BEYOND TOOTH PAIN

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

The resting position of the jaw, which is the position it should be in most of the time, is lips together with the teeth slightly separated. Breathing should be through the nose. The teeth should be touching a total of about 15 minutes in a 24-hour period of time. People who clench or grind touch their teeth much more than this. This is the primary reason people get orofacial pain.  Pain can also be caused by things like trauma to the head and neck or poor ergonomics (posture).

Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects your lower jaw to the muscles on the sides of your head and face. They control the joint’s movements. Women between the ages of 20 and 40 are the most frequent sufferers of orofacial pain due to added estrogen in their bodies. Estrogen impacts the body’s natural pain fighters (endorphins), increases inflammation in the temporomandibular joints, and compromises the strength and adaptive ability of all ligaments.

One in eight Americans suffer from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which can be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness.

Sleep disorders can also play a role in orofacial pain. If you have gone through treatment for orofacial pain and still experience problems, it is possible that a sleep disordered breathing problem such as sleep apnea could be contributing. People who have problems like this will often exhibit jaw pain due to the body moving the jaw around at night to get better air flow. Patients have no idea this is occurring usually until they wake with sore jaw muscles. Treating the sleep issues usually solves the jaw issues.

If the orofacial pain is not related to sleep, there are a variety of treatments that can help relieve symptoms. One device is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite. Permanent correction may sometimes require equilibration (reshaping teeth), orthodontics or a combination of these and other restorative dentistry. Many use a splint (day and/or night) on a daily basis to avoid having these other treatments done.

Other things that can help alleviate pain are using ice on the painful area, eating a softer diet and avoiding chewing gum or ice. It is important to be conscious to keep teeth slightly apart except when chewing and swallowing. Use of anti-inflammatories is okay to use if it is an acute short-term problem. Chronic problems are best treated by determining and treating the source.

Orofacial pain can range from tolerable to debilitating. Most of these problems can be corrected and/or managed. If your dentist can not help you, ask for a referral to a specialist.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.