August 6, 2020
Oral health during Covid-19 lockdown.
Pain in the jaw can come from 3 parts of the face.
1. Jaw joint (Temporomandibular Joint-TMJ)
2. Muscles of the facial area associated with the jaws.
3. Bones of the TMJ.
There are other parts of the face which may contribute to pain in the jaw and these are related structures such as the ear, nerves and teeth. Muscular pain from the neck and shoulders can also refer pain to the jaws.
Approximately 75% of the population will suffer, at some stage in their lives, from signs and symptoms associated with one of these anatomical structures. However 90% of these cases will resolve by themselves with little medical or dental intervention.
The diagnostic umbrella term for pain related to the jaw and surrounding anatomical structures is Temporomandibular Disorder (TMD)
Figure 1. Anatomy of the TMJ and associated muscles of the jaw. Courtesy of Midwest Chirodontic institute.
There are many causes of jaw pain. Trauma to the lower jaw from sporting accidents, motor vehicle accidents, impact to the jaw, teeth grinding, chewing on something very hard like ice cubes, toothache resulting from an infected tooth or gum. These are some of the more common causes of injury which can lead to jaw pain.
In very rare cases jaw pain is associated with some form of cancer involving tissues of the jaw joint or jaws and associated structures. These are very rare but must be ruled out with further scans if presenting signs and symptoms indicate this is needed.
1) Throbbing ache along the lower jaw which can radiate to the ear.
2) Sharp pain when pushing on the side of the cheek.
3) Restriction of movement during opening or closing often associated with pain.
4) Locking of the jaw during opening or closing.
5) Pain when chewing or immediately after chewing.
6) Difficulty chewing hard, chewy foods without pain.
7) Pain in the ear area.
8) Clicking sounds from the joint during opening and closing.
Management of TMD should start with conservative measures:
1) Rest the jaw – don’t over work the muscles or jaw joint by choosing soft foods requiring little to no chewing for up to 2 weeks.
2) Cold compress applied to the joint area if this is the site of injury. This is done only in the acute stage of the condition.
3) Warm compress applied to the area if the muscles are the cause of the pain.
4) Anti-inflammatory medication as prescribed by your dentist or medical GP for managing pain.
5) In some cases the use of a custom fitted night splint by your dentist can help improve the symptoms and rate of recovery.
6) Symptoms caused by the muscles used in chewing and neck and shoulder muscles can be manipulated by a physiotherapist specialising in TMD.
7) In some cases acupuncture can help relieve pain from TMD.
Figure 2. A custom fitted night splint.
Any treatment of the condition should not be carried out during the acute phase.
If symptoms persist after 3 months, a dental specialist should be consulted for further treatment and management. The surgeon may consider the use of various techniques to clean out the jaw joint. The use of botox injections into affected muscles may also be considered.