by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Pain in the jaw can signal either a primary problem in the jaw itself or referred pain from another location. To better understand jaw pain, let’s look at the anatomy.
The jaw joints are just in front of the ears where the lower jaw bone (mandible) meets the temporal bone of the skull. The joints allow a person to open and close the mouth and move it from side to side or backwards and forwards.
Between the two bones is a disc of fibrous tissue which helps the jaw to move smoothly.
There are various problems that can cause jaw pain, clicking, stiffness or spasm (trismus).
Older people may get pain in their jaw joint due to arthritis, when the joint becomes worn with age.
Jaw problems can develop if there are changes in the way the teeth meet with biting. This is called malocclusion. Another cause of jaw joint problems is previous jaw injuries, such as dislocation.
A common problem affecting the jaw joint is called temporomandibular joint (TMJ) dysfunction, where the jaw joint does not open or close correctly.
The most common symptoms include:
• pain - usually a dull ache in and around the ear, cheek bone or neck
• headache, especially in the morning
• jaw joint clicking - this may make a sound and you may feel a cracking, grating, crunching or popping sensation
• jaw locking - either open or closed
• being unable to open your mouth properly
Symptoms may be worse during activities such as chewing or yawning.
Pain can be caused by the ligaments and muscles surrounding the jaw tightening up.
Alternatively the ligaments may become loose, so that the disc of cartilage no longer stays between the jaw bone and the skull when the joint is moved. Jaw locking is caused by the disc slipping and getting stuck out of place.
One of the most common causes of TMJ dysfunction is teeth grinding and clenching.
Jaw joint problems are usually diagnosed by a dentist.
Treatment depends on the type of jaw joint problem you have.
In addition to the mechanical problems described above, there are many medical conditions that have been associated with jaw pain.
Rheumatoid arthritis, Lyme disease, and osteoarthritis are three common forms of arthritis that may affect the jaw. Careful history taking, physical examination, and laboratory testing will help in establishing the diagnosis. The diagnosis will lead to the specific therapy required.
Cancers of the head and neck may present with jaw pain. Evaluation by an Otolaryngologist (ENT physician) can help with diagnosis and management.
Infectious conditions such as osteomyelitis (bone infection), sinusitis, and actinomycosis (fungus), and tetanus may affect the jaw. Biopsy and infectious disease consultation is required.
Inflammation of the parotid gland due to either infection (often staph) or inflammation (Sjogren’s disease) may also cause jaw pain.
Occasional sinus headaches or stress headaches can be accompanied by jaw pain.
Trigeminal neuralgia, also known as tic douleroux, is a puzzling and painful irritation of the fifth cranial nerve and can cause intense jaw pain. Neurology evaluation is helpful in establishing the diagnosis.
More recently, osteonecrosis of the jaw (dead bone) has been reported inpatients treated with intravenous bisphosphonate drugs for osteoporosis. This is a potentially serious problem.
Another potentially lethal cause of jaw pain is heart attack. Jaw pain accompanied by sweating, nausea, or chest tightness demands immediate medical attention.
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