Causes of pain in the jaw when opening the mouth and chewing, what to do

The facial skeleton consists of the upper and lower jaw. The first anatomically consists of two bones with four processes and a body with an air sinus. The lower jaw is unpaired; the temporomandibular joint (hereinafter referred to as the TMJ) is “responsible” for its mobility. Muscles and teeth attached to the facial skeleton are responsible for chewing food, pronouncing sounds, providing facial expressions, etc.

Some people have jaw pain when opening their mouth, and discomfort can also occur when pressing on the bones on one side or both at the same time. Such symptoms indicate various dental and other problems - from jaw fractures and TMJ dysfunction to vascular and heart diseases. Pain in the jaw when opening the mouth is an alarming signal indicating the need to visit a doctor.

Causes of gum disease

If your gums hurt, then naturally you want to know why this is happening. In the development of diseases of the oral mucosa, factors such as diet, smoking, drinking alcohol, and poor-quality orthopedic structures in the mouth play an important role1.

Another important point is the quality of dental care. Poor hygiene leads to the accumulation and attachment of pathogenic microbes to the gums, which penetrate the mucous membrane and trigger the inflammatory process1.

Causes of gum disease3:

1. Injuries (exposure to mechanical and temperature factors, radiation, chemicals).
2. Infections:
   general infectious diseases (syphilis, HIV infection);
3. actually infectious and parasitic diseases of the mucous cavity

mouth (herpes virus, streptococci, staphylococci, candida).

1. Allergies.
2. Autoimmune diseases.
3. Intoxication.
4. Pathologies of organs and systems, metabolic disorders:
   • diseases of the endocrine and nervous systems;

   avitaminosis;

5. diseases of the blood and hematopoietic organs.
6. Treatment of oral diseases3.

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Diseases that cause gum pain

Stomatitis

Stomatitis is an inflammation of the oral mucosa, manifested in the form of redness, swelling, white lesions or ulcers.

The causes of stomatitis can be a local infectious process, systemic pathologies, the influence of a physical or chemical irritant, allergies4.

One of the most common dental diseases affecting the oral mucosa is chronic recurrent aphthous stomatitis3. According to WHO, this problem occurs in 20% of the population6. This form of stomatitis is characterized by alternating periods of remission and exacerbation with the appearance of aphthae on the mucous membrane and gums - round or oval lesions covered with white fibrinous plaque5.

The cause may be allergens (food, toothpaste components, dust, worms and their waste products, medications), disorders of the gastrointestinal tract, respiratory infections, pathologies of the nervous system, hypovitaminosis6.

There are two main forms of chronic aphthous stomatitis—mild and severe3,5,7.

The mild form begins with the appearance of swollen and reddened round or oval spots on the mucous membrane, which cause pain and burning. After 1-2 hours, these areas rise above the mucosa, and after a few hours, aphthae appear in their place, covered with a dense grayish-white fibrous coating. When you touch them, you feel a sharp pain3,5,7.

As a rule, with this form 1-2 aphthae appear, rarely more. Most often they are localized at 5:

• buccal mucosa;
• lips;
• the tip of the tongue and its lateral surfaces.

The occurrence of aphthae may be accompanied by inflammation of the lymph nodes and fever7.

After 2-4 days, the rashes are cleared of plaque, and within another 2-3 days they heal. Recurrence of aphthae is possible either 1-2 times a year or more often, depending on the severity of the disease3,5,6.

Exacerbation can be triggered by factors such as:

• local trauma;
• stress;
• overwork;
• previous viral infection;
• premenstrual syndrome.

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Gingivitis and periodontitis

Inflammatory or destructive processes in the tissues surrounding and holding the tooth in the jaw (gums, periodontium, bone, cement), as a rule, begin with gingivitis - inflammation of the gums, which can develop into periodontitis - inflammation of the gums and periodontium with further destruction of the bone of the interdental septa2.

Gingivitis causes swelling and bleeding of the gums; they hurt and ache when eating and brushing teeth2,3. In the absence of proper treatment, gingivitis turns into periodontitis - periodontal pockets deepen, bad breath appears, and teeth begin to loosen. At a later stage, tooth loss may occur2. The cause of the development of gingivitis and periodontitis in most cases are microbes that attach to the surface of the tooth above and below the gum, forming the basis of plaque3. Bacterial waste products - toxins and enzymes - cause inflammation in the gums3.

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Alveolitis

Alveolitis is a common complication after tooth extraction, when the bone socket is not filled with a blood clot, but remains empty, and infection penetrates there8. The main causes of development are pathogenic microbes that live in periodontal tissues and trauma associated with complex tooth extraction9.

With alveolitis, 1-3 days after tooth extraction, the gum under its socket becomes red, swollen and painful. The pain may radiate to the temple and ear areas. General manifestations are also possible - increased body temperature, sleep disturbances, enlarged and painful lymph nodes9.

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Associated symptoms

Pain in the jaw when yawning, opening the mouth and chewing is a common symptom for numerous diseases. An analysis of the accompanying symptoms helps to find out why the jaw hurts. The presence/manifestation is taken into account:

• Increased body temperature.
• Runny nose, sore throat, sinuses, ear.
• Hearing impairment.
• Pain in other joints of the body.
• Weakness, dizziness.
• Joint and bone deformities.
• Ulcers on the skin or in the mouth.
• Toothaches.
• A crunching sound in the joint when the mouth opens.
• Severe pain: when a fracture occurs, the jaw hurts so much that the mouth cannot open.
• Increased pain in the joint when turning the head to the left or right.
• Enlarged lymph nodes.

With dysfunction of the temporomandibular joint (TMJ), headaches may occur; a person is constantly accompanied by a crunching sound in the jaw.

What to do if your gums hurt

Treatment of inflammatory diseases of the gums and periodontium is one of the most pressing problems in dentistry10. Regardless of the diagnosis, thorough brushing of teeth and sanitation of the oral cavity are mandatory steps2.

If a patient has gum pain, the doctor determines how to treat it, depending on the cause of the disease: for candidiasis, antifungal drugs are used, and for a bacterial infection, antibiotics are used. Sometimes it may be necessary to remove tartar, replace fillings, or surgically repair the frenulum or vestibule2.

Since inflammatory diseases of periodontal and gums are classified as infectious, normalization of the microflora of the oral cavity is an essential element of treatment10.

Dental gel for gums with antimicrobial action METROGIL DENTA®11 can be used in therapy. The product is characterized by antiseptic and anti-inflammatory effects6. Indications for use11:

1. Acute and chronic gingivitis.
2. Acute ulcerative-necrotizing gingivitis of Vincent.
3. Acute and chronic, as well as juvenile periodontitis.
4. Periodontal disease complicated by gingivitis.
5. Aphthous stomatitis.
6. Cheilitis (inflammation of the lips).
7. Inflammation of the oral mucosa due to wearing dentures.
8. Alveolitis.
9. Periodontitis, periodontal abscess (as part of complex treatment)11.

The effect of the gel is provided by a combination of 1% metronidazole and 0.25% chlorhexidine in stable concentrations10,11

According to studies, already 30 minutes after applying METROGYL DENTA®, the number of pathogenic bacteria significantly decreased10. It has been shown that with mild forms of gingivitis and periodontitis, the oral microflora is normalized after 2-3 applications of the gel, with moderate periodontitis - after 3-5 procedures, and with severe periodontitis - after 5-7 procedures10. According to the results of the study, after using the drug, most patients note the disappearance of pain and itching in the gums, and the absence of bleeding10.

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Diagnostics

If a person has a sore jaw near the ear and it hurts to open his mouth, he should see a doctor as soon as possible. You should contact a dentist or therapist; if you have an injury, contact a traumatologist or surgeon. If the dentist does not identify a dental cause for the pain, he will refer the patient to an appropriate specialist.

Various tests may be needed for diagnosis:

• X-ray of the jaw.
• MRI.
• Examination by an otolaryngologist using special instruments.
• Blood analysis.
• Bacterial culture of purulent discharge.

Which doctor should I contact?

Only a dentist can accurately answer the question of what to do if your gums hurt. Many people, faced with gingivitis, periodontitis, diseases of the oral mucosa and even injuries, self-medicate12. The source of information about medications in most cases is not the attending physician at the appointment, but the Internet, television, radio, as well as advice from relatives and friends12. It is important to understand that self-medication can lead to the development of a number of complications12.

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The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Bibliography

1. The state of the dental status of the adult population depending on the presence of diseases of the oral mucosa / Mama before in R. M., Alizade A. R., Ibragimova L. K., Gamzaev B. M. // Problems of dentistry. - 2013. - No. 5. - P. 18-20.
2. Prevention and treatment of diseases of the oral mucosa. Omarova K.V. // Bulletin of Surgery of Kazakhstan. - 2011. - No. 4. - P. 128.
3. Therapeutic dentistry. Textbook / Borovsky E. V. Ivanov V. S., Maksimovsky Yu. M., Maksimovskaya L. N. / Moscow, 2011.
4. Stomatitis. MSD Handbook. Professional version - URL
5. Main diseases of the oral mucosa. Borodovitsina S.I. et al. /Ryazan: Atlas, 2021.
6. Chronic recurrent aphthous stomatitis. Maltabarova B. A. // Bulletin of Surgery of Kazakhstan. - 2011. - No. 3. - P. 106.
7. Chronic aphthous stomatitis in the practice of a dental therapist (literature review). Kosaeva Sh. K. // Bulletin of the Kazakh National Medical University. - 2014. - No. 1.
8. A new word in the treatment of alveolitis. Shlegel Yu. V., Hartman R. V. // Medico-pharmaceutical journal “Pulse”. - 2007. - No. 4. - P. 412-413.
9. Prevention and treatment of alveolitis / Rodionov N. T., Andreeva E. P., Dobrorodova S. V., Stoletnaya T. P. // Bulletin of the Smolensk Medical Academy. - 2010. - No. 2. - P. 110-111.
10. Dental gel for gums “Metrogil Denta®” in the treatment of periodontal diseases and oral mucosa // Practical Medicine. - 2009. - pp. 105-106.
11. Instructions for medical use of the drug METROGYL DENTA®.
12. Self-treatment of periodontal diseases and oral mucosa. / Tsepov L. M. et al. // Bulletin of the Smolensk State Medical Academy. — 2021.

Prevention

Treatment for pain in the jaw near the ear when opening the mouth can be very difficult and lengthy. Therefore, it is better to take care in advance to ensure that such a symptom does not appear. This requires prevention of those diseases that affect the jaw, joint structures and tissues located nearby:

• When talking, yawning and biting food, do not open your mouth too wide.
• You should not get carried away with too hard and viscous food - it can harm not only your teeth, but also your joints.
• It is necessary to avoid drafts and hypothermia, contact with infectiously infected people.
• A varied diet is needed to provide bone and cartilage tissue with all the beneficial substances.
• After installing the prosthesis on one or both sides, you should carefully check its compliance with the anatomical shape of the jaw: you need to open and close your mouth, try to close your teeth. If discomfort is felt, the prosthesis will have to be adjusted.
• It is necessary to treat diseased teeth in a timely manner so that the infection does not penetrate into the maxillary or mandibular bone.
• If your jaw suddenly begins to hurt on the left or right side, you should immediately consult a doctor - such a symptom may indicate a dangerous disease that requires urgent treatment.

If your jaw joint hurts when opening your mouth, do not put off going to the dentist. It is not recommended to rely on self-medication, since advanced diseases associated with such symptoms can be life-threatening.