Throbbing Tooth Pain but Dentist Finds Nothing: Sinus Toothache vs Nerve Pain vs Jaw Muscle Trigger Points

A throbbing toothache usually sends you straight to the dentist—and most of the time, that’s the right call. Cavities, cracked teeth, gum infection, and abscesses are common and can worsen quickly if ignored. But sometimes you get the most frustrating outcome: your dentist examines you, taps the tooth, checks the gums, reviews X-rays, and says, “I don’t see anything wrong.”

Yet the pain is still there—pulsing, radiating, sometimes waking you at night, sometimes feeling like it’s deep in the tooth root. When dental testing is normal, it often means the pain is non-dental tooth pain (also called non-odontogenic dental pain): pain that feels like it comes from a tooth, but the true source is somewhere else—often the sinuses, facial nerves, or jaw muscles.

This article breaks down the three big culprits behind “tooth pain with nothing found”:

1. Sinus toothache (referred pain from maxillary sinus inflammation)
2. Nerve pain that mimics toothache (especially trigeminal neuralgia and related nerve pain patterns)
3. Jaw muscle trigger points (myofascial pain referral from chewing muscles)

You’ll also get practical self-checks, the right questions to ask, and clear red flags that need urgent care.

Before you assume it’s sinus- or nerve-related, confirm the basics were truly checked:

• Dental X-rays were adequate (sometimes a small crack, early decay between teeth, or a subtle root issue may not show clearly on a single view).
• Your dentist tested for cracked tooth pain (bite test), gum pockets, and cold/heat response.
• The pain isn’t coming from a recent filling, crown, or bite change (even a “high bite” can trigger pain in the periodontal ligament and jaw muscles).
• If the pain persists, ask whether a cone-beam computed tomography scan is indicated (commonly used when a crack, root issue, or sinus/dental overlap is suspected—your clinician decides based on exam).

If your dentist is confident there’s no dental source—or you’ve had repeat normal exams—then you’re in the zone where sinus, nerve, and muscle causes rise to the top.

A classic dental problem often feels localized to one specific tooth (even if it radiates). Non-dental tooth pain often feels like:

• multiple teeth ache together (especially upper back teeth), or
• the “tooth” keeps changing (one day it’s the first molar, next day it’s the premolar), or
• the pain spreads to cheek, temple, ear, or jaw.

That pattern doesn’t guarantee anything, but it’s a helpful compass.

Your upper back teeth sit close to the maxillary sinuses (air-filled spaces behind the cheekbones). When the sinus lining becomes inflamed—after a cold, allergies, or sinus infection—the pressure and inflammation can be perceived as pain in the roots of upper teeth, even if those teeth are healthy.

Sinus toothache is commonly described as:

• dull, throbbing, pressure-like ache
• often affecting upper molars or premolars, sometimes more than one tooth
• worse with bending forward, sudden head movement, or position changes (pressure shift)
• accompanied by sinus symptoms (not always, but often)

A widely reported tell is: pain increases when you bend over or move your head quickly. ^{[1] [2]}

• nasal congestion, thick nasal discharge, post-nasal drip
• facial pressure under the eyes or in the cheeks
• reduced sense of smell
• pain that worsens during allergies or after an upper respiratory infection
• tenderness over the cheekbone area

Important nuance: you can have sinus inflammation from allergies or viral illness without a bacterial infection—so not every sinus toothache needs antibiotics.

Try these gently:

• Lean-forward test: does the toothache/pressure intensify when you bend forward for 30–60 seconds?
• Cheek pressure test: mild pressure over the cheek/sinus area increases discomfort?
• Multiple upper teeth: more than one upper tooth feels “sore” rather than one pinpoint tooth?

Sometimes it’s the other way around: a hidden dental infection can irritate the sinus. That’s why it’s valuable that you already had a dental exam—because clinicians often need to determine “sinusitis, dental infection, or both.” ^[1]

If your pain is sharp, sudden, electric, triggered by light touch—or seems wildly out of proportion to dental findings—think nerve pain.

The trigeminal nerve carries sensation from your face, teeth, and jaw to your brain. When it misfires, compresses, or becomes sensitized, the brain may interpret the signal as tooth pain even when the tooth is fine.

Trigeminal neuralgia classically causes:

• sudden, severe, electric shock-like jolts
• typically on one side of the face
• triggered by activities like brushing teeth, chewing, talking, shaving, or even light touch

Because triggers often involve the mouth, many people first suspect a tooth problem and may undergo dental procedures that don’t help—until a correct neurologic diagnosis is made. ^[4]

• brief bursts (seconds to minutes), sometimes repeated in clusters
• clear triggers (touch, wind, brushing, chewing)
• a “lightning” or stabbing quality more than a heavy pressure
• pain that can jump locations along the face/jaw

Not all nerve-related facial pain is classic trigeminal neuralgia. There are other neuropathic pain patterns and persistent idiopathic tooth pain syndromes described in the medical literature. ^[8]

If your symptoms match nerve-type triggers or electric-shock pain, consider:

• asking your dentist for referral to an orofacial pain specialist or neurologist
• keeping a trigger diary: brushing, chewing, cold air, talking, touching cheek
• avoiding unnecessary repeat dental work until nerve pain is evaluated

A surprisingly common cause of tooth pain with normal dental findings is myofascial pain—pain arising from tight, irritated jaw muscles with “trigger points” that refer pain to nearby areas, including teeth.

Trigger points are hyperirritable spots in muscle that can:

• hurt locally when pressed
• refer pain to distant locations in predictable patterns

In the chewing system, the key muscles are the masseter, temporalis, and pterygoid muscles.

• deep ache or throbbing that feels “in the tooth”
• soreness that increases after chewing, talking a lot, or clenching
• morning jaw tightness (often from sleep clenching or grinding)
• pain that spreads to ear, temple, cheek, or neck
• sensitivity that feels widespread rather than pinpoint

A key clue: the tooth hurts, but pressing a jaw muscle reproduces the tooth pain.

Wash hands, be gentle, and try:

• Press the masseter: place fingers on the cheek about halfway between the cheekbone and jawline; clench lightly to feel the muscle bulge; then relax and press slowly.
• Press the temporalis: at the temples, above the cheekbone, along the hairline area.

If pressing these spots recreates your “toothache,” that strongly suggests muscle referral (not proof, but a meaningful clue). Case literature describes tooth pain referral patterns from the masseter and related muscles.

Dental exams are excellent at finding tooth and gum pathology, but trigger points are a musculoskeletal problem, not a tooth problem. Unless the dentist specifically evaluates jaw muscles and bite function, the exam can look “normal.”

Common drivers include:

• stress-related clenching (awake or during sleep)
• prolonged gum chewing
• long dental appointments (jaw held open)
• poor posture (forward head posture increases jaw muscle load)
• bite changes from new dental work (sometimes temporary, sometimes needs adjustment)
• temporomandibular joint disorder (jaw joint and muscle pain conditions)

In temporomandibular joint disorder evaluations, clinicians look for muscle tenderness, jaw movement limits, joint noises, and referral patterns.

If red flags aren’t present (see below), conservative measures often help:

• Soft diet for a short period (reduce heavy chewing)
• Warm compresses over jaw muscles
• Gentle jaw stretching (stop if sharp pain)
• Stress and clench awareness (lips together, teeth apart, tongue resting on palate)
• Night guard if your dentist suspects sleep grinding
• Physical therapy focused on jaw/neck mechanics
• Trigger point–directed treatments by trained clinicians (some case discussions describe diagnostic relief when trigger points are treated).

• Upper back tooth/teeth ache with facial pressure
• Worse bending forward or with head position changes
• Recent cold, allergy flare, congestion, post-nasal drip

• Electric shock or stabbing bursts
• Clear triggers like brushing, touching face, talking
• Severe pain with normal dental tests, sometimes with pain-free gaps

• Ache after chewing, jaw fatigue, morning tightness
• Headaches at temples, ear fullness, jaw clicking
• Pressing masseter/temporalis reproduces the tooth pain

Even if the tooth looks fine, do not ignore serious warning signs. Seek urgent dental/medical care if you have:

• fever, spreading facial swelling, or worsening swelling
• difficulty swallowing, drooling, trouble breathing
• severe limitation in opening the mouth (trismus)
• numbness, facial weakness, or other neurologic changes
• unexplained weight loss, persistent and worsening pain, or neck/facial asymmetry

Specialist-oriented red flag lists for temporomandibular joint disorder emphasize persistent/worsening pain, trismus, cranial nerve abnormalities, neurologic dysfunction, systemic illness, and asymmetrical swelling as reasons for referral/escalation.

Consider primary care or ear-nose-throat evaluation, especially if symptoms are persistent or recurrent. Ask:

• “Could this be maxillary sinus inflammation causing referred tooth pain?”
• “Do my symptoms fit viral sinus inflammation, allergy-related inflammation, or bacterial sinusitis?”
• “Is imaging or specialist referral appropriate if this keeps recurring?”

Helpful background reading: ^[1]

Ask your dentist for referral to an orofacial pain specialist or neurologist. Ask:

• “Does this pattern fit trigeminal neuralgia or another neuropathic facial pain condition?”
• “What evaluation is appropriate before any more dental procedures?”

Authoritative overview: ^[4]

Ask about temporomandibular joint disorder / jaw muscle evaluation and conservative management. Ask:

• “Can you check for jaw muscle tenderness and trigger points that refer pain to teeth?”
• “Would a night guard help if clenching or grinding is suspected?”
• “Should I see a physical therapist who treats jaw and neck mechanics?”

Clinical overview on temporomandibular joint disorder and referral red flags: ^[5]

People often assume throbbing equals infection. But throbbing can also happen when:

• inflammation in sinuses increases pressure rhythms
• muscles develop sustained tightness and pain sensitization
• nerves fire abnormally (the brain can interpret neuropathic signals as pulsating)

So “throbbing” is a pain quality—not a diagnosis.

• Don’t keep repeating antibiotics without clear signs of bacterial infection.
• Don’t jump into root canal therapy when the tooth tests normal and multiple clinicians see no pathology—this can lead to unnecessary procedures if the source is nerve or muscle.
• Don’t ignore jaw habits (clenching, grinding, posture). These are fixable drivers.

If pain is persistent, the goal is to identify the pain generator (sinus, nerve, muscle, joint, or something else) and treat that system.

• A normal dental exam doesn’t mean the pain is imaginary—it often means the pain is referred or neurologic.
• Sinus toothache often affects upper back teeth and worsens with bending forward or head position changes.
• Trigeminal neuralgia and other nerve pain can feel like severe dental pain and is often triggered by touch, brushing, or chewing.
• Jaw muscle trigger points commonly refer pain to teeth and can be reproduced by pressing masseter or temporalis muscles.
• Watch for red flags (fever, swelling, neurologic symptoms, trismus, worsening pain) and escalate quickly when present.

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