can bruise the ligament under your tooth, making it tender when biting.Grinding can bruise the ligament under your tooth, making it tender when biting.

Fix:Fix:

• Nightguard
• Stress management
• Bite adjustment

When Chewing Pain Is Not a Root Canal Issue

Many dentists diagnose chewing pain as "you need a root canal."Many dentists diagnose chewing pain as "you need a root canal."

But root canal pain tends to show:But root canal pain tends to show:

• Spontaneous throbbing
• Pain at night
• Sensitivity to heat
• Lingering cold pain (20–30 seconds)
• Swelling or pus

If you ONLY feel pain when chewing, it's usually not the nerve dying.If you ONLY feel pain when chewing, it's usually not the nerve dying.

This is why chewing pain is one of the top reasons for unnecessary root canals.This is why chewing pain is one of the top reasons for unnecessary root canals.

How Dentists Diagnose Chewing Pain (In Plain English)

When a patient reports chewing pain, a proper exam should include:When a patient reports chewing pain, a proper exam should include:

• **Bite test on different cusps** — This identifies cracks and high spots.
• **Cold sensitivity test** — Checks if the nerve is healthy.
• **Percussion test (tapping)** — Determines gum vs nerve involvement.
• **Check bite alignment** — Very commonly missed.
• **X-ray review** — Looks for deep decay, old fillings, cracks, or infection.

If the dentist skipped tests or gave a quick diagnosis, it's a major red flag.If the dentist skipped tests or gave a quick diagnosis, it's a major red flag.

If your dentist recommended a crown or root canal, read Do I Really Need a Root Canal?

If your pain comes and goes rather than being constant, see Tooth Pain Comes and Goes — What It Means & When You Should Worry for more information.

What Chewing Pain Looks Like on an X-Ray

(Even if you're not looking at an actual image)(Even if you're not looking at an actual image)

Look for:Look for:

• Dark areas under fillings (leaks)
• Thin tooth walls (structural weakness)
• Decay close to the nerve
• Large fillings with cracks

Not accurate indicators:Not accurate indicators:

• Tiny shadows
• Normal bone variations
• Slight tooth overlap
• Minor dark spots near the gumline

These are often misinterpreted.These are often misinterpreted.

Chewing Pain That Needs Urgent Care

You need prompt attention if:You need prompt attention if:

• You see swelling
• You have fever
• Pain is constant and severe
• There is pus or a gum boil
• You can't close your mouth comfortably

These may indicate infection.These may indicate infection.

Chewing Pain That Can Wait

You can usually wait and monitor if:You can usually wait and monitor if:

• Pain only happens occasionally
• It's triggered only by hard foods
• Cold symptoms are short-lived
• No swelling is present

A second opinion is safe in these cases.A second opinion is safe in these cases.

When to Get a Second Opinion for Chewing Pain

You should ALWAYS get another opinion if:You should ALWAYS get another opinion if:

• A root canal was recommended immediately
• Your dentist didn't test your bite
• You weren't shown your X-rays
• You were told "just to be safe"
• You feel pressure to decide quickly
• The symptoms don't match the diagnosis

Chewing pain is very commonly misdiagnosed, so a review by an independent dentist is extremely valuable.Chewing pain is very commonly misdiagnosed, so a review by an independent dentist is extremely valuable.

How ToothCheck Can Help

At ToothCheck, you can send:At ToothCheck, you can send:

• Your symptoms
• Photos
• X-rays
• Prior dentist recommendations

And get:And get:

• Clear explanation
• Correct diagnosis
• Confidence score
• Treatment plan
• Urgency assessment

All within 24 hours.All within 24 hours.

This helps you avoid unnecessary root canals, crowns, or extractions.This helps you avoid unnecessary root canals, crowns, or extractions.

FAQ

Why does my tooth hurt only when I bite down?Why does my tooth hurt only when I bite down?

Usually from a crack, high bite, or loose filling — not nerve infection.Usually from a crack, high bite, or loose filling — not nerve infection.

Can chewing pain go away on its own?Can chewing pain go away on its own?

If it's due to bite or gum issues, yes. If caused by decay or cracks, it may worsen over time.If it's due to bite or gum issues, yes. If caused by decay or cracks, it may worsen over time.

Do I always need a crown for a cracked tooth?Do I always need a crown for a cracked tooth?

No. Many cracks can be repaired with a filling or onlay.No. Many cracks can be repaired with a filling or onlay.

What if chewing pain started after a new filling?What if chewing pain started after a new filling?

It's almost always a high bite — easy to fix.It's almost always a high bite — easy to fix.

What if different dentists gave me different answers?What if different dentists gave me different answers?

Chewing pain is complex and often misread — second opinions are very common.Chewing pain is complex and often misread — second opinions are very common.

Final Advice: Chewing Pain Doesn't Automatically Mean a Root Canal

Chewing pain is a warning sign — but the cause matters, and most causes are treatable without major procedures.Chewing pain is a warning sign — but the cause matters, and most causes are treatable without major procedures.

If something feels off about the diagnosis:If something feels off about the diagnosis:

Upload your X-rays to ToothCheck. Get a fast, unbiased second opinion within 24 hours.Upload your X-rays to ToothCheck. Get a fast, unbiased second opinion within 24 hours.

Clarity saves money, prevents overtreatment, and protects your teeth.Clarity saves money, prevents overtreatment, and protects your teeth.

Need clarity about your dental diagnosis?Need clarity about your dental diagnosis?

Upload your X-rays to ToothCheck and get a verified second opinion within 24 hours.Upload your X-rays to ToothCheck and get a verified second opinion within 24 hours.

Last medically reviewed: January 2025Last medically reviewed: January 2025