This article describes the conditions that can cause pain in the upper or lower jaw.
Causes of Jaw Pain
Common causes of UPPER jaw pain include teeth problems and sinusitis.
Common causes of LOWER jaw pain include teeth problems, temporomandibular disorder, inflamed salivary glands and the pain radiating from the upper back, neck, ear or heart.
Coronary heart disease can cause pain on the LEFT side of the lower jaw. There are no known conditions that would cause pain exclusively on the RIGHT side of the jaw.
Problems with the teeth, ear, chewing and neck muscles, salivary glands, jaw bone, nerves and arteries usually cause pain on ONE side and problems arising from the sinuses or systemic infections, such as tetanus, on BOTH sides of the jaw.
|Jaw Pain By Conditions:|
Jaw Pain By Symptoms:
Sudden, Severe, Shooting Jaw Pain
Throbbing Jaw Pain
|Headache and Jaw Pain||
Jaw Pain During or After Eating
Temporomandibular disorder (TMD) refers to pain and dysfunction of the chewing muscles and temporomandibular joints (TMJ), which connect the temporal bones of the skull with he jawbone (mandible). Causes include increased tension in the chewing muscles due to their overuse (gum chewing, eating hard-to-chew foods, nail biting, singing), poor posture, psychological stress (anxiety), sleep apnea or sleep deprivation, and disorders of the temporomandibular joints .
Symptoms include pain in front of the ear, jaw stiffness, decreased range of motion of the jaw (lockjaw or trismus) and clicking, popping or grating sounds during the jaw movements
Individuals with TMD also often suffer from insomnia, headache, migraine, chronic lower back pain, fibromyalgia, chronic fatigue syndrome (CFS), irritable bowel syndrome, interstitial cystitis, dizziness and ringing in the ears (tinnitus).
2. Teeth Problems
Teeth grinding at night (bruxism) can result in a temporary jaw pain in the morning and excessive wearing of the teeth . Causes include anxiety, sleep apnea, uneven bite and missed tooth.
Tooth decay with cavities (dental caries) can cause a toothache, sensitivity of the tooth to cold, heat, sweet foods or pressure and, occasionally, localized jaw pain .
Dental work that involves prolonged mouth opening or an injection can cause jaw pain, which should subside in a day or two. A tooth crown that sits too high can cause an uneven bite, which can result in the persistent jaw or ear pain .
A tooth abscess or granuloma can cause throbbing pain, tenderness and swelling in the gum and jaw .
An impacted wisdom tooth can cause pain, tenderness and swelling of the gum and jaw pain during mouth opening . Jaw pain after wisdom tooth extraction can be due to inflammation called “dry socket” (throbbing pain, usually from the 3rd to 5th day) or a nerve injury (numbness in the gums, tongue or chin lasting up to several weeks) .
Jaw pain after root canal treatment usually subsides within a week . If not, you should check with a dentist for eventual complications, such as infection. Failed root canal treatment can cause constant, throbbing pain in the jaw .
Periodontal disease (inflammation of the tissues around the teeth) includes gingivitis (red, swollen gums) and periodontitis (detached gums, loose teeth, jaw pain) .
Atypical odontalgia or phantom tooth pain is a throbbing pain in several teeth that can persist for months after tooth removal or root canal procedure without apparent reason .
3. Throat Conditions
Viral tonsillitis and strep throat (mostly in children) can cause sore throat, red and swollen tonsils, cough, hoarseness, pain in the ear or jaw on one or both sides and fever [19,38].
4. Ear Problems
Swimmer’s ear (an inflammation or infection of the external ear in swimmers and others who frequently have water in their ear canals) can cause a mild earache, itch and redness in the ear canal and pain below the ear .
An injury of the inner ear can result in “vestibular dysfunction” with a headache, jaw pain, vertigo and dizziness .
Swollen lymph nodes that appear as painful lumps below the jaw can be due to infections, such as a dental abscess, strep throat , infectious mononucleosis and cat-scratch disease (Bartonella henselae) .
Other painful lumps below the jaw include boils, cystic acne, infected epidermoid cysts and thyroid disorders, such as thyroid nodules  and thyroiditis .
Cancers of the neck and head can be associated with painless rather than painful lymph nodes.
6. Inflamed Salivary Glands (Sialadenitis)
Bacterial sialadenitis (mainly in elderly) can develop due to dehydration, stones in the salivary glands (sialolithiasis), autoimmune diseases (Sjögren’s syndrome), or impaired immunity (HIV/AIDS, radiation therapy, chemotherapy). Symptoms include dry mouth, pain, tenderness, redness and swelling in front of the ear, usually on one side, and fever .
Viral sialadenitis (mumps, epidemic parotitis; mainly in children) causes bilateral pain and swelling in front of the ears and fever .
7. Nerve and Artery Conditions
Shingles can cause a constant burning pain, extreme tenderness and itchy rash over the lower or upper jaw, usually on one side. It results from a reactivation of an old infection by the Herpes zoster virus. The rash usually disappears within a month. The pain that persists after the rash clears is called post-herpetic neuralgia .
Bell’s palsy appears as sudden weakness and pain in the facial muscles, ear and jaw, tinnitus, numbness, face drooping and mouth drooling, usually on one side. It is caused by inflammation or compression of the 7th cranial (facial) nerve .
Trigeminal neuralgia appears as sharp, electric-shock like pain on one side of the face, in the lower or upper jaw, teeth, gums, cheek and, less often, in the forehead or around the eye that lasts from few seconds to few minutes. It is caused by a compression of the 5th cranial (trigeminal) nerve, usually near the brainstem . The pain can be triggered by a light touch, sleeping on the side, talking, chewing, hot or cold food, cold wind, teeth brushing, shaving or head movements .
Glossopharyngeal neuralgia refers to stabbing pain in the distribution of the 9th cranial (glossopharyngeal) nerve: in the base of the tongue, throat, ear and jaw . The pain can be caused by a blood vessel or tumor pressing on the nerve or by multiple sclerosis.
Disorders of the spine in the neck, such as cervical spondylosis, arthritis or bulging or herniated disc that presses on the cervical spinal nerve root C2 can cause pain in the neck, back of the head and side of the lower jaw .
Complex regional pain syndrome (CRPS) refers to poorly localized chronic pain and skin changes, usually on one side of the face, due to a nerve damage caused by an injury or surgery .
A facial migraine is a pulsating pain in the nostrils, cheeks, gums and teeth . The pain can last from several hours to few days and is often associated with increased sensitivity to sound and light.
Atypical facial pain is poorly localized burning, gnawing or squeezing pain in the upper jaw on one side lasting for several hours. It was once thought to be a psychosomatic disorder but is now considered to have a neurological origin. Triggering factors may include facial trauma, dental work, sinus surgery, temporal tendonitis and a pinched nerve in the cervical spine [39,40,44].
First bite syndrome is an excruciating pain below the ear on one side lasting for few seconds after first few bites but not by subsequent bites. The pain can appear several days to months after a surgical procedure in the upper neck or parotid glands, probably due to a nerve damage . The condition can heal on its own within several months .
Carotidynia, also called “lower-half headache” or Fay syndrome, is a migraine-like disorder with tenderness and throbbing pain over the carotid artery bifurcation below the jaw, usually on one side [52,53].
Temporal arteritis is a chronic inflammation of the temporal artery with throbbing pain, tortuous blood vessels and extreme tenderness in the temple area and occasional jaw pain, usually only on one side .
8. Bone Disorders
Inflammation of the sinuses in the upper jaw (maxillary sinusitis) can cause constant deep dull pain, usually in both cheeks and in the upper teeth, blocked nose and nasal discharge. Causes include viral and bacterial infections and allergies.
Jaw fracture can cause pain, tingling, numbness, bruise, swelling and jaw deformity, teeth misalignment and crackling sound during moving the jaw .
A bone infection (osteomyelitis) in the lower jaw can develop as a complication of severe dental caries, tooth extraction or jaw fracture. Symptoms can include jaw pain, tenderness and swelling, loose teeth, fever or draining of the pus onto a skin surface (fistula) .
Jaw osteonecrosis is partial destruction and death of the jaw bone. Symptoms include pain, swelling and exposed bone in the gums. Causes include treatment with bisphosphonates, steroids, chemotherapy or radiation, jaw infection, tooth extraction or other trauma to the jaw [30,33].
Tumors of the jaw bone are rare. Main symptoms are jaw pain, tenderness and swelling .
Eagle syndrome refers to pain in the side of the face, throat and in the shoulder due to a compression of the muscles by :
- A prolonged styloid process, which is part of the temporal bone below the ear
- Calcified stylohyoid ligament, which runs between the styloid process and the hyoid bone in the upper front neck .
Drinking alcohol can cause severe burning pain below the ear lasting for several minutes. This can occur in individuals with Sjögren’s syndrome who have chronic inflammation of the salivary glands (sialadenitis) and in those with Hodgkin lymphoma .
According to anecdotal reports, certain beers and wines (mainly red), sometimes only in combination with fermented foods (yogurt, sauerkraut, sourdough, artisan rye bread) or spicy foods, can trigger shooting pain at the angle of the jaw on one or both sides [3,56]. The pain lasts for several minutes. The mechanisms can involve “histamine intolerance” (beer, wine and fermented foods are high in histamine) and an alcohol-induced increase of the secretion of saliva from the parotid glands and the constriction of the parotid duct . Swishing water in the mouth may reduce the pain.
Infections in which jaw pain may be an important symptom:
- Lyme disease
- Brain abscess
- References: 50,61
11. Referred Pain From the Chest, Neck and Upper Back
Referred pain is the pain that originates in one site and is perceived at a distant site of the body.
Angina pectoris, which occurs in coronary heart disease refers to a sudden squeezing pain behind the breastbone that usually lasts less than 5 minutes and can radiate between the shoulder blades, into the neck, lower jaw and teeth, shoulder and arm, usually on the left side. Other symptoms can include shortness of breath, nausea, sweating and dizziness.
Heart attack feels similar to angina pectoris, but the pain is usually stronger and lasts for more than 15 minutes. Rarely, angina pectoris or heart attack may present without chest pain and only with pain in the jaw or arm .
Gastroesophageal reflux disease (GERD) can be associated with burning pain behind the breastbone and in the throat (heartburn), indigestion, metallic taste in mouth and jaw pain, especially when lying down after meals and at night.
In myofascial pain syndrome, pressure applying to the muscle knots in the upper back, neck, shoulders or chewing (masticatory) muscles can trigger pain in the jaw [35,87]. The syndrome is common in athletes and office workers.
Jaw pain in women during pregnancy may be due to loosening of the ligaments around the temporomandibular joint. Associated problems include coccyx pain and pain in the pubic area due to symphysis pubis dysfunction.
Diagnosis of Jaw Pain
A doctor can often find a cause of jaw pain from your medical history and physical examination alone.
A dentist can spot a tooth problem.
An X-ray of the jaw can reveal tooth abscesses, cysts, maxillary sinusitis, tumors and fractures in the jaw bone and stones in the salivary glands (sialolithiasis).
A CT or MRI of the head or neck can detect abscesses and tumors in the soft tissues around the jaw and brainstem, abnormalities of the temporomandibular joint and herniated discs in the neck spine.
A Doppler ultrasound can detect abnormalities in the blood vessels in the neck .
Treatment and Prevention of Jaw Pain
To know how to treat jaw pain, you may first want to know the cause. Doctors who can give you a diagnosis include a general practitioner, dentist, neurologist, orthopedist, rheumatologist and maxillofacial surgeon.
If you think you may have the temporomandibular disorder or myofascial pain, try to learn how to cope with stress.
If you think you may have a problem with teeth, you can visit a dentist.
Infections can be treated with antibiotics and inflammatory diseases with steroids. Neurological disorders can be treated with anticonvulsants, strong analgesics or surgery.
A doctor can repair certain problems in the temporomandibular joint by an endoscopic procedure called arthroscopy .
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