Two Rounds of Ear Drops for What Was Actually a Molar

Quick answer: Teeth and ears share nerve pathways, so an upper back tooth can produce pain felt entirely in the ear, and a lower molar can refer up to the temple. If ear drops and antibiotics have not touched an earache in a week, and the ear itself looks normal, the tooth is the first place to look next.

The call

Yael, 39, from Tzur Hadassah, had been to her kupah doctor twice in ten days. The first visit produced ear drops, the second a course of antibiotics. The ear had been examined both times and looked, by her own account, unremarkable — no discharge, no fever, normal hearing.

What eventually brought her to us was her husband's observation that she had stopped chewing on the right side without noticing.

What we found

Her ear was not the problem. The upper right second molar had a deep filling with recurrent decay underneath, no response to cold at all, and marked tenderness to tapping. The x-ray showed a well-defined dark area at the palatal root tip.

The anatomy explains the confusion completely. Sensation from the upper back teeth travels via the maxillary division of the trigeminal nerve; sensation from parts of the ear travels via branches of the same nerve and its neighbours. The brain receives the signal and misattributes the location, because it has no experience of pain arising from inside a tooth root and defaults to a more familiar structure.

Referred dental pain has a recognisable pattern once you know it:

• Upper molars refer to the ear, the cheek and sometimes the temple.
• Lower molars refer to the ear, the angle of the jaw and down the neck.
• Upper canines and premolars refer to below the eye and the side of the nose, which is why they get mistaken for sinusitis.
• Lower front teeth refer to the chin.

The clue that it is dental rather than aural: chewing changes it, hot or cold provokes it, and the ear examination is normal.

What we did

Root canal treatment on the molar, over two visits, and a crown six weeks later. The earache went within three days of the first appointment, before the root canal was even finished, because the pressure at the root tip had been relieved.

We wrote to her family doctor with the diagnosis. That matters — she had been given antibiotics unnecessarily, and the record was worth correcting.

The outcome

No further ear symptoms in two years. The tooth is crowned and comfortable, and the lesion at the root tip healed on the follow-up x-ray.

The cost of the delay was three weeks of pain, two unnecessary prescriptions and a tooth that had drifted from treatable-with-a-filling to needing a root canal.

What to do if this happens to you

1. Press each tooth on that side firmly with a fingernail or a clean pencil end. A tooth that is sore to tap is your answer.
2. Test with cold water. If a specific tooth reproduces the ear pain, that is the source.
3. Notice whether chewing makes it worse. Ear infections do not care what you eat.
4. Ask whether the eardrum actually looked infected. A normal ear examination with persistent pain is a strong hint.
5. See a dentist if a week of ear treatment has changed nothing.
6. Do the reverse too. Jaw pain with normal teeth can come from the ear, the sinuses or the joint. It works both ways.

Earache that nothing is touching? Ramat Beit Shemesh Urgent Dental Care can rule the teeth in or out in one visit. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.