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

Dr. Al Danenberg ● Nutritional Periodontist

February 13, 2022 [printfriendly]

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/

 

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“My Tooth is Still Hurting”

Dr. Al Danenberg ● Nutritional Periodontist

April 20, 2020 [printfriendly]

 

 

George contacted me by email a few weeks ago. He wrote, “My tooth is still hurting, and my dentist can’t find out why.” He lives outside of the US, found me on the Internet, and wanted another opinion.

 

I responded to him and explained, “I cannot make a diagnose over the Internet. But I will look at your x-rays and review your medical and dental history. Then, I should have some ideas and actions you could take that I will discuss with you.”

 

George emailed back, “That makes sense to me.”

 

He then filled out an online questionnaire and other information. George submitted them to me online. Also, he had his dentist email the dental x-rays. I took a look, gathered my thoughts, and we talked via Skype.

 

 

George’s Dental Problems

George’s acute problems centered around two recent dental procedures: a dental implant to replace his missing lower molar and a completed root canal on a tooth that was abscessed.

 

After we met via Skype, George explained the details of his dental fiasco.

 

He had an implant placed in his lower left molar area, which did not cause any pain while it was healing for several months. Then a crown was cemented onto the implant. Within a couple of weeks, he noticed some tenderness in the gum tissue surrounding the new crown. He went back to his dentist who took a new x-ray and told him, “That’s normal. You need to clean the area better.” George left thinking that it would get better. It didn’t!

 

In addition, the same dentist completed a root canal on his lower right bicuspid, which was abscessed and hurting. The root canal was done while the implant was healing on the left side of his lower jaw.

 

Shortly after the gum surrounding the implant crown became sore, the root canal tooth became extremely tender. George returned to his dentist to check it out.

 

The doctor checked that tooth, took a new x-ray, and made sure that the tooth had normal biting pressures when George brought his teeth together. The doctor tried to encourage him, “Your tooth will be fine. It just takes some time to heal after the root canal.” It didn’t get better.

 

George lost confidence in his dentist and didn’t know where to turn. That’s when he found my website and contacted me. Once he decided to schedule a consultation, George requested his new x-rays and sent them along with other documents for our Skype meeting.

 

 

Causes of the Pain

The sore gum around the implant crown

 

The x-ray of the crown on the implant showed a small amount of cement pushed under the gum tissue after the crown was cemented. Excess cement left under the gum tissue is unfortunately a frequent problem after the cementation of a crown.  This may be difficult to see on an x-ray. However, it is evident on an x-ray when someone looks for it.

 

I explained to George that the dentist or hygienist would need to take the time to delicately clean out the area. I suggested that, “the cement fragment is just like a splinter in your finger. It is an irritant. Your finger will not heal until the splinter is removed completely. And so, the gum around the implant crown will not heal until the cement is removed thoroughly. If the cement remnant is not removed, infection eventually will destroy the jawbone around the implant. That could cause the implant to be lost.”

 

George agreed with me and promised that he would schedule another appointment with his dentist.

 

 

The root canal tooth

 

The cause of George’s other problem was more difficult to determine. After his dentist completed the root canal on his bicuspid, the pain not only continued but actually got worse. I suggested that George see a root canal specialist to evaluate that tooth and take a three-dimensional (3-D) x-ray of the area. I suspected a crack in the tooth root. This specialized x-ray could show a crack better than a standard dental x-ray.

 

I pointed out to George my thoughts about a crack. It could occur if too much pressure was applied to the tooth by his dentist when he performed the root canal. Or, heavy chewing pressure could cause the fracture. If the root is fractured, it might have been present even before the root canal was started.

 

 

Tooth Pain Resolved

George was able to have the cement removed that was lodged under his implant crown. Also, George had an endodontist evaluate his root canal tooth and took the necessary 3-D x-ray.

 

The x-ray clearly showed a hairline fracture in the root of the tooth. Unfortunately, the only option George had now was to extract that tooth. And so, George had the bicuspid extracted. I told him that later on the space could be replaced with an implant or a bridge cemented on the teeth on either side of the missing tooth.

 

At last, George was able to get his pain to stop. But only after the cement was removed from under the gum and after his cracked root canal tooth was removed.

 

 

My Recommendation

Pain is a terrible thing. Especially when professionals you trust can’t make it go away. It is not wrong to get another opinion from another professional. I always encourage patients to seek other ideas from other medical and dental experts if there is a concern or an unresolved question. Sometimes the cause of a dental problem is very difficult to determine; sometimes the problem is the result of poor dentistry.

 

At times, the dental problem is related to other problems occurring in different parts of the body. The mouth is intimately and intricately connected to the rest of the body. Whatever affects one cell will ultimately affect all other cells. The mouth is not an island unto itself.

 

Whenever there is pain, it could be the result of uncontrolled inflammation and infection. If infection and inflammation become systemic, many other parts of the body will be affected. The source of the problem must be discovered and treated appropriately.

 

 

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