What is Orofacial Pain?

Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles or temporomandibular joint. Problems can include temporomandibular joint discomfort; muscle spasms in the head, neck and jaw; migraines, cluster or frequent headaches; or pain with the teeth, face or jaw.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. Pain also can be caused by clenching or grinding teeth, trauma to the head and neck or poor ergonomics.

Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while others experience clicking when moving the jaw or even locking if the jaw is opened or closed.

Temporomandibular disorders (TMD)

The National Institutes of Health estimates that 5 to 10 percent of Americans have TMD, or problems affecting the jaw joint and/or muscles. Your temporomandibular joints are located where the skull connects to your lower jaw. To feel these joints, place your fingers in front of both ears and open your mouth. The muscles on the sides of your head and face control the movements of the joints. Researchers believe women between 20 and 40 may be more likely to suffer from TMD due to hormone levels.

Headaches

Approximately one in eight Americans suffer from headaches. Experts estimate that 75 percent of all headaches are caused by muscle tension, which may be related to the bite. Headaches also can be caused by clenching jaw muscles for long periods of time. Signs that may indicate a headache of dental origin include:

• Pain behind the eyes
• Sore jaw muscles or "tired" muscles upon awaking
• Teeth grinding
• Clicking or popping jaw joints
• Head and/or scalp is painful to the touch
• Earaches or ringing in the ears
• Neck, shoulder or back pain
• Dizziness

Sleep disorders

If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing disorder, such as snoring or sleep apnea. Bruxism is the technical term for grinding and clenching. Snoring that goes undiagnosed may lead to an increased tendency for the airway to collapse, leading to sleep apnea. Sleep apnea is a condition when the tissues and muscles in the back of the throat collapse the airway. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Are there any treatments available?

Your dentist has a variety of treatments that can help alleviate your orofacial pain. One device is called an orthotic, or splint, that is worn over the teeth until the bite can be stabilized. Permanent correction may require reshaping teeth, building crowns, orthodontics or a permanent appliance for the mouth. Your dentist might also recommend physical therapy, counseling, relaxation training or massage therapy.

Other ways to alleviate the pain include:

• Place an ice pack on the painful area for 10 minutes, three or four times per day.
• Eat softer foods and avoid chewing gum or ice.
• Cut food into smaller pieces.
• Keep upper and lower teeth slightly apart, except when chewing or swallowing. Keeping your tongue between your teeth may help with this.
• Sleep on your back.
• Don't rest your hand on your chin. When talking on the phone, don't rest the receiver on your shoulder.

What else will my dentist do?

Your dentist will take a medical and dental history to determine if any trauma has occurred in the facial area, perform a physical examination to examine your temporomandibular joint and head and neck. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort.

What Causes a Toothache?

While decay often is cited as the primary cause of a toothache, it's important for you to have a complete oral examination to determine the cause. Other dental causes of a toothache include: infection, gum disease, grinding teeth (bruxism), tooth trauma and an abnormal bite. Tooth eruption may be the cause of tooth or jaw pain in babies and school-age children.

TMJ, sinus or ear infections and tension in the facial muscles can cause discomfort that resembles a toothache, but often these health problems are accompanied by a headache. Pain around the teeth and the jaws can be symptoms of heart disease such as angina. If your dentist suspects a medical illness could be the cause of your toothache, he or she may refer you to a physician.

Why does my toothache?

You may have a dental cavity or advanced gum disease. The first sign of decay may be the pain you feel when you eat something sweet, very cold or very hot. If the pulp – the inside of the tooth that has tissue and nerves – has become irritated, this can cause pain in your tooth.

What are the symptoms of a toothache?

Because the symptoms of a toothache may resemble other medical conditions or dental problems, it can be difficult to diagnose the cause without a complete evaluation by your dentist. If you notice pus near the source of the pain, your tooth may have become abscessed, causing the surrounding bone to become infected. Or the pus could indicate gum disease, which usually is characterized by inflammation of the soft tissue and abnormal loss of bone surrounding the teeth.

Contact your dentist immediately if you have any of the following symptoms:

• Fever
• Difficulty breathing or swallowing
• Swelling around the tooth area
• Pain when you bite
• A foul-tasting discharge

How do I alleviate the pain if I cannot see my dentist right away?

Anyone with a toothache should see a dentist at once for diagnosis and treatment because, if left untreated, your condition can worsen. However, if you are unable to schedule an emergency appointment, a self-care treatment can temporarily alleviate pain and inflammation from a toothache:

• Rinse with warm salt water.
• Gently floss teeth to dislodge any food particles trapped between teeth.
• Take an over-the-counter pain reliever such as aspirin, ibuprofen or acetaminophen to relieve pain. If your child has a toothache, use acetaminophen.
• Never put aspirin or any other painkiller against the gums near the aching tooth, as it may burn the gum tissue.
• Apply an over-the-counter antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Direct application of oil of cloves (eugenol) may also help to numb the gums. The oil may be rubbed directly on the sore area or soak a small piece of cotton and apply it to the sore tooth.
• If there has been some trauma to the tooth, a cold compress may be applied on the outside cheek to relieve pain or swelling. If your tooth has been knocked out, forced out of position, loosened or fractured, visit the dentist's office or a hospital emergency room immediately.

How can my dentist help?

Your dentist will conduct a complete oral examination to determine the location and cause of the toothache, looking for signs of swelling, redness and obvious tooth damage. He or she may also take X-rays looking for evidence of tooth decay between teeth, a cracked or impacted tooth or a disorder of the underlying bone – problems that the dentist may not be able to find through a routine exam.

Your dentist also may prescribe pain medication or antibiotics to speed the healing of your toothache. If, by the time you see your dentist, your tooth has become infected, then treatment could require removal of the tooth or a root canal procedure, which involves removing the damaged nerve tissue from the middle of a tooth.

Is there a way to prevent a toothache?

The key to preventing toothaches is establishing a regular oral hygiene routine and sticking to it. For example, failure to brush and floss regularly after meals can significantly increase your risk of developing cavities. After you eat, bacteria in your mouth feed on sugar and starch and produce acid that can "eat" a hole (or cavity) in your tooth's enamel. If the cavity is not filled, it can cause considerable pain and potentially destroy the dentin, pulp and the tooth's nerve.

Here are a few tips to help reduce your risk for developing a toothache:

• Brush at least twice a day, preferably after every meal and snack.
• Floss once a day to prevent gum disease.
• Visit your dentist twice a year for oral examinations and a professional cleaning.

Headaches and Jaw Pain? Check Your Posture!

If you experience frequent headaches and pain in your lower jaw, check your posture and consult your dentist about temporomandibular disorder (TMD), recommends the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing dental education.

Poor posture places the spine in a position that causes stress to the jaw joint. When people slouch or hunch over, the lower jaw shifts forward, causing the upper and lower teeth to not fit together properly, and the skull moves back on the spinal column.

This movement puts stress on muscles, joints and bones and, if left untreated, can create pain and inflammation in muscles and joints when the mouth opens and closes.

"Good posture is important, yet many people don't realize how posture affects their oral health," says AGD spokesperson Ludwig Leibsohn, DDS.

Dr. Leibsohn treats patients who have complained of facial pain. "Their posture often is unbalanced, and this rearranges the position of the facial muscles, causing the bumps and grooves on the upper and lower teeth not to fit properly together," said Dr. Leibsohn.

An oral appliance can help align the teeth in a position that will reduce facial pain caused by poor posture. The appliance can also prevent future damage to teeth.

 

Frequent Headaches? Can't Sleep? Check Your Bite

The average person swallows 2,000 times per day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related health problems, such as frequent headaches or sleep disorders, because their jaw muscles must work harder to bring the teeth together, straining the surrounding jaw muscles.

This strain, know as orofacial pain, is defined as any pain in or around the face. Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while other experience clicking when moving the jaw.

Orofacial pain can also be caused by temporomandibular disorder (TMD), stress, nerve disorders or muscle spasms. Serious causes of orofacial pain are tumors in the jaw bone area, oral cancer or referred pain from cardiac disease.

"At the first sign of discomfort, see your general dentist," says Academy of General Dentistry spokesperson Peter G. Bastian, DDS, MAGD. "He or she knows your mouth best and how you handle day-to-day stress."

Sometimes orofacial pain may be difficult to diagnose if its origin is not localized in one area.

"Your dentist will try to diagnose the pain source by conducting tests to rule out a cracked tooth, the need for root canal, gum disease, clenching or tooth grinding," says Dr. Bastian. These factors can cause discomfort in the facial region but can be easily addressed."

Orofacial pain that lasts longer than 10 days to two weeks or is not related to a specific stressful event, such as a car accident, may signal a more serious problem requiring additional tests.

Common symptoms of orofacial pain:

• Pain behind the eyes
• Sore jaw muscles
• Teeth grinding
• Clicking or popping of joints
• Head/scalp painful to the touch
• Earaches or ringing
• Neck, shoulder or back pain
• Dizziness