Pain in the lower jaw - causes, diagnosis and treatment

Pain in the jaw when opening the mouth, localized anterior to the ear canal (anterior to the ear) is one of the main signs of problems with the temporomandibular joint (see “TMJ dysfunction”), which provides a mobile connection between the lower jaw and the skull.

Pain in the jaw joint can have varying degrees of severity, intensify when opening and closing the mouth, and be accompanied by difficulty and sometimes impossibility of opening the mouth. May be accompanied by various “noise effects” in the joint area: clicking (see “Clicks when opening the mouth”), grinding, creaking (see “Crunching when opening the mouth”). And also tinnitus. But all these signs, if left unattended, can soon have quite unpleasant consequences for the patient.

During a direct examination by a specialist, you will be able to find out your exact diagnosis, as well as receive a referral for diagnosis or a treatment plan.

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Why does pain occur in the lower jaw?

Purulent diseases

The cause of pain is inflammation of the bone, periosteum or nearby soft tissue. In 70-80% of cases the disease is of odontogenic origin. Less commonly, the process is provoked by acute infections and jaw injuries. Complemented by edema, hyperemia, general condition disorder, intoxication syndrome, regional lymphadenitis. Pain is observed in the following pathologies:

Periostitis.
The symptom is more pronounced in acute purulent periostitis. The pain is sharp, pressing or boring, radiating to the eye, ear, temple, neck. Intensifies when opening the mouth. Weakness, low-grade fever, and swelling of the cheeks are noted. In chronic periostitis, the pain is periodic, moderate or mild, pressing or bursting. The contours of the face are slightly changed.
Osteomyelitis.
Characterized by a sudden manifestation with a rapid rise in temperature to febrile levels, chills, and severe intoxication. The pain is shooting, pulsating, diffuse, radiating to the neck and half of the face. They get worse when swallowing, limiting mouth opening. The teeth are mobile, pus is released from the gums. The oral mucosa and skin of the chin become numb. In chronic osteomyelitis, the symptom increases after closure of the fistula, decreases or disappears after the outflow of pus resumes.
Perimaxillary abscess.
The formation of an abscess is preceded by toothache. Then dense swelling occurs. The pain quickly intensifies, and the symptoms of intoxication increase. The patient refuses food. After spontaneous opening, the manifestations disappear; in the absence of treatment, chronicity with periodic exacerbations, resumption of pain and suppuration is more often observed.
Perimaxillary phlegmon.
Typically acute onset with rapid progression of local manifestations, purulent-resorptive fever. The pain is jerking, aggravated by talking, chewing, and moving the lower jaw, and is complemented by increased salivation and the formation of a diffuse infiltrate with a fluctuation zone. The condition continues to deteriorate due to severe intoxication.

Traumatic injuries

Injuries to the lower jaw most often result from fights. Damage due to falls, car accidents, or industrial accidents is possible. In case of a bruise, the asymmetry of the face is caused by swelling of the soft tissues; the closure of the teeth is normal. The symptom is moderate, quickly decreases, and does not create serious obstacles to articulation or food intake.

Among the fractures, injuries to the body predominate; violations of the integrity of the angle and branches are less common. Half of the fractures are bilateral. At the time of injury, a sharp explosive pain occurs, decreasing only slightly over time, intensifying when talking, biting, or chewing. Possible numbness of the chin and lower lip. Facial asymmetry, articulation disorders, stepped dentition, mobility, and sometimes tooth dislocations are noted.

Fractures of the alveolar process of the lower jaw are less common than the upper jaw; they develop from impacts, falls from a height, etc. They are accompanied by intense spontaneous pain, which intensifies when swallowing or attempting to close teeth. The mouth is half-open, and the protruding edge of a bone fragment can be seen under the mucosa. The bite is broken, the teeth are mobile, dislocations are possible.

Pain in the lower jaw

Neuralgia

The symptom is accompanied by trigeminal neuralgia involving the 3rd branch (n.mandibularis). It is provoked by external factors (shaving, cold air, water), stress on the masticatory muscles. Prosopalgia is paroxysmal in nature and is a series of pain impulses that are felt like a lumbago or electric shock from the side of the face along the lower jaw to the chin. The pain is sudden, lasts several minutes, reaches such intensity that the patient freezes, does not move, does not speak.

With neuralgia of the glossopharyngeal nerve, the pain impulse is caused by chewing, swallowing, talking, lasts from several seconds to 3 minutes, occurs at the root of the tongue, spreads through the tonsils, palate, pharynx, ear. Radiating pain in the lower jaw. In patients with ganglionitis of the submandibular node, the pain is paroxysmal, burning, boring, pulsating. Lasts from 1 minute to 1 hour. They begin in the tongue, spread to the lower jaw, temple, back of the head, neck, and shoulder girdle.

Muscle damage

Bruxism is formed due to spasm of the masticatory muscles. After night attacks, patients are bothered by pain in the jaws, caused by clenching and intense movements relative to each other. Muscle pain, dental pain, headaches, dizziness, and drowsiness are possible. With myofascial syndrome, pain develops due to overload of the masticatory muscles. It is perceived as moderately expressed and deep. At first it appears only under load (chewing, clenching the jaws), then it increases and becomes constant.

Dental reasons

The symptom is disturbing in the first days after tooth extraction. It is especially pronounced in the presence of an inflammatory process, removal of impacted or incorrectly erupted wisdom teeth. Some patients report pain due to wearing braces and dentures. Aching, pressing or pulling pain in the jaw and masticatory muscles, problems with chewing and swallowing, biting the cheeks and tongue are detected in children with malocclusion.

The cause of severe progressive paroxysmal pain, which spreads to the entire lower jaw and intensifies at night, is acute diffuse pulpitis. Prolonged intense pain under the influence of external stimuli, spontaneously occurring pain attacks are also observed during the period of exacerbation of chronic pulpitis. Irradiation along the trigeminal nerve is typical. Between attacks, moderate or minor aching pain is possible, aggravated by biting.

Tumors of the lower jaw

Pain syndrome is characteristic of a number of odontogenic and non-odontogenic benign neoplasms. Distinctive features of such neoplasias are slow growth and lack of germination of surrounding tissues:

Odontogenic fibroma.
More often diagnosed in children. The pain is aching, not intense, and does not occur in all patients. It can be combined with tooth retention and inflammation in the affected area.
Cementoma.
As a rule, it is localized in the area of molars or premolars of the lower jaw. The course is asymptomatic or with minor pain that increases with palpation.
Osteoma.
Accompanied by pain, facial asymmetry, slowly increasing over months or years. Large tumors limit the mobility of the lower jaw.
Osteoid osteoma.
Unlike other neoplasms, the pain is sharp, intense, intensifying at night and when eating. The face is asymmetrical, in the oral cavity there is a bulge in the area of premolars or molars.
Osteoblastoclastoma.
More common in adolescence and young adulthood. Facial asymmetry, tooth mobility, aching, bursting pain gradually progress. Over time, fistulas form over the neoplasia. Pathological fractures are likely.

Malignant neoplasms of the lower jaw are found less frequently than benign ones. Cancer is characterized by a rapid increase in pain, radiating to the cheek, ear, eye, and temporal region. Accompanied by mobility, tooth loss, germination of masticatory muscles, salivary glands, and ulceration. Osteogenic sarcomas rapidly progress and quickly infiltrate soft tissues. Over the course of several months, the pain increases from moderate, pressing, aching or bursting to constant, unbearable, and can only be eliminated with narcotic analgesics.

Cardiac ischemia

Irradiation into the lower jaw can be observed with angina pectoris and myocardial infarction. Painful sensations are caused by the spread of impulses from the heart to the upper thoracic segments of the spinal cord, from there, along other nerves - to the face, neck, left arm, left shoulder blade. The main symptom is burning, pressing, squeezing or bursting pain behind the sternum.

An attack of angina lasts several minutes and is eliminated after stopping physical activity and taking nitroglycerin. During a heart attack, the pain is wave-like, very intense, lasts more than 30 minutes, and does not disappear when using the methods listed above. In the atypical course of a heart attack and coronary artery disease, retrosternal pain may be absent, only reflected pain is observed, including in the jaw.

Associated symptoms

Not only pain syndrome can indicate the development of diseases of teeth and gums. Warning signs are also:

bad breath,
bleeding gums,
swelling of the cheek or lip,
redness and swelling of the gums,
mobility of teeth,
local temperature increase.

Have you noticed several of the listed signs at once? Make an appointment with a dentist. An experienced doctor will help eliminate the problem and maintain dental health.

Diagnostics

Diagnostic measures are carried out by a dentist or maxillofacial surgeon. According to indications, a neurologist, cardiologist, and other specialists are involved in the examination. The doctor determines the nature of the symptom, its changes since its onset, and its dependence on external factors. Identifies other complaints, conducts a general and dental examination to detect objective changes (hyperemia, edema, decayed teeth, asymmetry). To make a final diagnosis, data from studies such as:

Radiography
. Informative for injuries, purulent processes (except for the acute stage), tumors, and some dental pathologies. Helps confirm the presence of a fracture, identify other bone changes, differentiate osteomyelitis and periostitis from inflammation of the surrounding soft tissues, distinguish between benign and malignant neoplasms.
CT scan
. CT scanning of the jaw provides more accurate data on the condition of hard structures compared to radiography. It is carried out when the diagnostic value of x-rays is insufficient, there is a need to clarify the location of fistulas, the nature of injuries and neoplasia. A CT scan of the skull makes it possible to determine the narrowing of the foramina, which causes compression of the nerve with the development of neuralgia.
Magnetic resonance imaging.
Recommended to exclude tumor and vascular origin of compression of the nerve trunk. Detects cysts, neoplasia, aneurysms, and tortuosity of vessels passing next to the nerve.
Electrophysiological studies
. Electromyography allows you to confirm pathological muscle activity during myofascial pain, bruxism, and assess the quality of neuromuscular transmission during neuralgia. Electroneurography makes it possible to determine the extent and level of nerve damage. An ECG is indicated for patients with suspected ischemic heart disease.
Invasive techniques
. A lymph node biopsy is performed when the submandibular or cervical lymph nodes are enlarged in patients with tumors. For perimaxillary phlegmon with a deep location of the purulent focus, a diagnostic puncture may be required to verify the diagnosis.
Lab tests
. The causative agent of purulent processes is determined by inoculating the discharge on nutrient media. For neoplasms, a morphological study is performed to determine the type and degree of malignancy of neoplasia.

Consultation with an oral and maxillofacial surgeon

Causes

The TMJ connects the lower jaw and the temporal bone of the skull. This is a very mobile joint, actively moving during speech, chewing, swallowing, and if its normal functioning is difficult, then the person’s quality of life suffers significantly. The tissues surrounding the joint have many nerve endings, and even minor disturbances in the functioning of the TMJ lead to discomfort, pain and deterioration in the general condition of a person. A complete clinical and instrumental examination will allow us to find out the exact cause of the pain and differentiate the pathology from other problems in the maxillofacial area.

Treatment

Conservative therapy

Therapeutic tactics are determined by the cause of the symptom. For patients with dental pathologies, local treatment is indicated. Removable dentures and orthopedic structures are replaced, and other types of prosthetics are selected. In case of pulpitis, the cavity is treated with antiseptics, antibiotics, proteolytic enzymes, pastes are applied to eliminate inflammation and stimulate regeneration, and after a few days a filling is performed. For other diseases, the following methods are recommended:

Inflammatory processes
. Antibiotic therapy is carried out in the pre- and postoperative period. At the initial stage, broad-spectrum drugs are administered parenterally. After receiving culture results, the medication is changed taking into account antibiotic sensitivity. Dressings are performed and rinsing is performed. Analgesics are prescribed to reduce pain.
Traumatic injuries
. In case of fractures of the angle, the body of the lower jaw without displacement, conservative immobilization is carried out by double-jaw wire splinting. To prevent inflammation, antibacterial agents are used, and painkillers are used to reduce pain.
Neuralgia
. Anticonvulsants are used to eliminate pain attacks. To enhance the effect, the treatment program is supplemented with antispasmodics, antihistamines, and microcirculation correctors. Trigger point blockade is carried out with a mixture of glucocorticoids and local anesthetics. They give a referral for ultraphonophoresis and galvanization with novocaine.
Muscle pathologies
. For bruxism, an integrated approach is effective, including medication, dental, physiotherapeutic, psychotherapeutic methods, and the use of protective mouthguards. Patients with myofascial syndrome are prescribed muscle relaxants, NSAIDs, and antidepressants.
IHD
. As part of drug therapy, antianginal agents, beta-blockers, calcium channel blockers, antioxidants, antiplatelet agents, and antisclerotic drugs are indicated.

Surgery

The choice of surgical technique depends on the cause of the symptom:

Inflammatory diseases
: opening, drainage of abscesses and phlegmons, sequestrectomy for osteomyelitis.
Injuries
: open osteosynthesis using bone sutures, polyamide thread, mini-plates.
Neoplasms
: curettage, excision of benign neoplasia within healthy tissue (often with extraction of teeth), resection or disarticulation of the lower jaw for a malignant tumor.
Neuralgia
: microsurgical decompression, percutaneous radiofrequency destruction, stereotactic radiosurgery.
IHD
: thrombolysis, emergency coronary angioplasty in the acute period of a heart attack; planned coronary artery bypass surgery, balloon angioplasty for angina pectoris, post-infarction conditions.

Advanced carious process

If the pathology is caused by dental diseases such as caries, pulpitis, periodontitis, as well as their complications (flux, cyst, abscess, granuloma, fistula), then not only does the head hurt, but also the diseased teeth, and sometimes the entire jaw, cramp.

Pulpitis causes severe pain in the tooth and surrounding tissues.

At first, short aching sensations occur only in response to some irritant (food temperature, mechanical impact). But if the pathology is started, the pain appears involuntarily and does not go away for a long time, it radiates to all adjacent areas, and often does not have a clear localization.

Comments

My wisdom teeth came out. While they were climbing and after that, my head and jaw ached for some time. Then everything went away. I didn't go to the doctor. Now the pain has appeared again, and I noticed as if my front teeth began to run into each other, although this had not happened before. If it's because of wisdom teeth, will removing them help straighten the remaining teeth?

Olga (12/17/2020 at 04:10) Reply to comment

Editorial staff of the portal UltraSmile.ru (12/21/2020 at 09:12) Reply to comment

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What to do if your jaw hurts near your ear when you open your mouth and when you chew

Without a diagnosis, a person cannot choose the correct treatment - which is why jaw diseases cannot be treated on their own. In addition, some of the listed pathologies are useless to treat without hospital conditions.

Although the patient himself is not able to cure such a symptom, sometimes urgent help is required at home, as the pain can be very severe. Following these recommendations can help reduce discomfort:

You cannot heat the jaw area near the ear : if there is a purulent-inflammatory process, such manipulations will provoke a rapid release of pus and its spread into the bloodstream, which threatens intoxication and general infection. To relieve discomfort, you can apply a cool compress, but only if the pain is not caused by an infection.
Yawning, chewing, and opening your mouth should be done very carefully.
To prevent pain from intensifying, you need to temporarily avoid hard and sticky foods, which require increased chewing load. You can't chew gum.
If it hurts to open your mouth, conversations should be reduced to a minimum.
If a patient has a jaw injury - he cannot open his mouth, yawn, or speak - you need to call an ambulance and try to provide maximum rest to the damaged joint. Moving the jaw and turning the head can cause bones to shift. For open fractures, the skin around the wound is treated with an antiseptic. If there are bone fragments, they should not be touched.

Hypothermia, viral and infectious diseases

A symptom such as simultaneous pain in the head, jaw and teeth can be caused by simple hypothermia (for example, you were blown by a strong wind, caught in the rain, got wet feet and froze), as well as any infectious and viral disease, for example, acute respiratory viral infections, acute respiratory infections , flu. During this period, the body temperature rises, a cough and runny nose begins, all adjacent organs swell, and general malaise is noted.

It is very important to emphasize that against this background, immunity decreases and dental diseases, if they occur, worsen or progress. For example, perhaps you had caries, the symptoms of which you did not pay attention to for a long time, and during the period of illness it begins to progress and can lead to pulpitis, the formation of gumboil on the cheek.

Viral and infectious diseases can aggravate dental diseases and cause swelling

Decayed teeth or missing teeth

It would seem that if there are no teeth, there are no problems. However, this is not the case, especially if you are in no hurry to restore the “gaps” with prosthetics or implantation. Even if there is one or more damaged teeth in the mouth (due to injury or caries), the neighboring elements of the row are forced to work more actively, the muscles in certain areas tense more, and the person himself adapts, chewing food only on the comfortable side of the jaw. Result: overload and disruption of the temporomandibular joint.

If a tooth is missing, the load is distributed to adjacent units, which can cause pain

Absolutely the same thing happens if a person is missing 1-2 or more teeth. It’s just that the more defects there are in the mouth, the more negative the consequences for the neighboring elements of the row and the jaw apparatus as a whole.

Neurological pathologies

Neurogenic pain, i.e. sensations caused by pathologies of the facial or trigeminal nerve often occur after hypothermia, head and face injuries. They are always accompanied by a number of additional symptoms, which makes it possible to determine nerve damage.

Why does it hurt to open your mouth?

It is recommended to use anti-inflammatory drugs, painkillers, warming procedures, and neuroprotectors

Opening the mouth is accompanied by pain because the affected nerve is irritated.

The nature of the sensations and accompanying symptoms

The pain can be completely different in nature.

Associated symptoms depend on which nerve is affected - pain in neighboring areas of the face, dry mouth, impaired facial expressions, cough, sore throat, swallowing problems, sore throat, inability to chew, impaired diction.

Treatment methods

The use of anti-inflammatory drugs, painkillers, warming procedures, and neuroprotectors is recommended. Operative methods are ineffective.

Strong galvanic currents in the oral cavity

We are talking about such a phenomenon as galvanism, and about a disease such as galvanosis. The pathology is associated with the appearance of galvanic currents in the mouth and their increased effect on the body. It is typical for people who have prostheses with a metal component. Naturally, the reaction does not occur out of nowhere, but due to individual intolerance to certain metal alloys, heterogeneous potential of metals (if there are several different structures in the mouth), poor quality of materials and violation of their manufacturing technology.

The disease can be caused by metal structures installed in the mouth

Night grinding of teeth

In another way, this phenomenon is also called bruxism. Since jaw clenching occurs mostly at night, and this happens involuntarily, many people remain unaware that they suffer from this disease for a long time. As a rule, relatives and friends report the pathology. But you can suspect something is wrong yourself by the following symptoms: weakness, fatigue, tension, headaches and jaw pain in the morning, that is, immediately after sleep. Also, many patients experience increased sensitivity and abrasion of the enamel, the formation of chips and cracks in hard tissues.

Bruxism can also cause discomfort