Tooth pain is most often caused when the nerve to a tooth is irritated, but there are numerous other reasons for a person to experience tooth pain. Risk factors for a toothache include dental infection, gum disease, plaque, dental decay, injury, cracked teeth, poorly placed fillings or crowns, failing or leaking fillings or crowns, loss of a tooth (including tooth extractions), temporomandibular joint (TMJ) disorders, and obstructive sleep apnea. There are instances, however, where pain originating from outside the mouth radiates to the mouth, thus giving the impression that the pain is of tooth origin. This often happens when there is a problem with the jaw joint (temporomandibular joint or TMJ), ears, nerves, sinuses, or muscles.
TMJ is the joint that connects the lower and upper jaw. The term TMJ stands for Temporo-mandibular Joint. This is one of the most complex joints in the entire body, capable of forward and backward movement, rotations, and side-to-side movements. TMJ often refers to complications and problems with this joint. Some of the most common symptoms of TMJ problems are:
- Limited movement of the lower jaw
- Clicking sounds
- Muscle spasms
- Locking of the jaw
The two TMJs that connect your lower jaw, the mandible, to the temporal bone of the skull on either side, are actually very complex joints that allow movement in three dimensions. The lower jaw and temporal bone fit together as a ball and socket, with a cushioning disk in between. Large pairs of muscles in the cheeks and temples move the lower jaw. Any of these parts — the disk, the muscles or the joint itself — can become the source of a TMD problem. If you are in pain, or are having difficulty opening or closing your jaw, a thorough examination can help pinpoint the problem area; then an appropriate remedy can be recommended.
As with any other joint, the TMJ can be subject to orthopedic problems including inflammation, sore muscles, whiplash, strained tendons and ligaments, and disk problems.
Signs and Symptoms of TMD
Clicking Sounds — Some people with TMD hear a clicking, popping or grating sound coming from the TMJ when opening or closing the mouth. This is usually caused by a shifting of the disk inside the joint. Someone standing next to you might even be able to hear it. Clicking by itself is actually not a significant symptom because one third of all people have jaw joints that click, studies show. However, if the clicking is accompanied by pain or limited jaw function — the jaw getting “stuck” in an open or closed position, for example — this would indicate TMD.
Muscle Pain — This can be felt in the cheeks (masseter muscles) and temples (temporalis muscles), where the two big pairs of jaw-closing muscles are located. If you feel soreness and stiffness upon waking up in the morning, it's often related to habits such as clenching and/or grinding the teeth at night. If you have this type of nocturnal habit, a custom-made nightguard should be very helpful in decreasing the force applied to your teeth, which will in turn allow your muscles to relax and relieve pressure on your jaw joints. Other self-care remedies are discussed below (please see Relieving the Pain).
Joint Pain — Pain that's actually coming from one or both jaw joints technically would be described as arthritis (“arth” – joint; “itis” – inflammation) of the TMJ. Radiographs (x-ray pictures) show that some people have arthritic-looking TMJs but no symptoms of pain or dysfunction; others have significant symptoms of pain and dysfunction but their joints look normal on radiographs. There is no cure for arthritis anywhere in the body, but medication can sometimes help relieve arthritic symptoms.
Relieving the Pain
Once you have been examined, a strategy for treating your condition and managing your pain can be developed. Sometimes a temporary change to a softer diet can reduce stress on the muscles and joints. Ice and/or moist heat can help relieve soreness and inflammation. Muscles in spasm can also be helped with gentle stretching exercises. Non-steroidal anti-inflammatory medications and muscle relaxants can also provide relief.
People don't generally think of a dentist as the healthcare professional to see for recurring headaches or migraines; yet dentists can play a role in diagnosing and even treating your condition. That's because quite often, recurring pain that is felt in the area of the temples on the sides of the head is actually caused by unconscious habits of clenching and/or grinding the teeth. These habits, which often manifest during sleep, put tremendous pressure on the muscles that work your jaw joint, also called the temporomandibular joint (TMJ).
The fan-shaped temporalis muscles located over your temples on either side of your head are two of several muscles involved in jaw movement. You can easily feel them working if you put your fingertips on your temples while clenching and unclenching your jaw. When temporalis muscles go into spasm from too much clenching, headache symptoms may result. This is not to say that headaches and migraines are always caused by TMJ problems, also known as temporomandibular disorders (TMD). But given the established link between them, it definitely bears looking into — especially if a diagnosis remains elusive in your case.
Sources of Relief
The first thing you need is a thorough oral exam to determine if there is evidence of a clenching or grinding (also known as “bruxing”) habit or TMD. If so, there are things you can do for immediate and long-term relief. Sometimes eating softer foods for a few days can reduce stress on the muscles and joints. Ice and/or moist heat can help relieve soreness and inflammation. Gentle stretching exercises, non-steroidal anti-inflammatory medications such as ibuprofen, and muscle relaxants can also provide relief.
Finally, a custom-made nightguard to wear when you sleep might be recommended. This plastic oral appliance, which fits over the teeth, can control or even eliminate clenching and grinding, reducing pressure on the muscles that work the jaw and the jaw joint itself. Some users have reported that their headaches or even migraines are less frequent and/or less intense.
Will a nightguard or other TMD therapy relieve your headaches? It depends on the source of the problem. But living with chronic headaches or facial pain is no fun — so don't delay scheduling an exam and a consultation.