Why does the jaw hurt near the ear on the right or left and what to do about it

Jaw pain in the ear area usually indicates ear and dental pathologies. However, in practice it turns out that severe pain syndrome is caused by joint, heart and tumor diseases. Discomfort in the jaw area may also indicate the progression of a benign or malignant tumor. Therefore, if persistent pain is detected, it is necessary to urgently consult a doctor.

What problems can cause such pain?

Most often, discomfort in the jaw space near the ear develops against the background of dental, bone, joint and heart problems.

Features of pathologies are presented in the table:

Cause of pain	Description
Bone problems	General information: When bone tissue is damaged, the pain radiates to the ear area. Most often this happens with head injuries, fractures of the facial bones of the skull and injuries to the jaw. Symptoms: In case of fractures or damage to bone tissue, the patient detects hematomas at the site of impact, feels pain when chewing or opening the mouth, and observes the appearance of swelling in the fracture area. In more advanced cases, bone displacement develops, which leads to severe pain in the jaw and ear. Read also: What are tapes? How to do taping correctly? What's the benefit
With joints	General information: Diseases of the temporomandibular joint are often accompanied by aching pain that radiates to the ear area. As the inflammatory process progresses, it becomes difficult for the patient to open his mouth and chew food. Often, the pain syndrome develops against the background of arthrosis, arthritis, which manifests itself in the form of stiffness in mouth movements and aching pain. Symptoms: With articular pathologies, the patient experiences discomfort when opening the mouth, a characteristic clicking sound in the jaw when trying to chew food, and a change in the nature of the pain during the day: it can be aching, pressing, pulsating. When pressing on the problem area, the pain usually intensifies.
Problem with the heart and blood vessels	General information: If discomfort in the jaw area is accompanied by pain in the left side of the chest, then the cause of the problem may be cardiovascular disease. As angina progresses, pain radiates to different organs. Most often, discomfort is felt in the arm and shoulder area, but often heart pain radiates to the left jaw and ear. Symptoms: Cardiac pathologies are accompanied by the appearance of sharp pain in the heart, as well as discomfort in the arm, jaw, and temporal zone. As the disease progresses, the pain intensity increases. In this case, the patient needs immediate medical attention.
Tumors	General information: With the development of tumor pathologies, in addition to discomfort, the patient may find a lump in the jaw area or behind the ear. The tumor either hurts when pressed or does not produce significant symptoms. It all depends on the nature of the tumor. Symptoms: With the development of tumor diseases, the patient may notice a lump on the jaw or near the ear, which hurts when touched, swells, and interferes with chewing food and opening the mouth. In addition, the patient may observe an increase in the nearest lymph nodes if we are talking about a malignant disease. If a lump is detected, you should not hesitate to seek medical help or self-medicate, as this can lead to disastrous consequences.
Dental problems	General information: Dental pathologies are one of the most common causes of pain in the jaw and ear. Discomfort occurs against the background of untreated caries, pulpitis, and growth of wisdom teeth. Symptoms: With dental pathologies, the patient feels pain not only from the outer part of the jaw, but also from the inside. It is painful for the patient to chew food, open his mouth, or drink hot or cold drinks. In some diseases, for example, pulpitis, the pain spreads to the entire facial part, on the side of which the diseased tooth is located.

Doctor about the causes of jaw pain:

Why does my jaw hurt near my ear?

Pain in the jaw area is a serious symptom that signals the progression of various pathologies. These can be dental diseases, ENT diseases, viral infections, oncological processes in the body. Only a doctor can determine the cause of discomfort after a comprehensive diagnosis.

Dental diseases

Dental diseases are one of the main reasons influencing the development of jaw pain.

Common pathologies that cause pain:

osteomyelitis . A purulent infectious disease that affects most of the structural components of the jaw bone. The pathology is accompanied by aching pain in the chin area, weakness, chills, and increased body temperature. As the disease progresses, it is difficult for the patient to open his mouth, chew food, or talk. In more advanced cases, the patient's lower face swells, fistulas form, or an abscess develops. Pathology is eliminated with the help of antimicrobial and anti-inflammatory drugs;
gingivitis . This is an inflammatory disease of the gums that appears against the background of a violation of the integrity of the dentogingival attachment. Gingivitis most often affects teenagers or pregnant women. The development of the disease is influenced by many factors: improper oral care, bad habits, reduced immunity, dental pathologies, caries, infections. The main symptoms of the pathology include pain in the jaw area, radiating to the ear, swelling and redness of the jaw, pain in the teeth, which intensifies when eating cold, hot and spicy foods. In advanced cases, the gums begin to bleed. Gingivitis is treated with antibiotics, anti-inflammatory drugs, and immunostimulating medicinal products;
alveolitis . a disease accompanied by acute and aching pain in the tooth socket, which most often develops after tooth extraction or surgical treatment. Pain in the gums itself after surgery is considered normal, but if it does not subside a week after the procedure, we may be talking about the formation of alveolitis. As the disease progresses, the patient experiences pain in the tooth socket, which increases in intensity upon contact with food. Discomfort is added by periodic bleeding of the gums, pain in the jaw, ear, and temple areas. The pain syndrome varies in nature: from acute to mild. Treatment occurs with the help of anti-inflammatory and analgesic agents;
abscess . An abscess develops due to various reasons: injury, infections, viruses, untreated dental pathologies. Accompanied by the appearance of severe headaches that radiate to the jaw, ear, and temples. The patient's temperature rises, general signs of chills appear, and a swelling forms in the gum area, under which there is pus. The tumor hurts when pressed. To treat an abscess, surgical methods combined with drug therapy are used. Initially, the doctor removes the tumor, cleans the wound, and then prescribes antibiotics and immunostimulating drugs to the patient.

Osteomyelitis

Gingivitis

Alveolitis

Abscess

Often, pain in the jaw appears due to an incorrect bite or untreated caries. In such cases, the pain syndrome is unexpressed and may disappear and reappear. Discomfort is easily relieved with analgesics.

Important! The patient must remember that if the problem is ignored for a long time, there is a risk of developing complications with more serious and intense symptoms.

ENT diseases

Discomfort in the jaw area can develop against the background of ENT pathologies :

glossitis . Glossitis is an inflammation of the tongue tissues, which indicates the development of viral infections. The pathology is accompanied by pain in the tongue area, spreading to the gums and jaw, a burning sensation when food gets in, the development of swelling of the tongue, increased salivation, and speech dysfunction. To treat the disease, antibacterial, antifungal, anti-inflammatory drugs, as well as immunostimulating agents are used;
pharyngitis . Pharyngitis is an inflammatory disease that occurs against the background of damage to the mucous membrane of the throat and lymphoid tissue. The disease develops when viruses, infections, and fungi enter the body. Pharyngitis is accompanied by pain and dryness in the throat, inflammation of the cervical and ear lymph nodes, pain in the chin, cheekbone, ear area, fever and chills. The disease is treated with anti-inflammatory drugs, antibiotics, antiviral drugs;
erythroothalgia . Erythroothalgia is a clinical syndrome that is accompanied by acute pain in the ear cavity, radiating to the chin, jaw, and back of the head. The pathology often entails an increase in body temperature and discomfort when opening the mouth and chewing food. To eliminate the disease, complex therapy is used, which is selected individually.

Glossitis

Pharyngitis

Erythroothalgia

Pain syndrome in the jaw area near the ear can also appear against the background of chronic tonsillitis, acute rhinitis, sinusitis, and diffuse otitis media. If such diseases develop, the patient will need medical attention.

Other diseases

Jaw pain can occur due to the following diseases:

carotidynia . This is a type of migraine accompanied by acute headache and discomfort in the lower part of the face. If left untreated for a long time, the pain syndrome spreads to the entire facial area;
inflammatory process in ARVI . Pain syndrome during ARVI signals inflammation of the ternary nerve. In this case, the infection penetrates the nerve and blood vessels, as a result of which the patient’s entire face begins to hurt. The patient observes pressing pain in the jaw, temples, and frontal area. Inflammation of the ternary nerve is treated with antibiotics, anti-inflammatory drugs, painkillers;
TMJ dysfunction . Dysfunction of the temporomandibular joint is accompanied by pain in the jaw and ear when swallowing food or opening the mouth. Patients may observe the appearance of crunches and clicks that appear at the slightest movement of the jaw. Often, TMJ dysfunction is accompanied by congestion and tinnitus, hearing impairment;
oncology . Jaw cancer develops against the background of frequent injuries to the maxillofacial area, lack of timely treatment of dental pathologies, smoking and drug abuse. The pathology is accompanied by the development of weakness in the body, sudden weight loss, headache and jaw pain, and the appearance of lumps in the problem area.

Discomfort in the jaw area under the ear can signal the development of neuralgic pathologies: inflammation of the superior laryngeal or glossopharyngeal nerve. In this case, the pain is acute. Often, pain in the jaw area indicates cervical osteochondrosis, scoliosis, and vegetative-vascular dystonia.

Causes not related to diseases

Discomfort in the jaw often develops due to bruises, fractures and dislocations, which patients can receive in accidents, fights, or falls.
With minor injuries, swelling in the problem area, mild pain, and the appearance of bruises and hematomas are observed. The patient experiences malaise, headache, dizziness and drowsiness. With fractures, the patient develops the following symptoms :

acute pain that is not relieved by analyzing means;
nausea, headache, dizziness;
problems opening the mouth and chewing;
speech dysfunction;
facial asymmetry;
the appearance of bruises;
drooping eyeballs.

A fracture is dangerous because it can cause breathing problems and contribute to tongue retraction.

Attention! In case of a jaw fracture, you must immediately call an ambulance. Self-medication can lead to disastrous consequences. In 10% of cases, jaw fractures are fatal.

Primary treatment of pain in temporomandibular joint disorders

An important part of dental treatment is monitoring, diagnosing and treating pain, as well as relieving the underlying causes of pain. However, most dental patients with symptoms of unexplained pain often succumb to inappropriate diagnosis, resulting in misdiagnosis and ineffective treatment. As a result, the patient not only continues to suffer from chronic pain, but also becomes disillusioned with the dental treatment provided.

Pain in the maxillofacial area

By definition, pain in the maxillofacial area (orofacial pain) is associated with localization in the soft and hard tissues of the head, face and neck. With painful stimulation of these zones, through the structure of the trigeminal nerve, impulses reach the corresponding centers of the brain. In the brain, such signals are interpreted “as unpleasant sensory or emotional sensations that arise as a result of actual or potential tissue damage.” The density of tissue in the affected area greatly complicates the procedure for making a correct diagnosis. Quite often, patients describe the location of the toothache away from the actual site of the lesion. The phenomenon of referred pain is based on the interweaving of many sensitive nerve endings that are directed to the nucleus of the trigeminal nerve from the skin and deep tissues of the head and neck.

Toothache is one of the most common forms of pain in the maxillofacial area. The next most frequently reported pain is pain due to dysfunction of the temporomandibular joint (TMJ) and headaches. Often the patient may experience pain of several etiologies at once. The difficulty of diagnosing the main source of pain is also associated with the possible concomitant development of fibromyalgia, chronic fatigue syndrome, or other pathological conditions. In such cases, the best way to make a diagnosis is to use the principle of “peeling the onion” - verifying changes in symptoms one by one.

Temporomandibular joint

The temporomandibular joint (TMJ) is a complex joint that allows for both rotational and gliding movements of the mandible. Structurally, it consists of the condyle of the lower jaw, which in shape corresponds to the articular fossa of the temporal bone. The articular disc is made of dense fibrous cartilage and prevents direct contact between bone surfaces. The anterior part of the disc lacks blood vessels and nerve endings, while the posterior part, on the contrary, is characterized by an abundance of these structures. The joint is lubricated by a special synovial fluid contained in its composition. The movements of the TMJ are ensured by the masticatory muscles. Another main type of muscle that is not involved in the development of TMJ movements, but is responsible for demonstrating emotions, is the facial muscles. The complex of masticatory muscles includes the masticatory muscles themselves, the temporal muscles, the medial pterygoid muscles and the lateral pterygoid muscles.

Temporomandibular joint disorders

Temporomandibular joint disorders are a group of musculoskeletal and neuromuscular diseases that primarily negatively affect the function of the joint itself, the masticatory muscles, or the articular disc. The possibility of TMJ disorders should be taken into account when carrying out the differential diagnosis of facial pain, since TMJ dysfunctions are the most common cause of pain in the area of the dentofacial apparatus of non-odontogenic etiology. To make a correct diagnosis, you should carefully study the patient's medical history, taking into account the onset and duration of pain, as well as the effects of factors associated with relief or worsening of pain. Along with constant pain in the jaw projection, patients often complain of ear pain, headache and diffuse facial pain. In addition, they may complain of radiating pain or a feeling of stiffness in the face, jaw or neck, associated with restrictions in jaw movement, painful clicking or cracking sounds when closing or opening the mouth. Patients may also indicate changes in the nature of the relationship of teeth with each other. The above symptoms may be especially severe early in the morning, or worsen throughout the day. The threshold, localization, pain sensitivity and the nature of the description of pain sensations differ in different patients, and if we also take into account the complex mechanism of formation of the pain impulse, then one thing becomes obvious - diagnosis is an extremely important stage for the objectification of painful changes. History remains one of the key aspects of a comprehensive diagnosis, helping to detail aspects associated with the development of pain. In addition, during the collection of anamnesis while talking with the patient, the doctor can visually assess the nature of the movements of the lips and jaw, his facial expressions and posture, as well as his emotional status. Historically, occlusal disorders have been considered the primary cause of TMJ dysfunction. However, according to recent studies, these constitute only a small proportion of cases associated with painful joint dysfunction.

There are many classifications of TMJ dysfunctions. In other words, pain due to TMJ dysfunction can be arthrogenic and myogenic. Arthrogenic (joint and disc) dysfunction of the TMJ is usually caused by disc displacement or develops secondary to degenerative changes in the disc, ankylosis, dislocation, infection or neoplasia. Myogenic dysfunctions occur due to muscle hyperactivity or due to bruxism, hypermobility, or external stimuli. Myogenic joint dysfunctions can cause ischemia of the skeletal muscles of the face. Irreversible damage to myocytes develops after 3 hours of the ischemic state and in parallel with progressive microvascular disorders. All this only complements the pathological cycle of the mechanism of development of facial pain. Patients with myogenic dysfunction of the TMJ are characterized by the development of more complex pathological disorders and more severe pain compared to patients with arthrogenic dysfunctions. That is why the main principle of treating joint dysfunction is focused on treating and stopping the hyperactivity of the masticatory muscles.

Myofacial pain syndrome

According to the National Institute of Dental Research, the most common form of TMJ dysfunction is myofacial pain syndrome (MPS). With this chronic inflammatory disease, damage occurs not only to the muscles, but also to the fascia. The root causes of this disorder are repetitive movements, damage to muscle fibers and excessive tension in the ligaments and tendons. Patients themselves often complain of depression and fatigue, and even during a clinical examination, the doctor may notice some changes in their behavior. A differential sign of MPS is the presence of so-called trigger points, the activation of which provokes the development and irradiation of pain to different parts of the head and neck area. Trigger points (photos 1 - 4) are formed in the projection of excessive muscle contraction and dysfunction of one of the components of the biomechanical complex of the head and neck. This type of muscle spasm differs from physiological tension of the entire muscle: due to local excessive contraction, blood flow directly to the area of contraction is stopped, which consequently leads to the development of ischemia. The buildup of waste products and toxins sensitizes the trigger point, essentially causing it to send pain signals to the brain, causing even more contraction. Thus, the mechanism of trigger point formation includes a vicious circle of metabolic crisis. Clinically, trigger points can be identified by analyzing existing signs of the lesion, reproducing symptoms and performing palpation. Deep palpation almost always allows you to identify the main trigger zones. Often, when pressing on the trigger area, the patient may experience muscle twitching.

Photo 1. Trigger points of the masticatory muscle in the projection of the upper musculotendinous junction of the superficial layer and central trigger points of the superficial layer with corresponding patterns of pain spreading to the area of the lower jaw, teeth and gums.

Photo 2. Trigger points of the masseter muscle in the lower part of the superficial layer of tissue with corresponding patterns of pain spreading to the lower jaw and superciliary region.

Photo 3. Trigger points of the masseter muscle in the upper part of the deep tissue layer below the TMJ with corresponding patterns of pain spreading to the ear area.

Photo 4. Trigger points of the temporal muscle and projection of the spread of referred pain.

Masseter muscle

The masticatory muscle is the main muscle of the complex of the entire masticatory musculature. The lower jaw is the only movable part of the skull, the movements of which are ensured precisely by the masticatory muscle. It is located in the parotid region along the posterior edge of the jaw, easily visualized and palpated when the jaws are clenched.

The average person can bite with 150 pounds of force, but a bite force of more than 250 pounds is considered normal. This strength of the masticatory muscle is achieved due to specific biomechanical conditions: its lever arm is much shorter than in other muscles. Given the high activity of the masticatory muscle, its tension is visualized even when a person’s emotional state changes. When tension in the muscle continues for too long a period of time, this provokes the formation of those same trigger zones associated with myofacial pain. When trigger points are located in the projection of the masticatory muscle, the patient may experience pain in the eyes, on the surface of the face, in the structure of the jaw and teeth. According to Simons and colleagues, the trigger mechanism of the masseter muscle may even be responsible for the development of pain and itching in the structure of the ear, as well as the development of tinnitus - an unexplained ringing in the ears. Photos 1-3 show trigger points in the masseter muscle and general pain patterns (shown in red). It must be remembered that the facial nerve is motor and is responsible for the innervation of facial muscles. Therefore, when treating trigger points in the deep layers of the masticatory muscle, it is necessary to take into account the specific anatomy of the facial nerve in the projection of the zygomatic arch.

Temporalis muscle

The temporalis muscle is a large, thin, fan-shaped muscle located on the side of the skull above and in front of the ear. Although the masseter muscle is considered the most powerful, the temporalis muscle also plays an important role in the chewing process. It originates from the temporal bone of the skull and passes completely under the zygomatic arch (cheekbone), attaching to the lower jaw, thus assisting the masseter muscle in closing the jaw and retracting it. By placing your fingers just above your ear, squeezing and unclenching your jaw, you can feel the biomechanics of the temporal muscle. Photo 4 shows how strongly trigger points in the temporalis muscle are associated with the possibility of developing pain in the projection of the upper teeth, head, cheeks, eyes and ears. Often, when the nature of pain is incorrectly diagnosed, doctors resort to endodontic treatment, although such treatment may be completely non-odontogenic in nature.

Treatment with botulinum neurotoxin type A

Considering the basic principle of “do no harm,” the treatment of myofacial pain should be carried out through the implementation of non-invasive and reversible intervention methods. To relieve TMJ dysfunction, various palliative approaches and combinations thereof can be used, which include, but are not limited to, splint therapy, massage, physiotherapy, biofeedback, acupuncture, chiropractic, the use of ethyl chloride sprays and stretches, the use of antidepressants, narcotic and non-steroidal anti-inflammatory drugs. In addition, botulinum neurotoxin type A (BoNT-A), which is widely used in cosmetics (Botox, Dysport, Xeomin), and which has been previously approved by the US Food and Drug Administration (FDA) for the treatment of painful conditions potentially associated with disorders in the TMJ area (dystonia of the neck muscles, migraine, etc.). BoNT-A is an injectable pharmaceutical agent that is derived from the bacterium Clostridium botulinum. In small doses, this purified protein can be used to achieve selective skeletal muscle relaxation as it inhibits the release of acetylcholine at the neuromuscular junction. Consequently, due to this, the muscle will not be able to contract with the same intensity, since the amount of available neurotransmitter is markedly reduced. Constant, sometimes dysfunctional contraction of the masticatory muscles may be the main cause of the formation of trigger points in TMJ-associated disorders associated with myofacial pain syndrome. Treatment of TMJ dysfunctions with BoNT-A lasts for a month, allowing the effect to be achieved for 3-4 months. In this case, the physiological functions of chewing, speech, and swallowing remain unimpaired, but the intensity of pain noticeably decreases. Unlike systemic medications, botulinum toxin acts only locally, allowing relief of both active and latent trigger points. Immediately after the injection, the patient may report immediate pain relief as a “dry needling” effect develops. Although this approach cannot cure the cause of pain dysfunction, the effect of BoNT-A injections becomes more and more durable over time. On the other hand, in cases of resistance to other treatment methods, this approach may represent a successful alternative aimed at relieving existing pain. Dentists who are considering using BoNT-A in their practice as an approach for the management of pain associated with TMJ dysfunction may benefit from specialized training. During the latter, the doctor will be able to become familiar with the anatomy, physiology, pharmacological characteristics, as well as adverse reactions and potential complications associated with the use of botulinum toxin. The average price of a bottle with 100 units of active substance for a doctor is about $600. Before using BoNT-A, it is also necessary to take into account the specifics of local legislation regarding the performance of such manipulations.

Bruxism and Dental Sleep Medicine

Dental parafunction is a habit due to which certain organs of the oral cavity or the dentition do not function correctly. Moreover, it is not associated with the processes of drinking water or food, or with the function of speech. The most common parafunction remains bruxism, clenching and pathological abrasion. All of them can potentially be associated with TMJ dysfunctions. Physiological pressure applied to a tooth ranges from 20–80 psi (0.14 to 0.55 MPa), while with bruxism it can reach 300–3000 psi (2.07–0.55 MPa). 20.7 MPa). It is logical that under such conditions the load on the masticatory muscles increases significantly, and their overload, in turn, leads to the development of myofacial pain syndrome.

Masseter muscle hypertrophy

When examining patients with facial pain syndrome associated with TMJ dysfunction, the dentist often identifies the presence of trigger points in the projection of the masticatory muscle. In addition, such patients may experience such strong hypertrophy of this muscle that it provokes a distortion in the appearance of the face. Hypertrophy of this kind can be treated with the same BoNT-A used according to the injection protocol in cases of TMJ dysfunction. Botulinum toxin injections reduce the intensity of muscle contractions and allow the muscle to relax, eliminating the possibility of clenching the teeth with excessive force. But it should be remembered that the goal of such treatment is not only to relieve pain, but also to normalize the visual shape of the face, the distortion of which was caused by hypertrophy (photo 5-6).

Photo 5. View of a patient with hypertrophy of the masseter muscle before treatment.

Photo 6. View of the patient after treatment of masseter muscle hypertrophy using botulinum toxin.

Obstructive sleep apnea

Obstructive sleep apnea (OAE) occurs when repeated episodes of complete or partial blockage of the upper airway occur during sleep. During an episode of OAE, the diaphragm and chest muscles begin to work harder to open blocked airways and allow air into the lungs. Patients with OAE often experience TMJ dysfunction and signs of nocturnal bruxism. The American Academy of Dental Sleep Medicine classifies sleep bruxism as a movement disorder. To record data on bruxism and OAE, it is advisable to use a home monitoring device. Important indicators are the level of oxygenation, pulse, airway patency, the presence of snoring, the specifics of chest movements and body position during sleep. Once an apnea-hypopnea index score has been recorded in a patient with signs of bruxism, which could potentially indicate the presence of OAE, the dentist should contact the patient's physician for a more detailed diagnosis. If UAE is mild or moderate in severity, a customized intraoral device can be made for the patient, which will prevent tongue retraction and dislocation of the lower jaw, thus ensuring patency of the upper respiratory tract.

Headache

The connection between sleep bruxism, TMJ dysfunction and headaches is well established. Headaches provoke the development of significant discomfort, disruption of normal daily activities and possible further chronification of painful sensations. About 30% of patients with headache suffer from associated functional impairment and do not seek medical help. Patients may describe signs of headache during a history taking during a dental examination.

Tension headaches and migraines

Tension headache (TTH) is the most common form of primary headache, affecting most of the population at least once in their lives. Pain that develops from trigger points in the projection of the masticatory muscle can be either episodic or chronic, and clinically it is quite difficult to differentiate them from migraine pain. Therefore, it is necessary to remember that tension-type headache, as well as TMJ dysfunction, can be characterized by the presence of pain, which is a variant of migraine, although they themselves consist of a migraine-like component. Sometimes there is an overlap of symptoms of several pathologies, which can be interpreted both as diagnostic criteria for TMJ dysfunction and as diagnostic criteria of the International Headache Society. The relationship between TMJ dysfunction and headaches has been described in detail in the literature. Patients with an established diagnosis of tension-type headache or migraine, which can be triggered by temporalis muscle myalgia, may also present with symptoms characteristic of TMJ dysfunction.

On the other hand, patients who have undergone treatment for TMJ dysfunctions also experience a decrease in headache intensity levels. Recent evidence suggests that among patients with signs of vascular pain and migraines, there is an increased prevalence of TMJ dysfunction, since the latter can be interpreted as components of a complex of pain sensations with a specific localization. We should also not forget about the potential role of disorders of the facial nerve and facial muscles, which can also provoke the development of pain.

On October 15, 2010, the FDA approved BoNT-A injections for the prevention of headaches in adults with chronic migraine. The treatment protocol includes selective relaxation of hyperfunctional muscles of mastication or facial expression. The treatment approach is to use the lowest effective dose needed to relieve pain; The dosage of the drug depends on the individual response of each individual patient to the therapy. Again, dentists considering the use of BoNT-A injections are strongly advised to undertake appropriate practical training and follow the principles of existing legislation. However, the mechanism by which BoNT-A relieves migraine pain is not entirely clear. It is believed that botulinum toxin, by turning off muscle tension, reduces the load placed on them, and thus relieves pain associated with bruxism or clenching. However, the release of neuropeptides, especially calcitonin gene-related peptide (CGRP), is considered an integral component of the pathophysiological mechanism of migraine. It was found that BoNT-A not only affects the autonomic nervous system, but also directly reduces the amount of CGRP released by trigeminal neurons. Based on this, it can be assumed that BoNT-A relieves headaches through a direct effect on the central nervous system.

Cervicogenic headaches

Neck pain and neck muscle soreness are common symptoms of primary headaches. The diagnosis of cervicogenic headaches (CHH) refers to cases where the headache develops due to bony structures or soft tissues localized in the neck. The pathophysiology of this condition most likely involves disturbances in one or more muscular, neurogenic, osseous, articular, or vascular structures of the neck. Such lesions are often the result of head or neck trauma, but can develop in the absence of a history of trauma. Clinical signs of CDH may mimic those of primary headache, tension-type headache, and migraine. The diagnosis of CDH can only be made after a thorough history and physical examination. Diagnostic criteria include one or more of the following symptoms: moderate or severe pain in the occipital, frontal, temporal, orbital region of the head, neck and back; intermittent or chronic pain, usually deep and not throbbing; headache triggered by neck movements; or restriction of neck movements. Patients with CDH are usually characterized by a slight forward head tilt. Muscle trigger points are localized in the projection of the suboccipital, cervical and brachial muscles, and with physical or manual stimulation they can provoke the development of headaches in the head area. Studies show that 44.1% of patients with CDH have myofacial pain syndrome associated with TMJ dysfunctions. Moreover, when treating TMJ dysfunctions in patients with CDH, a more effective outcome of pain relief is noted, which allows patients to increase the range of motion of the neck as a whole. Like other pain symptoms associated with myofacial pain syndrome, they also respond well to BoNT-A injections.

conclusions

TMJ dysfunctions are characterized by a set of clinical manifestations that are often painful and lead to limitations in physical activity. However, they are self-limiting and usually respond to conservative treatment, such as BoNT-A injections. The basic principles of treatment are aimed at reducing pain and restoring the range of muscle motion, which helps reduce existing physical limitations and relieve pain of associated etiology. Treatment of TMJ dysfunctions also helps prevent the development of tooth damage and chipped restorations, pathological tooth mobility and periodontal tissue pathologies, which can be associated or caused by bruxism. During the treatment of dysfunctions, some patients manage to simultaneously get rid of night bruxism and relieve chronic pain in the neck and shoulders. If a patient is suspected of having signs of nocturnal bruxism, they should undergo home monitoring for potential obstructive sleep apnea. Despite the generalized nature of pain in the head and neck area, patients with chronic orofacial pain often initially seek help from a dentist. Therefore, the clinician must be theoretically and practically prepared to treat TMJ dysfunctions and relieve associated pain during their daily dental practice.

Authors: Lisa Germain, DDS, MScD Louis Malcmacher, DDS, MAGD

Associated symptoms and what they indicate

You can determine the cause of the pain syndrome if you carefully study its nature. The pain can be acute, throbbing, pressing, mild, and appears only when chewing or pressing. Each of them indicates the presence of different diseases in the body.

Different localization of pain

If pain appears in different places and does not have a clear localization, this may indicate dental and neurological pathologies.
For example, with pulpitis, half of the facial part is affected, on the side of which the diseased tooth is located. In this case, the patient is tormented by shooting pains that manifest themselves in the jaw, temple, cheekbone, and chin. The same is observed with inflammation of the ternary nerve. In this case, the patient also observes a shift in pain from the jaw area to the temporal, zygomatic, and frontal.

Different character

You can determine the cause of discomfort by the nature of the pain :

spicy _ Sharp and acute pain most often develops against the background of an open or closed fracture, neuralgic inflammation, pulpitis, osteomyelitis;
pulsating _ Pulsating sensations can develop against the background of caries, periodontitis, cysts, gingivitis, angina pectoris, otitis media;
aching _ Such sensations signal malocclusion, infectious pathologies, growth of wisdom teeth, neuralgic diseases, dislocations;

Pain in the ear that extends to the jaw and back in some cases indicates the development of infectious diseases, diseases of the jaw and temporal joint, otitis media, tumor neoplasms, and dental pathologies.

Pain occurs when chewing

Pain in the jaw area sometimes does not bother a person at rest, but makes itself felt when chewing food.
Most often, such symptoms indicate the following pathologies :

bruises, dislocations, closed fractures due to accidents, injuries, falls;
dental diseases: pulpitis, periodontitis, alveolitis;
growth of wisdom teeth;
purulent diseases: osteomyelitis, boil, abscess;
tumor neoplasms: osteoma, adamantioma;
carotidynia, inflammation of the ternary nerve.

Reference! Pain in the jaw area, radiating to the ear, often occurs after wearing braces or undergoing surgical treatment.

Pain when pressed

If intense pain in the jaw and chin develops with pressure, this may indicate the following pathologies :

wisdom tooth growth;
injury to the jaw area: dislocation, bruise;
inflammation of the lymph nodes due to viral infections;
purulent processes: abscess, osteomyelitis, phlegmon;
pathologies of the temporomandibular joint due to arthritis, arthrosis;
bite problems;
benign and malignant neoplasms;
neuralgic diseases.

Often pain when pressing occurs against the background of angina or heart attack.

Unilateral/bilateral pain on the right/left

Unilateral pain on the right or left side of the face can signal dental and neuralgic diseases. Discomfort on the right or left often occurs due to a diseased tooth located in these parts. Similar symptoms are observed with pulpitis, periodontitis, caries.

Also, one-sided discomfort can indicate heart disease or the growth of wisdom teeth, inflammation of the ternary nerve. Bilateral pain is typical for bruises, dislocations, and malocclusion.

Jaw cracked

Pain syndrome, which is accompanied by a crunching sound, can signal the progression of the following pathologies :

arthritis, arthrosis;
TMJ dysfunction;
wear of tooth enamel;
injuries;
malocclusion;
neurotic spasms.

A painful jaw crunch occurs when the ligaments are sprained.

The jaw/cheekbone is swollen

Swelling may appear as a result of injury to the problem area.
Swelling often develops after dental surgery. Similar symptoms are observed with purulent abscess, malignant or benign diseases, and enlarged cervical and ear lymph nodes.

A number of other pathologies in which the patient detects puffiness and swelling in the chin area:

odontoma;
cementoma;
osteoma;
odontogenic fibroma.

Swelling sometimes appears as wisdom teeth grow.

Doctor about jaw pain:

Diagnostics and x-ray of the temporomandibular joint

Diagnosis of TMJ when it is dysfunctional is difficult due to the variety of clinical complaints. This leads to the fact that the patient can undergo examination by different specialists for a long time, wasting time. A full examination is carried out by dentists

(primarily an orthopedist or orthodontist) and neurologists.

Diagnosis with the naked eye is difficult, and TMJ problems can only be directly noticed if the malocclusion is clearly visible. Most often, dysfunction of the temporomandibular joint is associated precisely with disorders of bite and jaw closure.

The most reliable and effective way is to conduct x-ray diagnostics and orthopantomogram

jaws. In some cases, an MRI may also be done.

How to relieve the condition at home

In case of fractures or other injuries to the jaw area, the patient is advised to immediately apply a cold compress to the sore spot and not remove it until the doctor arrives.
If dental pathologies cause discomfort, you need to take a painkiller and rinse your mouth with warm soda solution. It is not recommended to take a horizontal position during throbbing and nagging pain, as the discomfort will intensify.

If the pain appears as a result of viral infections and inflammation of the lymph nodes, you need to gargle with a solution of furatsilin or soda with salt, drink an anti-inflammatory antipyretic drug and wait for the ambulance to arrive.

Treatment of the temporomandibular joint

Complex treatment of TMJ is possible only in dentistry, and is possible thanks to:

surgery on the lower jaw;
orthodontic treatment
(prescribing special trainers that will be worn at night and reduce pain by adjusting the load on the joint - the same trainers are recommended for bruxism) and bite correction with braces;
orthopedic treatment
and
implantation
(insert a suitable prosthesis to restore the correct closure of the jaws).

Treatment is always prescribed individually, based on the results of an examination by an orthodontist, and is most often carried out comprehensively. It is dangerous to neglect TMJ diseases: this can lead to arthrosis, in which connective tissue grows in the joint cavity, which, in turn, threatens complete immobilization of the joint (ankylosis).

Severe pain and joint spasms can be relieved with compresses and painkillers; Stresses that provoke tension in the joint can be relieved with sedatives, but all these are half measures that do not treat the root cause of the pain.

Which doctors should I contact?

The choice of doctor for discomfort in the jaw area depends on the pathology that led to such symptoms.
If you have jaw pain, you can go to the following specialists:

therapist (will examine the patient and give a referral to the right doctor);
traumatologist;
dentist;
ENT;
infectious disease specialist;
cardiologist;
neurologist;
oncologist.

Advice! In case of acute abscesses and other purulent pathologies, it is advisable to immediately contact a surgeon.

What kind of diagnostics awaits?

Diagnostic methods are prescribed by the doctor after a thorough examination of the patient and studying his medical history. To make a diagnosis, the following research methods :

laboratory tests to determine the presence of infections, viruses and other pathogenic microorganisms;
radiography;
CT scan;
Magnetic resonance imaging;
arthrography;
electromyography.

If the doctor suspects the development of a malignant tumor, the patient will be prescribed blood tests for tumor markers. If there are lumps and ulcers, a cytological examination is performed (piercing the lump and collecting a fragment of internal secretion). If the patient has enlarged lymph nodes, a biopsy is performed.

What to do if your child’s jaw hurts

Pain in the jaw area in a child can also signal pathologies such as dislocations, bruises, pulpitis, caries, and pharyngitis. It is forbidden to independently engage in diagnostics if a pain syndrome is detected in a child.
Parents should immediately contact a therapist or pediatric dentist, surgeon, or neurologist. If dental problems are detected, children are prescribed medication. In more advanced cases, surgical therapy is used.

For serious injuries, physiotherapeutic procedures or surgical treatment are prescribed. For ENT pathologies, antibiotics, anti-inflammatory medicinal products, and immunostimulating drugs are used. To relieve pain before seeing a doctor, you can give your child half a painkiller tablet. For bruises, apply a cold compress to the problem area.

What is jaw pain like?

Pain in the jaw usually brings very severe discomfort and anxiety.
By nature, they can be acute, sudden, pulsating, or vice versa - aching, chronic, protracted. Often these sensations are so intense that they can even cause a depressed emotional state and depressive disorders [1]. It largely depends on the nature of the pain in the facial area, as well as accompanying symptoms (joint mobility, clicks in it, the presence of swelling, etc.) why the patient’s jaw hurts. During the examination, doctors also pay attention to the localization of sensations - whether they are unilateral or bilateral [1]. It is often difficult to determine exactly whether pain in this area is associated with injury or pathology of the bones, joints, or is caused by some other reason.

Treatment methods, depending on the cause

Depending on the diagnosis made by the doctor, different methods of treating discomfort in the jaw area are used. This may include medication, surgery and herbal medicine.

Medication

For pain in the chin area, anti-inflammatory, analgesic, and antibiotic drugs are used. This method of therapy is effective for the following diseases :

inflammatory diseases of the jaw joint;
infectious pathologies;
viral infections;
dental diseases;
articular and cardiac pathologies.

Important! Drug treatment is also advisable for problems with bones and ENT pathologies.

Surgical

Surgical methods of therapy are used in the following cases :

malocclusion. Orthognathic surgeries are performed to remove facial asymmetry and change the bite;
skeletal deformities of the jaw of the second, third class, developed against the background of injuries and dislocations;
purulent abscess;
dental pathologies requiring tooth extraction.

Surgical treatment is also prescribed in cases where medication has proven ineffective.

What types of operations are performed:

removing the abscess and clearing the wound of pus;
installation of a seal;
installation of artificial dentures or crowns;
surgery to restore bite;
removal of teeth that cannot be treated with medication;
removal of roots.

In oncology, excision of malignant neoplasms and metastases that have developed as the disease progresses is performed.

Physiotherapeutic

Physiotherapeutic procedures are used for pathologies of the temporomandibular joint, as well as after fractures, dislocations and bruises.
Such treatment methods relieve pain, reduce the manifestation of joint noise, swelling, and pulsation.

Physiotherapy for jaw diseases includes the following treatment methods :

transcutaneous nerve stimulation to reduce pain;
procedures using ultrasound to reduce myofascial pain);
short-wave diathermy to reduce the intensity of pain and swelling;
laser therapy to eliminate myogenic pain;
manual therapy to alleviate negative symptoms in temporomandibular pathologies;
home exercises to strengthen muscle and bone tissue.

Ultrasound and laser treatment methods are carried out within a medical institution. Manual therapy is used after a doctor’s prescription and is carried out in specialized offices or at home.

Folk

Traditional methods must be used in conjunction with medication and physiotherapeutic treatment.
Home therapy involves the use of anti-inflammatory compresses and herbal ointments, which reduce the intensity of pain, swelling and discomfort when swallowing.

How to make anti-inflammatory compresses :

Mix one egg yolk with a teaspoon of turpentine, pour 1 spoon of apple cider vinegar into the mixture, mix all ingredients thoroughly. Treat the affected area with the resulting solution 3 times a day;
Grate the black radish on a fine grater, strain the mixture through cheesecloth, add a spoonful of fresh honey, a glass of vodka and a spoonful of salt. Mix all ingredients. Apply the resulting solution to the affected area and leave for 15 minutes. Repeat the procedure 2 times a day.

Advice! In addition to compresses, the patient must remain in bed, exclude hard foods from the diet so as not to injure the jaw, and carry out simple exercises to develop the jaw joints.

Diagnostics

To find out what may be causing your jaw pain, you must immediately consult a doctor for diagnosis and appropriate treatment.

List of sources

Isaykin A.I., Smirnova D.S. Dysfunction of the temporomandibular joint // RMJ. 2021. No. 24. pp. 1750-1755 https://www.rmj.ru/articles/bolevoy_sindrom/Disfunkciya_visochno-nighnechelyustnogo_sustava/#ixzz6EmX7dOtR (access date: 02/23/2020).
Dentistry. Textbook Aleksandrov M.T., Bazhanov N.N., Medvedev Yu.A., Platonova V.V., Sergeev Yu.N. / Ed. N.N. Bazhanova. - M.: GEOTAR, 2008.
Gingivitis and Periodontal Disease (Gum Disease) // WebMD Medical Reference Reviewed by Michael Friedman, DDS on March 17, 2019 https://www.webmd.com/oral-health/guide/gingivitis-periodontal-disease#1 (access date : 02/23/2020).
Fedorova I.N. Bruxism. Unsolved problem. – Moscow, 2009, pp. 1-2.
Bezzubikova M.V. Dental and somatic manifestations of bruxism syndrome // BMIK. 2021. No. 2. URL: https://cyberleninka.ru/article/n/stomatologicheskie-i-somaticheskie-proyavleniya-sindroma-bruksizma (date of access: 01/31/2020).
Why Your Jaw Hurts // WebMD Medical Reference Reviewed by Alfred D. Wyatt Jr., DMD on March 21, 2021. https://www.webmd.com/oral-health/why-your-jaw-hurts#1 (date access: 01/30/2020).
Gaifullina R.F., Kim Z.F. and others. Infarction-like myocarditis: difficulties and solutions in diagnosis // Bulletin of modern clinical medicine. 2021. No. 1. URL: https://cyberleninka.ru/article/n/infarktopodobnyy-miokardit-trudnosti-i-puti-resheniya-v-diagnostike (date of access: 02/23/2020).

Supporting actions

Self-massage of the jaw area is necessary for developing muscles and joints. It is carried out using the following techniques :

stroking;
rubbing (with gentle pressure);
effleurage

Before the procedure, the patient will need to thoroughly wash their hands and treat them with a small amount of oil, which will ensure good gliding of the hands over the skin. After this, you need to walk lightly over the problem area, spending no more than 5 minutes on each part of the body. The total duration of the massage should be within 15 minutes. You can massage the jaw area 2-3 times a day.

Gymnastics should be done only after a doctor’s prescription. It includes a series of strengthening and relaxing procedures that reduce pain and also allow the patient to get rid of crunching in the jaw area.

Examples of muscle relaxation exercises:

the patient massages the chin area for 5 minutes, and then slowly pronounces all the letters of the alphabet, starting with the letter “B” and adding the sound “A” to each of them. The result is the syllables “Ba”, “Va”, “Ga”;
the patient pronounces the letters of the alphabet, while simultaneously massaging the area of the chin and jaw;
to strengthen the ligaments, the patient opens his mouth, stretches out his tongue to the fullest extent and tries to pull it towards the chin, in this position he lingers for 10 seconds. The exercises are repeated 15 times.

Therapeutic exercises can be performed 2-3 times a day. It is advisable that it goes away a few hours after eating. The duration of classes should not exceed 15 minutes. During the process, all movements must be smooth; strong jerks can lead to increased pain.

What to do if you have jaw pain:

Possible complications

If you do not promptly pay attention to the pain in the jaw area that extends to the ear, you may encounter unpleasant complications . Among them:

partial or complete hearing loss;
increased sensitivity of teeth, development of carious processes;
muscle tension, which leads to pain in the back, shoulders, chest;
dizziness, visual impairment, appearance of “spots” before the eyes;
sleep disturbance, insomnia, and resulting depression;
photophobia (fear of bright lighting);
pain in the eyeball area;
the appearance of tumor formations in the jaw area (during oncological processes);
metastasis to vital organs.

In the initial stages of pathology development, the patient has a considerable chance of a full recovery. If you ignore the problem, the risk of encountering unpleasant consequences increases. In such cases, you will have to resort to surgery.

Pain in the jaw area is a serious symptom that signals the progression of many diseases. If discomfort is detected, the patient must take a painkiller tablet, apply a cold compress to the problem area (if damaged) and call a doctor. Such symptoms should not be ignored, as they can lead to problems with hearing or vision.

After recovery, you need to monitor the condition of your teeth, regularly visit the dentist, monitor your diet and the quality of food you eat, avoid stressful situations, and check every year for the presence of cancer processes in the body.