Diagnostic examination
We test each suspect tooth with a bite stick cusp by cusp, apply cold, check for cracks with a dye and a bright light, probe the gum and take an X-ray. Finding the right tooth is the whole battle.
About this treatmentDental condition · Wimpole Street, Marylebone
Pain when biting: reading the pattern to find the tooth and the cause
A tooth that hurts only when you bite on it is giving you a specific piece of information: something around or inside it is being loaded in a way it cannot tolerate. The rest of the time it may feel entirely normal, which is why people often put up with it for months, chewing on the other side and hoping it resolves. The pattern of the pain tells us a great deal. A sharp jab on biting that stops the moment you release usually points to a crack or a filling that is flexing. Pain on releasing the bite rather than closing is almost diagnostic of a crack. A dull, bruised feeling on every contact suggests the ligament around the root is inflamed, whether from a high filling, an infection at the root tip or overload from grinding. Tenderness on biting alongside a swollen gum points to a gum abscess or a wisdom tooth. At Wimpole Street we work through these systematically, tooth by tooth, cusp by cusp, because the treatment for each is different and the wrong one does not help.
Recognising it
How it usually feels
A sharp pain on biting that vanishes as soon as you release
Typical of a crack or a filling that flexes under load.
Pain on letting go rather than on closing
The two halves of a cracked tooth spring back together; a strong pointer to a crack.
A bruised, tender feeling on every contact
Inflamed ligament around the root from overload or infection.
Pain only with certain foods
Grainy bread, seeds and fibrous meat find the exact spot; soft food does not.
A tooth that feels taller than the others
Ligament inflammation lifts the tooth slightly, so it meets first.
Tenderness with swelling or a bad taste
An abscess at the root tip or in the gum pocket beside the tooth.
Behind the symptoms
What's going on
- 01
A cracked tooth
Large fillings, grinding and chewing hard objects leave molars prone to hairline cracks that flex on biting and pinch the nerve. The crack is often invisible on an X-ray and on the surface, which is why the pattern of pain is so important in finding it.
- 02
A high filling or crown
A restoration standing slightly above the surrounding teeth takes the first hit on every closure. The ligament around the root becomes bruised and the tooth aches on biting until the surface is adjusted.
- 03
Infection at the root tip
A tooth whose nerve has died develops inflammation in the bone beneath the root. Pressure on the tooth compresses this inflamed area, so biting hurts even though the tooth itself no longer feels cold or hot.
- 04
A loose or failing filling
A filling that has debonded or has decay beneath it moves slightly under load. The movement irritates the dentine and lets fluid shift within the tooth, producing a sharp twinge.
- 05
Gum abscess or food packing
A periodontal pocket that has become infected, or a wedge of food trapped between two teeth, inflames the gum and ligament so that the tooth is tender to press on. The gum is usually visibly swollen or bleeds when probed.
- 06
Bruxism and overload
Clenching or grinding, particularly at night, bruises the ligaments of several teeth, so that a number of them feel tender in the morning. A single tooth can be overloaded if it takes more than its share of the bite.
Before your appointment
What you can do today
- Chew on the other side and avoid hard, crunchy or seeded foods until the tooth has been examined.
- Take an anti-inflammatory such as ibuprofen as directed on the pack, if suitable for you, since ligament inflammation responds well to it.
- Floss gently between the sore tooth and its neighbours in case a food fragment is wedged there.
- Notice whether the pain is on closing or on releasing, and which foods trigger it; this shortens the diagnosis.
- If you wake with several tender teeth, you may be grinding; wear any night guard you already have.
- Do not chew ice, pens or nuts on the affected side while waiting to be seen.
These are holding measures, not a substitute for an examination. Use any pain relief exactly as directed on the pack and check with a pharmacist if you take other medicines.
In the chair
How we treat it at Wimpole Street
Bite adjustment
A high filling or crown is marked and polished so that the tooth meets evenly with its neighbours. The ligament then recovers over a few days.
About this treatmentOnlay or crown for a cracked tooth
A crack is stopped from propagating by binding the tooth together with a bonded onlay or a crown. Done early, most cracked teeth keep a healthy nerve.
About this treatmentReplacing a failing filling
A loose or leaking filling is removed, any decay beneath it cleared, and a new bonded filling placed. If the remaining tooth is thin, an onlay may be recommended instead.
About this treatmentRoot canal treatment
When the nerve has died and infection at the root tip is causing the tenderness, the canal system is cleaned and sealed. Biting pain typically eases within days of the first visit.
About this treatmentGum treatment
An infected pocket is cleaned and drained, packed food removed and the tooth contact reshaped if it is trapping debris. Persistent pockets are treated as part of a periodontal programme.
About this treatmentFees
Costs to expect
An examination at Wimpole Street with the bite tests and X-rays needed to trace biting pain is expected to be £95. A bite adjustment made at that visit is usually included. Replacing a failing filling is from £185, and an onlay or crown to protect a cracked tooth is £995.
Root canal treatment is around £695 for a front tooth or £895 for a molar, typically followed by a crown on back teeth. Treatment of a gum abscess is quoted at the visit, with a periodontal course from £850 if deeper pockets are found. A night guard is £795. Extraction, if a crack runs below the gum and the tooth cannot be saved, is from £250, with replacement options discussed afterwards.
Figures are indicative prices for Wimpole Street and are confirmed in a written plan once a dentist has examined you. Fees match our South Kensington and St Paul's clinics.
Don't wait if
When to see a dentist
- Pain on biting has lasted more than a week or is getting worse.
- The pain is sharp on releasing the bite; this strongly suggests a crack.
- A tooth feels taller than the others or the bite feels different.
- The gum beside the tooth is swollen, bleeding or producing a bad taste.
- Several teeth are tender in the morning.
- A filling or crown was placed recently and the tooth has not settled.
FAQ
Common questions
Because cracks are often invisible, X-rays show cracks only when they have separated the tooth, and the pain from one tooth is frequently felt in another. The bite-stick test, where you bite on a small plastic wedge one cusp at a time, reproduces the pain precisely and is how the tooth and even the cusp are identified.
No. Enamel and dentine do not knit back together, and every bite flexes the crack a little further. Left alone, a crack that is causing pain on biting tends to progress towards the nerve or down the root. Protecting the tooth with an onlay or crown while the nerve is still healthy is the way to keep it.
Tenderness to pressure without any cold response often means the nerve has already died and the problem has moved to the bone around the root tip. An X-ray usually confirms it, and root canal treatment is the way to resolve both the infection and the biting pain.
Yes. Hours of clenching overnight bruise the ligaments of the teeth that take the load, so they feel tender to bite on in the morning and ease through the day. Several teeth being sore at once, especially with jaw muscle stiffness, points to this rather than to a single tooth problem.
Marylebone, W1
Wimpole Street opens 1 October 2026
Leave your details and we will be in touch when the Marylebone diary opens. If the problem cannot wait, the same clinicians are already seeing patients in South Kensington and at St Paul's.
Opening 1 October 2026
Wimpole Street is not yet seeing patients. Until then, please book or call our South Kensington clinic on 020 7183 2362 or our St Paul's clinic on 020 7183 3709. Questions about the new clinic: wimpolestreet@md.co.uk.
Until we open
Need an appointment before 1 October 2026?
The same clinical team already works from two other Medical & Dental clinics. Book at either one now and, if you prefer, move your ongoing care to Wimpole Street once the doors open.
South Kensington
- 20 Old Brompton Road, London SW7 3DL
- Open seven days a week
- 020 7183 2362
St Paul's, City of London
- 5 Ave Maria Lane, London EC4M 7AQ
- Open Monday to Friday
- 020 7183 3709
