The patient presents with a sharp, throbbing pain in a tooth. This pain is often worse when the patient is in a recumbent position. This individual may or may not be aware of a cavity in the affected tooth. Initially, the pain is decreased by heat application and increased by cold application, but as the condition progresses, heat application worsens the pain, whereas application of ice dramatically relieves it. (The patient may arrive with their own cup of ice and may not allow examination unless ice can be kept on the tooth.) Oral examination may reveal dental cavities (caries) or an extensive tooth restoration, without facial or gingival swelling.