Tooth pain when biting but your X ray looks normal: what it could be
It is frustrating when biting on a tooth hurts, but the X ray shows nothing obvious. The good news is that this is common and often treatable. The key is finding the cause, because some problems hide between teeth, sit in the ligament around the tooth, or only show up under certain bite pressure.
If you have swelling, fever, a bad taste, or pain that wakes you at night, do not wait. Use our emergency dentistry route or contact the practice for advice.
Quick answer
Tooth pain when biting with a normal looking X ray is often caused by a bite that is slightly high, a tiny crack that is hard to see, inflammation in the ligament around the tooth, or irritation under an old filling. These issues can be invisible on routine X rays, so dentists use bite tests, cold tests, tapping, and sometimes 3D imaging to pinpoint the problem.
- If it hurts on release when you stop biting, think possible crack.
- If it hurts on one specific spot, think bite interference or a single cusp issue.
- If it is tender to tap and feels bruised, think ligament inflammation.
Why an X ray can look normal even when something is wrong
Dental X rays are excellent for spotting decay between teeth, infections around roots, and bone changes. But not every problem shows clearly, especially early on. Pain can come from:
- Pressure and micro movement in the ligament that holds the tooth in place
- Small cracks that run in directions X rays do not capture well
- Inflammation inside the tooth before an infection forms
- A slightly high bite after a filling
That is why a proper assessment matters. If you are due a review, start with dental check ups and cleaning so we can test the tooth properly and check your bite.
Most common causes of biting pain with a normal X ray
1) High bite after a filling
Even a tiny high spot can overload one tooth and cause sharp pain when you bite. It often starts soon after a new filling or crown, and the tooth can feel bruised.
Related treatment options may include adjusting the bite, or reviewing your restoration via dental fillings or a restoration check.
2) Cracked tooth syndrome
Small cracks can cause pain on biting, especially when you release pressure. The crack may be invisible on an X ray and even hard to see clinically without special tests.
Early stabilisation can reduce symptoms and protect the tooth from worsening. Sometimes a protective dental crown is recommended depending on the crack location and tooth strength.
3) Inflamed ligament (periodontal ligament bruise)
Grinding, clenching, or chewing something hard can inflame the ligament around a tooth. The tooth may feel taller or tender when tapping.
A night guard, bite balancing, and reducing overload are common approaches, especially if you also have jaw tension.
4) Early pulp inflammation
The nerve inside the tooth can become inflamed from deep decay, repeated dental work, cracks, or trauma. Pain might be triggered by biting, and it can progress to heat or cold sensitivity.
If tests show the nerve is not recovering, root canal treatment can save the tooth.
5) Gum pocket or trapped food
A deep gum pocket or food trapped between teeth can mimic biting pain. This may come with bleeding gums, a bad taste, or tenderness when flossing.
Hygiene advice and professional cleaning can make a big difference, so a review with check ups and cleaning is usually the starting point.
6) Sinus and referred pain
Upper back teeth can ache during sinus congestion and feel sore on pressure. The tooth itself may be healthy, but the sensation can be confusing.
A dentist can help rule out tooth causes first before you assume it is sinus related.
Quick self check at home (no special tools)
- Pain on release? Often points toward a crack or cusp issue.
- Pain only on one side when chewing? Think high bite or one tooth overload.
- Pain with a bad taste or swelling? Think infection or gum pocket, get checked.
- Pain after a new filling? High bite is common and easy to adjust.
What to do today (safe steps)
- Avoid chewing on that side to prevent worsening irritation or cracking.
- Choose softer foods and avoid hard crusts, nuts, ice, and sticky sweets.
- Keep hygiene gentle but thorough including careful flossing to remove trapped food.
- Note patterns: pain on release, cold sensitivity, night pain, or a high feeling tooth.
- Book an assessment so we can test the tooth and your bite properly.
If you feel anxious about dental visits, our team is experienced with nervous dental patients. Tell us what worries you and we will take it step by step.
When it is urgent
Please treat this as urgent and seek advice quickly if you notice any of the following:
- Swelling of the face, gum, or jaw
- Fever, feeling unwell, or a spreading infection taste or smell
- Difficulty swallowing or breathing
- Severe pain that wakes you at night or does not settle
- A tooth that feels loose after trauma
Use our emergency dentistry guidance, especially if symptoms are escalating.
How dentists find the cause when X rays look normal
A targeted exam is usually more useful than repeating the same X ray. Common checks include:
| Test | What it helps identify | What you might feel |
|---|---|---|
| Bite test (on a small tool) | Cracks, cusp fractures, localised biting pain | Pain on biting or on release |
| Tapping and pressure | Ligament inflammation, early root issues | Bruised or tender feeling |
| Cold test | Nerve inflammation, pulp health | Short sharp response or lingering ache |
| Bite check (articulation paper) | High bite points after fillings | Pain only on one contact point |
| Gum probing | Pockets, localised gum issues, some crack patterns | Tender spots or bleeding |
| 3D imaging (if needed) | Hidden cracks, root issues, complex cases | Usually no discomfort, depends on case |
If we find an old restoration is part of the problem, you may need a repair or replacement through dental fillings, or protection with a dental crown, depending on how much tooth structure is at risk.
Treatment options (what usually fixes it)
Treatment depends on the cause. Many cases are straightforward once diagnosed. Here are common paths:
- High bite adjustment: quick, often immediate relief if a filling is high.
- Stabilising a cracked tooth: bonding, onlay, or crown to protect the tooth.
- Replacing or reshaping a restoration: if a filling is leaking or biting pressure is uneven.
- Night guard: if clenching or grinding is overloading the tooth.
- Root canal treatment: if nerve inflammation is irreversible and the tooth can be saved.
If biting pain is linked to broader bite issues, we may also discuss orthodontic options such as Invisalign for alignment and long term stability.
FAQs
Can a tooth be cracked if the X ray looks normal?
Yes. Small cracks can be hard to see on standard X rays, especially if they run in a direction the image does not capture. A bite test and close inspection usually help identify it.
Why does it hurt more when I release my bite?
Pain on release can happen when a tooth flexes slightly, which can occur with cracked tooth syndrome or a weakened cusp. It is a useful clue for diagnosis.
Could it just be a high filling?
Very possibly, especially if symptoms started after recent dental work. A minor bite adjustment can relieve pressure and let the ligament settle.
How long should I wait before booking in?
If biting pain lasts more than a couple of days, or is getting worse, book an assessment. If you have swelling, fever, or severe pain, treat it as urgent and use our emergency pathway.
Will I need a root canal?
Not always. Many biting pain cases are bite related or crack related and can be managed without root canal treatment. If tests show the nerve is not recovering, a root canal may be the best way to save the tooth.