What does this mean?
Sensation in your face is carried by a single nerve. Its three branches supply the forehead, the upper jaw and the lower jaw separately. Wherever the fibres are irritated, the pain can spread across the whole area that branch serves. This is why the tooth where you feel the pain may not be where the problem is.
What sets this symptom apart from similar ones is how long it lasts. Pain described as lightning-like lasts from a few seconds up to two minutes and then stops completely; between attacks your face feels normal again. It usually starts with touch rather than with heat or cold: washing your face, brushing your teeth, shaving, stepping out into the wind or simply talking can be enough. Pain coming from the nerve inside a tooth, by contrast, gets worse with hot and cold, lasts for minutes and wakes you at night.
How pain is described is not a diagnosis. The same description can be heard in shingles on the face in the days before the rash appears, in a cracked tooth and in facial pain for which no cause is found. Telling these apart takes an examination, X-rays and, where needed, an assessment in neurology. Taking out a sound tooth simply because the pain points to it usually does not stop the pain.
More than one condition can sit behind this description; some start in a tooth, some in a nerve. The headings below are not ranked by likelihood, they show where your dentist looks in order to tell them apart.
Likely causes
What helps at home?
- Note down for a few days how long the pain lasts, how many times a day it comes and what sets it off; that record is more useful at the examination than describing it from memory.
- Do not stop brushing your teeth because it sets the pain off; try a gentler way with a soft brush and warm water, because letting your mouth care slip adds a second problem on top of the first.
- Do not increase your painkiller dose on your own; ordinary painkillers are often not enough for this kind of pain, and a higher dose brings side effects of its own.
- Do not push for the tooth the pain points to be taken out; an extraction done before the source is confirmed cannot be undone.
- If there is also numbness, loss of feeling or loss of strength in the painful area
- If redness, blisters or a rash appear on your face, on your forehead or around your eye
- If the pain comes with a fever, swelling of the face or difficulty opening your mouth
- If the pain started for the first time before the age of forty, or affects both sides of your face at once
- If your vision has become blurred or you have started seeing double
Frequently asked questions
- Could this pain be toothache?
- It could be. A cracked tooth and an inflamed tooth nerve also cause sharp, sudden pain. The difference usually comes out of how long it lasts and what triggers it: pain from a tooth starts with hot and cold, lasts for minutes and gets worse at night. Where the pain lasts only seconds and is set off by touch alone, the teeth may turn out to be sound. The decision is made with an examination and X-rays.
- Nothing showed on my X-ray, so why does the pain carry on?
- An X-ray shows changes in the bone and in the tooth; it does not show the nerve itself. When facial pain carries on although the X-ray is clear, the next place to look is at nerve-related causes. What is needed at that point is not another dental procedure, but an assessment in neurology.
- Should I see a dentist or a neurologist?
- Seeing a dentist first makes sense; if there is a dental cause, that is where it shows up quickest. If nothing dental is found, the rest of the assessment belongs in neurology. Diagnosis and any decision about medication are neurology's field; what the dentist adds is stopping an unnecessary procedure and pointing you to the right place.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.