Use article in phrase "very bad tooth ache"

[English-test.net]

Could you please clarify an answer in Test 2
Elementary Incomplete Sentences?

Question 8 out of 10 I cannot work today because I have very bad tooth ......

(a) pain
(b) hurt
(c) damage
(d) ache

If the sentence read "I cannot work today because I have a very bad tooth .....," then I would agree that 'ache' is the correct answer. Since the word 'a' is not included, 'ache' does not sound correct.

Elizabeth Adams

[English-test.net]

Hi Elizabeth,

Thank you for your question and for showing interest in our tests. In the particular test you refer to, the choice of ache is clearly the correct one since the other words do not link naturally with tooth. The use or not of the article 'a' before the qualified noun in the sentence is I believe a matter of choice rather than a matter of correctness. If you use 'a' you are referring to pain in one particular tooth but if you omit it, you are referring to more general pain in your 'tooth area'.. Both are acceptable. Interestingly I believe you would have to say 'a very bad headache' as clearly you have only one head!

Best wishes

Alan Townend

[Mejcej]

Hi Alan,

I just want to say a big thank-you for such a comprehensive explanation.
Well done, I have just filled another gap in my understanding of English.
Articles have been my nightmare for the last two years and I still can't get them right.
I am only slowly beginning to understand the way "they work". Analyses like the one
of yours help me immensely to get closer.
Thanks

[Prezbucky]

I think that without "a", the most correct answer is "pain".

I have a toothache.

vs.

I have toothache.

http://dictionary.reference.com/browse/toothache

Perhaps both are acceptable... I see that at the bottom of that web page (hyperlink), a sample sentence -- sans article -- has been provided.

Egads!
_________________
Billie Jean is not my lover. Hee.

[Prezbucky]

Here we see it with and without an article:
-----------------------

What is a toothache?

"Toothache" usually refers to pain around the teeth or jaws. In most instances, toothaches are caused by tooth or jaw problems, such as a dental cavity, a cracked tooth, an exposed tooth root, gum disease, disease of the jaw joint (temporo- mandibular joint), or spasms of the muscles used for chewing. The severity of a toothache can range from chronic and mild to sharp and excruciating. The pain may be aggravated by chewing or by cold or heat. A thorough oral examination, which includes dental x-rays, can help determine the cause, whether the toothache is coming from a tooth or jaw problem.

...from http://www.medicinenet.com/toothache/article.htm

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This reminded me that in the case of the plural (toothaches), there are clear cases in which an article is added, and when it is left out:

"I hate toothaches."

"The toothaches were driving me crazy!"
_________________
Billie Jean is not my lover. Hee.