The Many Causes
Jaw pain can be disconcerting for patients. It affects their ability to eat, speak, sleep, and function throughout the day. It can also take a toll on their sense of well-being.
It would be difficult to list all possible causes for jaw pain. However, most of the complaints normally heard in dental offices are caused by conditions that fit into a few broad categories.
Dental
The dentist will begin the evaluation process under the assumption that the cause of a patient’s pain is related to dentition. This would include cracked, decayed, or abscessed teeth, teeth that are overly sensitive because of dentin hypersensitivity, teeth that are damaged as a result of gum disease, or impacted wisdom teeth. If a definite offender can be found, the search might stop here, and treatment can begin.
Depending on the causative factor, the treatment could consist of placing restorations, performing root canal therapy or tooth desensitization procedures, wisdom tooth removal, or the treatment or extraction.
When patients experience a pain in their jaw that does not go away, they should pay close attention to all the symptoms. With a good history, their dentist can usually determine the origin and start taking steps to correct the problem.
Joint/Muscle
Another area the dentist would want to investigate is the jaw joint, or temporomandibular joint (TMJ). Patients who grit, clench, or grind their teeth excessively, who have an uneven bite, are under a great deal of stress, or who have a pathologic condition in the joint itself, such as arthritis or disk displacement, could be suffering from a condition known as temporomandibular joint disorder, or TMD. Its symptoms include an aching jaw, pain on opening and closing, jaw stiffness, and popping or clicking in the jaw. Another condition that can mimic pain in the TMJ and should be considered in the differential diagnosis is ear pain, such as that caused by an ear infection.
The treatment for TMD is usually a multi-pronged approach, which could include measures to lower stress levels, fabricating a bite guard, applying heat and/or cold packs, and dispensing pain medications. If these measures do not work, the dentist might consider referring the patient to a maxillofacial and oral surgeon to evaluate whether surgery on the TMJ is indicated. If the pain is believed to be radiating from the ear, referral to a physician might be the next step.
Jaw Pathology
There are a variety of fluid-filled cysts and other pathological tumors that can form in the jaws and cause pain. These include such entities as dentigerous cysts, odontomas, ameloblastomas, and cancerous lesions. These can sometimes grow aggressively and destroy a large portion of the jaw. A panoramic radiograph is the best way to quickly identify or rule out this source of pain. If a lesion is located, the dentist will want to refer the patient to an oral and maxillofacial surgeon for further evaluation and treatment.
Sinus
The maxillary sinus is located just above the roots of the upper back teeth. When it becomes inflamed or infected, it can cause pain that feels identical to a toothache in an upper molar. A discriminating dentist will be able to distinguish between the two, and if the pain is sinus-related, refer the patient to a physician for treatment of the sinus condition.
Nerve and/or Vascular
This could be any one of a large group of neuralgias arising in the head and neck region that are caused by nerve and/or vascular tissues. Some of these are relatively common, but a few are not. These include such conditions as tension, cluster, or migraine headaches, a type of nerve pain known as trigeminal neuralgia, temporal arteritis, and a host of others. Dentists suspecting any of these conditions may refer patients to a physician for further evaluation.
Referred/Cardiovascular
Problems arising in other parts of the body can present as jaw pain. Pain that is felt in a location other than its point of origin is known as referred pain. Most dentists are aware of this phenomenon and almost always consider it as part of their differential diagnosis if they are unable to establish any other cause for the pain.
One particularly significant type of referred pain to the jaw that is occasionally seen is that which arises during a heart attack. These patients often come to the dentist complaining of pain in the jaw. A dentist who cannot find a dentition-related cause for the pain should suspect that the patient could be having a heart attack. Other possible symptoms the patient might be having include:
- Pain in the left shoulder
- Pressure or tightness in the chest
- Nausea
- Indigestion
- Heartburn
- Shortness of breath and fatigue
- Dizziness or lightheadedness
Especially suspect are those patients who have heart attack risk factors—for example, a middle-aged smoker who is overweight, perhaps diabetic, in poor physical shape, and who has a history of hypertension and/or high cholesterol. In cases such as these, decisive action by an alert dentist could save the patient’s life.
The Road to Relief Begins at the Dental Office
There are many possible causes for jaw pain, and patients cannot always discern what is causing theirs. If it persists, you should schedule a dental appointment. Dentists are highly astute in evaluating the source of head and neck pain, and they are well qualified to treat many of the causes. For those patients they are unable to help, they will refer them to the appropriate dental or medical specialist.
