An Overview of Jaw Pain

Finding out what causes jaw pain can be difficult, mostly because there are numerous sources from which the pain can originate, such as muscles, bones in the jaw, teeth, or areas of the body you do not necessarily suspect, like your ears, sinuses, or even your heart.

Pain is your body's way of signaling that something is wrong—you're grinding your teeth, you have an infection, or you have a joint disorder, for example—so getting to the bottom of your jaw pain is important, not only for your comfort but also to fix the underlying problem, which can be serious.

The most common causes of jaw pain are dental issues and disorders that affect your temporomandibular joint, the joint that connects your lower jaw bone to your skull.

The most common presenting signs and symptoms of temporomandibular joint disorder include jaw tenderness that may feel like a toothache, as well as headache or an earache. The pain may get worse when chewing food and a person may hear and/or feel a clicking or popping noise when eating, as well as an overall decreased jaw range of motion. In addition, this condition may be associated with neck stiffness and pain, and shoulder pain that radiates down the arm.

Teeth grinding can cause jaw pain and, since many people do this while sleeping, you may not be aware that you are, too.

Symptoms of bruxism include jaw, face, and neck pain; headaches; and dental problems, including fractured and worn down teeth.

Besides teeth grinding, other muscle overuse conditions, like teeth clenching and excessive gum chewing, can also cause jaw pain.

There are multiple dental problems associated with jaw pain. For example, a crack tooth may cause intermittent, dull or sharp jaw pain that is triggered by biting or eating. A cavity may cause constant pain that is worsened by hot or cold food. Other dental problems like tooth abscesses and dry sockets may also cause jaw pain.

An infection within the head and neck area, specifically a sinus or ear infection, may cause jaw pain. Besides jaw pain, other symptoms of sinusitis may include:

• Fever
• Headache
• Toothache
• Cheek pain
• Nasal congestion

Likewise, besides jaw pain, other symptoms of an ear infection may include difficulty hearing, vertigo, nausea, and occasionally, ear drainage.

Injuries to the jaw or face, including a dislocated or broken jaw, can cause significant pain.

While jaw pain is classically linked to a TMJ problem, infection, or dental issue, there are other causes that a doctor needs to consider.

Jaw pain may signal a heart attack, a potentially life-threatening condition that warrants immediate medical attention. Besides a crushing or heavy feeling in the center of left side of the chest that may move to the jaw, neck, or shoulder, other potential symptoms of a heart attack include difficulty breathing, sweating, dizziness, nausea and vomiting, and weakness.

If you or someone you're with may be having a heart attack, go to the emergency room or call 911 immediately.

Autoimmune conditions like rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus may also cause jaw pain, specifically symptoms that mimic those of TMJ disorder.

Trigeminal neuralgia is a severely painful condition that affects the trigeminal nerve, which helps you detect facial sensations and move your jaw. This condition causes one-sided attacks of sharp, electric-shock-like pain in the lips, eyes, nose, jaw, forehead, and scalp. The pain is generally triggered by eating, talking, or exposing your face to cold air.

Osteonecrosis occurs when the blood supply to a bone is disrupted and the bone begins to die. It can cause severe pain. Causes of osteonecrosis include excessive alcohol consumption, the use of corticosteroid medications, and trauma.

Certain types of cancer, like oral cancer, may cause jaw pain. With oral cancer, there may be other symptoms present, such as a persistent pain in the mouth, a sore in the mouth that doesn't heal, trouble chewing or moving the jaw, swelling of the jaw, loosening of the teeth, and a lump or mass in the neck.

It may surprise you that the above list of jaw pain causes is not exhaustive. This is why it's important to seek out a proper diagnosis from a doctor or dentist.

While the majority of jaw pains are not related to medical emergencies like a heart attack, if your discomfort is severe and/or prolonged, or if your pain is associated with symptoms like trouble breathing, chest pain, sweating, or dizziness, be sure to seek immediate medical attention.

In order to access the cause of your jaw pain, your doctor will first ask you several questions about your pain, like when it began, how severe it is, and whether the pain is intermittent or constant. He will also inquire about whether there has been any recent jaw trauma, as well as habits that may trigger jaw pain. The timing of the jaw pain, like whether it occurs in the morning upon awakening, can also help a doctor figure out the diagnosis.

After a thorough history, your doctor will begin the physical examination, with a close look at your mouth, teeth, TMJ, neck, and shoulders.

Specifically, for suspected TMJ disorder, your doctor may measure the range of motion of your jaw opening. While a normal opening is 40 to 55 millimeters, people with TMJ often have a jaw opening that is less than 30 millimeters. Patients with TMJ may also have muscle tenderness around the TMJ, as well as joint crepitus (a crackling sensation) or a clicking sound when the jaw opens and closes.

Lastly, it's common for a doctor to do a cranial nerve exam, in order to ensure that the pain you are experiencing is not related to an irritated or compressed nerve (for example, trigeminal neuralgia).

Bloodwork is not often needed to access jaw pain unless there is a concern for an autoimmune condition, at which point pertinent antibodies and inflammatory markers may be drawn.

In addition, if you are being ruled out for a heart attack in the emergency room, an electrocardiogram and blood tests (for example, cardiac enzymes) will be ordered.

Depending on the findings from the history and physical examination, imaging tests may help provide additional insight or confirm a diagnosis. For certain causes of jaw pain, like TMJ disorder, a dental problem, or a fractured or dislocated jaw, a plain X-ray or panoramic X-ray is usually sufficient.

For more complex diagnoses, such as osteonecrosis of the jaw, or for the diagnosis of a sinus infection, a computed tomography (CT) scan may be ordered. Magnetic resonance imaging scans (MRIs) are often used to more thoroughly evaluate the TMJ in people with chronic or severe pain. An MRI may also be used to evaluate the trigeminal nerve in trigeminal neuralgia.

The treatment of jaw pain depends on its cause but may include therapies like taking a certain medication, employing self-care strategies, or undergoing surgery.

Specific medications are prescribed for certain diagnoses—for instance, an antibiotic will be prescribed for a sinus or ear infection, while the anticonvulsant Tegretol (carbamazepine) or Trileptal (oxcarbazepine) is used to treat trigeminal neuralgia.

For TMJ disorder, a combination of medications (for example, a nonsteroidal anti-inflammatory and/or a muscle relaxant) and self-care therapies (for example, trigger avoidance and changing sleeping posture) is recommended.

If teeth grinding is the culprit behind your painful jaw, a mouthguard may be helpful. Mouth guards can either be purchased at a drugstore and molded to fit your teeth, or you can have one custom made at your dentist's office.

Surgery is often one of the primary treatments for oral cancer, and surgical repair may be necessary for a jaw fracture.

While getting to the bottom of your jaw pain may take a little patience and persistence on your end, especially if you find yourself going back and forth between your dentist and your primary care doctor, rest assured that once the source is found and a diagnosis is made, the vast majority of people can obtain relief.