I saw Monique as a patient about a year ago. She entered my office saying, "My jaw pain is killing me."
She had a root canal procedure done on her lower right molar and a crown placed on that tooth about four months before I saw her. At that point, she reported having severe pain in that tooth, her jaw muscles, and her jaw joint.
At first, she thought the root canal was failing and was the cause for her pain. Not only was that not the case, but I was able to eliminate her jaw pain in one visit.
What is jaw pain?
Alvin Danenberg, DDS.As a periodontist, I frequently treat temporomandibular joint (TMJ) pain or temporomandibular disorders (TMDs). Many of the causes of this type of jaw pain also can damage the jawbone around the roots of teeth.
In my experience, between 60% and 70% of adults have experienced some symptoms of TMD. Their most frequent complaint is pain either in the jaw joint or the jaw muscles. Patients often experience discomfort when opening their jaw, along with popping and cracking sounds in the jaw joints when opening and closing. Some patients also experience buzzing or ringing sounds in their ears.
8 possible causes
TMDs are multifactorial, and their sources may be difficult to identify. I initially focus on the following eight related causes for TMDs:
- Trauma (such as a car accident) involving the jaw joint, which could damage the joint structures
- Clenching and grinding the teeth
- Teeth that have been improperly restored or are out of alignment
- Poor nutrition and unhealthy digestion, which could cause chronic inflammation and affect all joints in the body, such as in patients with rheumatoid arthritis
- Emotional stress, such as illustrated by a study by Lei and colleagues in Cranio (April 28, 2016).
- Lack of sleep
- Excessive estrogen, although studies vary
- Infection in the joint
Treatment options
First, the most obvious potential causes must be addressed. If the bite is causing muscle and jaw soreness, then the bite must be corrected. Correcting heavy pressures on the chewing surfaces of the teeth by polishing these areas correctly may be all that is necessary to make the bite healthy.
If a patient grinds his or her teeth habitually, sometimes a bite guard could be worn during sleep to reduce the pressures in the jaw joint. At other times, orthodontic treatment might be necessary to correct the bite.
Based on experience and published studies, I recommend the following actions for my patients:
- Reduce stress.
- Get restorative sleep.
- Eat a nutrient-dense, anti-inflammatory diet to improve hormone balance.
- Avoid eating foods that contain chemicals, which could damage hormonal balance.
- Investigate medications or surgery for TMDs as last resorts.
Monique's jaw pain
After an examination, I determined that Monique's pain was related to her bite after her crown was made. The crown was improperly designed and shaped poorly. The chewing surfaces between that tooth and her upper teeth were bumping too hard. Since these pressures were too heavy, her jaw muscles went into spasm, which in turn caused her jaw pain. Monique couldn't make this pain go away and didn't know what was causing it.
All I needed to do for Monique was to determine the spots on the crown that were hitting her upper teeth too hard. I then reduced these heavy pressure points by smoothing and polishing the chewing surfaces so that her teeth came together properly. She immediately noticed her jaw was more comfortable.
Putting it all together
Many factors affect jaw pain. The more obvious causes should be explored first. If grinding habits or bite problems exist, these must be corrected. Stress reduction, restorative sleep, and good nutrition to provide proper hormone balance must be implemented to reduce TMD symptoms. If symptoms persist, other treatment options should be considered to make the patient comfortable.
A version of this column first ran on Dr. Danenberg's blog. DrBicuspid.com appreciates the opportunity to reprint it. Future columns will address how dentists can serve their patients and their profession.
Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.
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