“My Jaw Pain is Killing Me”
– 10 Causes … Treatment Options –

Dr. Al Danenberg Nutritional Periodontist

February 13, 2022

Have you ever experienced jaw pain? It is estimated that up to 80% of people have experienced some type of jaw or tooth pain at some point in their lives. So, if you haven’t experienced it firsthand, there’s a good chance you will.

Today, we’re going to look at some of the causes, treatment options, and how you can be proactive to avoid this unpleasant experience all together!

On July 3, 2016, I published a Blog about Monique. She was a patient I saw in 2015. She was one of many patients I treated for similar symptoms. She entered my office saying, “My jaw pain is killing me.”

Another patient I treated in 2018 had similar symptoms but they were much more serious. Jonathan had a root canal procedure performed on his upper right molar about 3 months before I saw him. His general dentist performed the root canal and also placed a crown on that tooth. Then, Jonathan began to have severe pain in that tooth, in his jaw muscles, and in his jaw joint.

At first, Jonathan thought that the root canal was failing and was the cause of his pain. That was part of his problem. The other immediate cause was related to his biting pressure on that newly crowned tooth, which Jonathan didn’t consider.

When I saw him on an emergency visit, I needed to get him out of pain. I also had to determine a definitive treatment plant to resolve his issue for good. I treated the emergency problem that day; the other was definitively treated later in the week.

 

What Is Jaw Pain?

As a periodontist, I frequently treated jaw pain.[1] Most pain comes from the jaw joint and the muscles that help chew food. This jaw pain may be called TMJ (temporomandibular joint) pain or TMD (temporomandibular disorders). Many of the causes of this type of jaw pain also can damage the jawbone around the roots of teeth. Here’s the inside skinny about jaw pain (TMD).

More than 40% of adults experience pain in their mouth annually, according to the Centers for Disease Control and Prevention (CDC).[2] But only 50 to 60% of people with jaw joint pain will seek treatment. Those who don’t get treatment continue to live with painful side effects.

The most frequent complaint I have seen is pain either in the jaw joint or in the jaw muscles. Another common symptom is discomfort when opening the jaw, most obvious when eating or speaking. Popping and cracking sounds in the jaw joints when opening and closing may be present. Also, buzzing or ringing sounds in the ears are possible. Sometimes there is swelling; most of the time swelling is not obvious.[3],[4] Pain also can be isolated to the areas around the roots of the teeth.

 

10 Causes of Jaw Pain

TMD is multifactorial, and there may be sources that are difficult to identify.[5],[6]

Below are 10 related causes for TMD:

  1. Trauma (like a car accident) involving the jaw joint could create damage in the structures of the joint resulting in pain.
  2. Habits of clenching and grinding the teeth can damage the jaw joint and cause muscle pain. These habits also wiggle the roots of the teeth in the jawbone, which will damage the bone around the teeth and may cause tooth pain and cause the tooth to feel loose. Grinding also may crack teeth.
  3. Improperly designed chewing surfaces because of a poorly shaped crown or a poorly placed filling material could cause forces that rock a tooth from side to side. The rocking motion can cause spasms in the jaw muscles as well as cause a hairline crack to develop in the root of the tooth. This also can cause the involved teeth to feel loose in the jawbone.
  4. Poor nutrition and unhealthy digestion could cause chronic systemic inflammation that could affect all joints (example: rheumatoid arthritis).
  5. Emotional stress has been shown to create biochemical changes in the blood system that could increase chronic inflammation throughout the body and joints.
  6. Lack of sleep increases chronic systemic inflammation and can affect joints in the body.
  7. Excessive estrogen may increase inflammation and damage in the jaw joint.
  8. Infection beginning in the joint will cause swelling and pain.
  9. Infection in the jawbone from a failing root canal filling, from residual infection in an extraction site, from an abscessed tooth or a decayed tooth, and from other areas of infection in the mouth and head can affect the TMJ.
  10. Complications with airway space because of a narrow jaw, improper position of the tongue, and misalignment of teeth can create obstructive breathing and poor oxygenation which can result in clenching, teeth grinding, and jaw pain.

 

Treatment Options for Jaw Pain

First, the most obvious potential causes must be addressed.[7]

If the bite is causing muscle and jaw soreness, then the bite must be adjusted. Correcting heavy pressures on the chewing surfaces of the teeth by selectively smoothing out these heavy pressure areas may be all that is necessary to make the bite healthy and stop the pain.

If a patient grinds his or her teeth habitually, sometimes a bite guard could be worn during sleep to reduce the pressures in the jaw joint. If people go to the gym and perform strenuous workouts, they often clench. This also would be a good time to wear a bite guard to protect the teeth and jaw joint.

At other times, orthodontic treatment might be necessary to correct the bite. In more complicated cases, the upper and lower arch may be too narrow to allow the tongue to fit comfortably between the lower teeth. In this case, the upper and lower jaw arches could be widened, the teeth properly positioned, and the tongue given more comfortable space. These efforts will open a compromised airway space regaining normal function for the tongue, improved oxygenation, and reduced bruxism.

I published a paper called, Shoddy Dentistry & Mouth Splinters, where I describe many dental issues that could cause dental pain and inflammation. It’s Free to download if you would like.

Clinical studies show other factors affecting TMD. Examples are emotional stress and lack of sleep, which have been reported to aggravate the symptoms of TMD.[8],[9]

Based on published research papers, these other therapeutic steps should be considered:

  • Treat any obvious or not-so-obvious infections or inflammation in the mouth
  • Reduce stress
  • Get restorative sleep
  • Eat a nutrient-dense, anti-inflammatory diet
  • Avoid eating foods that contain chemicals that can affect the gut and create chronic systemic inflammation
  • Seek the advice of a myofunctional therapist and an orthodontist who are trained in proper jaw structure and function
  • Only as last resorts, investigate medications or surgery for TMD

 

How I Eliminated Jonathan’s Jaw Pain

Jonathan’s pain was related to (1) his bite after his crown was made and (2) a hairline crack in the root of his upper molar root canal tooth. The crown was improperly designed and shaped poorly. The chewing surfaces between that tooth and his lower molar were bumping too hard. Since these pressures were too heavy, his jaw muscles went into spasm, which in turn caused his jaw pain initially. Jonathan couldn’t make this pain go away and didn’t know what was causing it. He also could not tell if the upper crowned tooth was hurting more than the lower molar tooth which was also being pounded with heavy biting forces.

In addition, the heavy pounding pressures on the crowned tooth which had the root canal procedure eventually caused a hairline crack in the roots of that molar. A root canal tooth tends to be more brittle and prone to root fracture. The hairline fracture went through the roots of the upper molar into the jawbone.

At first, I needed to get Jonathan out of pain. The first thing I did was to determine the spots on the crown that were hitting his lower molar too hard. I used a very thin “carbon paper” to visualize the responsible heavy pressure points. I then evened out these heavy contacts by smoothing and polishing the chewing surfaces so that his teeth came together properly. Immediately, he noticed his jaw was more comfortable.

Next, I rescheduled Jonathan to extract the upper molar. Once there is a crack in the root that travels up the root into the jawbone, it is not treatable. After I extracted the tooth and prepared the bone socket to receive an implant, Jonathan scheduled to have me place a zirconia-type implant into the socket about a month after the extraction. At times, a bone graft and other bone rebuilding procedures are required to restore the bone socket to receive an implant.

 

Putting It All Together

Many factors affect jaw pain. The more obvious causes should be explored first. If grinding habits or bite problems exist, these must be corrected. If those pressures on the tooth have cracked the root, then the tooth must be extracted since a cracked root cannot heal.

Any irritant in the mouth that may cause infection or inflammation must be diagnosed and treated appropriately.

If the jaw is out of alignment or if the jaw needs to be widened, proper orthodontic treatment is crucial to regain function, to provide room for the tongue to become comfortable, to normalize the airway space, and to resolve TMD issues.

Also, stress reduction, restorative sleep, and good nutrition must be implemented to reduce TMD symptoms.

If symptoms persist, other treatment options must be investigated and implemented to resolve the issues and make the patient comfortable.

 

[1] https://www.ncbi.nlm.nih.gov/books/NBK551612/

[2] https://www.forbes.com/health/body/common-causes-of-tooth-pain/#footnote_1

[3] https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/temporomandibular-disorders-tmd.html

[4] http://www.ncbi.nlm.nih.gov/pubmed/21835653

[5] http://www.rjme.ro/RJME/resources/files/570116185189.pdf

[6] http://www.ncbi.nlm.nih.gov/pubmed/?term=Association+between+estrogen+levels+and+temporomandibular+disorders%3A+a+systematic+literature+review

[7] http://www.ncbi.nlm.nih.gov/pubmed/?term=Different+association+between+specific+manifestations+of+bruxism+and+temporomandibular+disorder+pain

[8] https://pubmed.ncbi.nlm.nih.gov/33829540/s

[9] https://pubmed.ncbi.nlm.nih.gov/27687043/

 

Schedule a ”30-Minute Free Consult” with me to answer some of your questions and determine if we are a good fit for a coaching program! CLICK HERE.

 

If you don’t want to miss out on new posts, sign up for my Free “Belly Bites” Newsletter and receive your free copy of Dr Al’s “5 Things That Could Be Impacting Your Health Right Now” HERE.

 

Inadequate Dental Exam
Results in Continued Pain

Dr. Al Danenberg Nutritional Periodontist
June 25, 2018

 

 

 

Inadequate Dental Exam

 

Last week a friend of mine, whom I will call Craig, called me. He lives about 300 miles away from where I live. He told me about his dental problem. His story is a recurring concern I have about some dentists performing an inadequate dental exam. A lack of an in-depth exam can result in continued pain for the patient as well as expensive, unnecessary, and possibly harmful treatment.

 

 

Craig’s Problem

Craig told me that several weeks ago he had pain in his upper left molar area. He had so much pain that he could not sleep. Ibuprofen was not taking care of his pain. So, he went to his dentist, who took an x-ray.

 

Craig is a healthcare professional, but not a dentist. So, Craig understands medical terminology and the process of correctly diagnosing a problem.

 

His dentist explained that he saw an old filling in the last molar that could be causing the problem. The doctor recommended to remove the old filling and replace it with a new one. Craig accepted the dentist’s conclusion, and the dentist proceeded to remove the filling and place a new one at that appointment.

 

My friend believed that the dentist knew what he was talking about and left the office after the procedure. Craig thought his problem was solved. However, the pain was not gone. It just got worse.

 

He returned to his dentist the following week and explained the problem was getting worse. The dentist then suggested that the tooth probably had a crack and would require a root canal and crown to save the tooth. At that point, Craig was concerned about his dentist’s diagnosis. So, he called me for my opinion.

 

 

My Opinion

Craig emailed the digital x-ray to me, so I could explain what I saw. It was a standard, two-dimensional dental x-ray. When I looked at the x-ray, I noticed changes in the bone density around the roots of his molar teeth. These changes suggested the teeth were in trauma. The trauma was typical of a clenching or grinding habit. Tooth trauma like this could wiggle the teeth and damage the jawbone. This could cause pain in the tooth area, pain in the muscles of the jaw, and pain in the jaw joint.

 

After I explained to Craig what I saw in his x-ray, he told me that he clenches his teeth most of the time. My next question to my friend was, “Did your dentist ask if you were aware of clenching or grinding your teeth?” Craig told me his dentist never discussed it nor questioned him about it. He also said the dentist never explained what he saw in the x-ray other than the old filling.

 

I told Craig a 3D x-ray of the area might help identify if there was a cracked root or other damage around the tooth that could not be seen from a standard dental x-ray. I also suggested that he purchase a soft bite guard from the drug store to cushion his bite while he slept. If the pain was only from clenching or grinding, then the soft bite guard might be able to lessen the severe pressure and possibly relieve the pain.

 

Craig immediately went to his drugstore and purchased a soft bite guard for about $20. He called me the next day excited, “Last night was the first night in several weeks that I had no pain and could sleep all night long.”

 

 

Closing Thoughts

I know that diagnosing problems in dentistry can be difficult. But, a well-trained dentist should be able to look at an x-ray and see what I saw.

 

When there are obvious changes in the bone suggesting tooth trauma, then one of the first questions the dentist needs to ask the patient is, “Are you aware of any habits of clenching or grinding your teeth?”

 

Certainly, the first thing a dentist should not do is replace an old filling before a thorough evaluation is done. An inadequate dental exam often results in a misdiagnosis and continued pain as was the case for my friend Craig.

 

To completely correct Craig’s problem, he may need to have various chewing surfaces of his teeth smoothed and polished to “even out” his bite pressures. Also, Craig may need a customized bite guard.

 

 

If you don’t want to miss out on new posts, sign up for my email alert list here.

Buy My Book

Crazy-Good Living

What Did You Say I Have?

        Alvin H. Danenberg, DDS       November 8, 2015

 

evolution r“What did you say I have? I brush my teeth everyday and floss when I can. Now you say I have gum disease that is eating away at my jawbone! How did this happen to me?”

 

You are not alone!

 

A study published in 2010 demonstrated that 93.9% of adults in the United States had some form of gingivitis, which is inflammation of the gum tissues surrounding the teeth.

 

Another study published in 2012 by The Centers for Disease Control and Prevention stated that 47% of the US adult population has periodontitis (the advanced stage of gum disease that eats away at the jawbone). If you were over 65 years old, the prevalence of this advanced infection jumped to 70%. Wow!

 

Advanced gum disease typically does not hurt. The earlier stage of this disease, which is gingivitis, usually produces bleeding gums. But, if gingivitis progresses to the more advanced stage of periodontitis, the bleeding generally stops as the infection moves deeper under the gums to begin destroying the jawbone.

 

If left untreated, periodontitis will cause teeth to get loose. Teeth will become sore and painful to the touch. Chewing will become uncomfortable. Infection that is around the tooth root could be pushed into the blood system, affecting other areas of the body. These gum infections could also become severe in the mouth resulting in much swelling, bleeding, and odor. Once the structure of the jawbone is significantly destroyed, the only option would be to extract the teeth involved. In addition to mouth problems, gum disease has been associated with many other bodily conditions such as diabetes, pre-term and low-weight babies, heart disease, and many more.

 

There are many causes. The most common is bacteria that get under the gums around the teeth that thrive off of the sugars and refined carbohydrates we eat abundantly everyday. Another cause is the lack of efficient oral hygiene, which includes effective tooth and gum cleaning habits. Additional causes are the health of our digestive system, the nutrients that are in our foods, our stress level, and our genetic predisposition. Frequently, habits like gritting or grinding your teeth, even if you are not aware of this habit, could weaken the jawbone and result in further destruction.

 

You cannot change your genetics, but you can change the quality of foods you eat and your lifestyle, and you can learn to properly clean around your teeth and gums.

 

Those who read my blogs may know that I am a periodontist (gum specialist) with 41 years experience in treating patients with advanced gum disease. I also am licensed in the laser gum treatment called LANAP® (Laser Assisted New Attachment Procedure), which is patient-friendly and involves no cutting with scalpels and no stitches. I have found this to be the best way to treat advanced gum disease. In addition, I am a Certified Functional Medicine Practitioner using this background to guide patients to a healthier diet and lifestyle. Some of my patients decide to complete a 3-Day Food Journal, which allows me to evaluate their eating and lifestyle habits and then to recommend healthier food and lifestyle choices.

 

I offer my patients a Lifestyle Repair Plan, in which I recommend an anti-inflammatory diet, selecting from a host of nutrient-dense foods. These are the foods that have a great deal of nutrients packed into each calorie. My Plan also incorporates changes in lifestyle that are critical for overall health. Included are concepts of health maintenance like Oral Care, Restorative Sleep, Efficient Exercise, and Stress Reduction – concepts that I have summarized into simple and doable steps.

 

My goal for my patients is to treat their active gum infections, teach them methods to maintain a healthy mouth, and assist them with eating and lifestyle changes that could lead not only to a healthier mouth for the rest of their lives but also to a healthier body.