What Causes Tooth Pain That Comes and Goes?

Quick Answer

If your tooth hurts occasionally but then feels normal, possible causes include:

• Early tooth decay
• A cracked tooth
• Teeth grinding (bruxism)
• Gum recession
• Tooth sensitivity
• Bite problems
• Sinus pressure
• A developing tooth infection

If pain lasts more than 24–48 hours, keeps returning, or is accompanied by swelling or fever, schedule a dental evaluation right away.

To get answers related to your situation, schedule an appointment at Denver Smiles. This blog has been clinically reviewed by Dr. Hana Rugova, DDS, MSc, PhD, head doctor of Denver Smiles. Dr. Rugova provides direct patient care in comprehensive restorative dentistry, cosmetic dentistry, dental implants, and emergency dental care. She uses advanced diagnostic imaging and evidence-based treatment to identify the underlying causes of tooth pain and help patients preserve their natural teeth whenever possible.

What Causes Tooth Pain That Comes and Goes?

Tooth pain that comes and goes is usually a sign that something is irritating the tooth or surrounding tissues, even if the discomfort temporarily disappears. Common causes include tooth decay, cracked teeth, microscopic cracks, worn enamel, exposed roots, bite-related stress, sinus pressure, or an infection affecting the dental pulp. Because these problems usually do not resolve on their own, recurring tooth pain should be evaluated by a dentist. Once the irritation is removed, the sensation may disappear.

This pattern explains what causes intermittent tooth pain in many cases. The tooth may react only under certain circumstances, even though the underlying problem remains present.

Common Causes of Tooth Pain That Comes and Goes

Early Tooth Decay

Many people are surprised to learn that a cavity doesn’t always cause constant pain. In its early stages, tooth decay may only affect the outer layer of the tooth, causing occasional sensitivity to sweets, hot or cold foods, or cold drinks. Because the discomfort comes and goes, it’s easy to ignore until the cavity becomes larger and more painful. According to the CDC, nearly 90% of adults have had at least one cavity, making tooth decay one of the most common causes of intermittent tooth pain.

Think of an early cavity like a bruise on an apple. The apple may still look and feel fine, but the bruised area is weaker and more vulnerable to further damage. An early cavity works the same way—the tooth may seem normal most of the time, but the weakened area is more sensitive and can continue to break down if left untreated. Catching a cavity early often means simpler, less invasive treatment and a better chance of preserving healthy tooth structure.

Cracked Teeth

Small cracks in a tooth—known as incomplete tooth fractures—can be difficult to detect without a thorough dental examination. These fractures have an unknown depth and direction and may eventually extend into the tooth’s pulp (nerve) or the surrounding periodontal ligament if left untreated.

Cracked tooth syndrome has a multifactorial cause. It can develop when excessive biting forces are applied to a healthy tooth or when normal chewing forces act on a tooth that has been weakened by large fillings, wear, or previous dental treatment. Because chewing involves constantly changing pressure and angles, the crack may flex only under certain conditions, irritating the nerve and causing pain. Once the pressure is released, the tooth often feels normal again, making the discomfort seem to come and go.

Symptoms vary depending on the location and severity of the crack, but patients commonly report brief, sharp pain when biting, sensitivity to cold foods or drinks, or a sudden “rebound pain” when biting pressure is released. Some people also experience discomfort when chewing fibrous or sugary foods or while grinding their teeth. Since these symptoms can be difficult to reproduce during an exam, identifying the exact tooth is not always straightforward. As the crack progresses, bacteria can enter the tooth, leading to inflammation of the dental pulp and, in more advanced cases, infection or periodontal complications.

The American Association of Endodontists notes that cracked teeth and inflamed dental pulp often cause intermittent pain in the early stages before symptoms become more frequent or constant.

Teeth Grinding and Clenching

Grinding places repeated stress on the teeth and supporting structures.

Over time, this pressure can irritate the periodontal ligament surrounding the tooth root, leading to soreness that may seem inconsistent throughout the day. This pain will tend to feel more like a temporary low grade throbbing. About 25% of people clench and grind their teeth, 80% of this group don’t even realize they do it.

Gum Recession

Gum recession exposes the tooth’s root surface, which is much more sensitive than enamel. As a result, hot, cold, sweet, or acidic foods and drinks can trigger a sudden, sharp pain or temporary throbbing that quickly fades. Because the sensitivity is occasional, many people assume it’s nothing serious.

Common causes of gum recession include aggressive brushing, excessive biting or grinding forces, and gum disease. Since the root remains exposed, sensitivity can return whenever it is triggered, making gum recession one of the most common reasons tooth pain comes and goes.

Sinus Pressure

The upper back teeth sit very close to the maxillary sinuses, separated by only a thin layer of bone. In some people, the roots even extend into the sinus cavity. Because of this close connection, pain can travel in either direction.

Inflammation from allergies, a cold, or a sinus infection can create pressure that feels like a toothache, often affecting several upper teeth at the same time. Likewise, dental problems such as tooth abscesses, advanced gum disease, infected cysts, or procedures like extractions, implants, and sinus lifts can spread infection into the sinus and cause odontogenic (tooth-related) maxillary sinusitis.

Signs Your Tooth Pain May Be Serious

A recurring toothache does not always indicate an emergency, but some symptoms deserve prompt attention.

Watch for:

• Swelling in the gums, face, or jaw
• Fever
• A bad taste or drainage near a tooth
• Lingering sensitivity after the trigger is gone
• Persistent throbbing
• Difficulty chewing
• Pain that interrupts sleep

These may be signs of tooth infection or another condition that requires timely care.

If swelling or severe pain develops, emergency dentistry services may be appropriate.

Tooth Sensitivity vs Tooth Infection: What’s the Difference?

Although both conditions can cause discomfort, they develop for different reasons.

 Some patients with tooth nerve pain symptoms are unsure whether they are dealing with sensitivity or infection. A clinical examination is often needed to identify the source of the problem.

How Dentists Diagnose Intermittent Tooth Pain

Intermittent pain can be challenging because the tooth may feel normal during the appointment.
Digital X-rays and diagnostic testing help identify hidden concerns that may not be visible during a routine visual examination.

A dentist may evaluate:

• Existing restorations
• Bite alignment
• Areas of enamel wear
• Cracks and fractures
• Gum health
• Nerve response

At Denver Smiles, Dr. Rugova uses digital radiographs, intraoral imaging, 3-D imaging (CBCT), comprehensive clinical examinations, bite analysis, and pulp vitality testing to determine why tooth pain occurs—even when symptoms are intermittent. Patients often discover that recurring pain is linked to a condition that can be addressed before it becomes more advanced.

Treatment Options for Tooth Pain That Comes and Goes

The most effective treatment for tooth pain that comes and goes depends on what is creating the irritation.

Treatment may include:

• Deep Cleaning
• Dental Fillings
• Dental Crowns
• Night Guard
• Gum treatment
• Bite adjustment
• Desensitizing treatments
• If decay or infection extends into the center of the tooth, a root canal may be recommended to remove the damaged tissue.
• Laser treatment
• Prescription medications
• Product recommendations
• General Dentistry

Temporary Ways to Relieve Tooth Pain at Home

While waiting for an appointment, some people find short-term relief by:

• Rinsing with warm salt water
• Avoiding foods that trigger sensitivity
• Using a soft-bristled toothbrush to keep the tooth clean and reduce irritants that are present
• Taking over-the-counter pain medication
• Avoiding chewing on the affected side

While these steps can help you feel more comfortable for a short time, they will not resolve the problem affecting the tooth.

When Should You See a Dentist?

If the same tooth repeatedly becomes painful, it is worth investigating.

A recurring pattern often indicates that the tooth is responding to an ongoing issue rather than a one-time event. Delaying an evaluation may allow a manageable problem to become more complex over time.

If you are looking for a dentist in Lakewood, at Denver Smiles an examination can help determine whether the source of the pain involves the tooth, surrounding tissues, bite forces, or another contributing factor.

Don’t Ignore a Toothache That Keeps Returning

Even when discomfort disappears between episodes, the underlying condition may continue to progress. Paying attention to recurring changes in sensation, temperature sensitivity, or chewing discomfort can help prevent more significant dental problems in the future.

At Denver Smiles, care begins by identifying the source of recurring tooth pain and discussing treatment options tailored to each patient’s needs and oral health findings. Whenever possible, Dr. Hana Rugova focuses on preserving natural teeth through early diagnosis and restorative treatment. However, if a tooth cannot be saved because of extensive decay or fracture, she also has expertise in dental implant placement to restore function and appearance.