Athena Vale
Experiencing pain is frustrating, especially when the source is unclear. Toothaches can be caused by a variety of factors, including cavities, gum disease, and receding gums. However, tooth pain can also be muscular in origin, with trigger points in masticatory (chewing) muscles referring pain to the teeth. This phenomenon, known as myofascial pain, affects an estimated 25% of facial and tooth pain cases and can be challenging to diagnose accurately. Myofascial pain syndrome (MPS) can cause hypersensitive bands within muscles, creating trigger points that lead to referred pain in distant areas of the body. TMJ disorders, affecting the temporomandibular joint that connects the lower and upper jaw, can also result in tooth pain.
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What You'll Learn
Myofascial pain syndrome
MPS can occur in patients with a normal temporomandibular joint and is characterised by muscle tension, fatigue, or, rarely, spasm in the masticatory muscles. Symptoms include pain and tenderness in and around the masticatory structures or referral to other locations in the head and neck, often with abnormalities of jaw mobility. It is important to note that MPS is not limited to the muscles of mastication and can occur anywhere in the body, most commonly involving muscles in the neck, shoulders, and back.
The diagnosis of MPS can be challenging due to the overlap of symptoms with other disorders and the complexity of the oral cavity. Dental clinicians are often involved in the diagnosis and management of tooth pain, but myofascial pain is one of the most frequently occurring orofacial pains of non-odontogenic origin and is often misdiagnosed by dentists. A systematic approach is necessary when evaluating oral and facial pain patients to differentiate between primary (odontogenic) toothache and muscular toothache. For example, applying heat or cold to the tooth will not increase the pain in cases of muscular toothache, and infiltration of local anaesthesia around the painful tooth will not decrease the pain. However, palpation of the trigger point in the muscle will increase the toothache because it is the actual source of the pain.
Treatment options for MPS include conservative management such as analgesics, muscle relaxation techniques, modification of parafunctional behaviour (e.g. teeth clenching and grinding), and the use of oral appliances. In some cases, low doses of benzodiazepines or muscle relaxants may be recommended. Behavioural modalities and physical therapy may also be appropriate.
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Masticatory (chewing) muscles
Masticatory, or chewing, muscles are a group of muscles responsible for the chewing movement of the mandible at the temporomandibular (TMJ) joint. They enhance the process of eating and assist in grinding food. They also function to approximate or bring together the teeth. The four main muscles of mastication are the temporalis, medial pterygoid, lateral pterygoid, and masseter muscles. They originate from the surface of the skull and attach onto the rami of the mandible at the TMJ. The movement performed by these muscles includes elevation, depression, protrusion, retraction, and side-to-side movement.
Masticatory muscle disorders include myofascial pain and dysfunction, myositis, and neoplasms. Myofascial pain and dysfunction may result from nocturnal bruxism (involuntary clenching or grinding of the teeth during sleep), habitual clenching of the mouth, and whiplash injuries during trauma. Bruxism is important to recognize and monitor because of the extremely powerful forces exerted on teeth, periodontal structures, temporomandibular joints, and masticatory muscles, which often cause tooth wear and destruction, temporomandibular joint and muscle pain, as well as tension-type headaches.
Myofascial pain syndrome, or MFP, is caused by hypersensitive bands within your muscles that create trigger points. When a muscle knots up, it can cause referred pain in an area of the body far away from that particular muscle, setting off a pain response in a nerve located elsewhere. Up to 25% of facial and tooth pain is thought to be caused by myofascial pain syndrome. In most cases, once the trigger is addressed, the phantom pain in the tooth disappears.
Masticatory myalgia is characterized as a dull persistent ache overlying the jaw and temple muscles with occasional references to other structures such as the head, neck, ear, and teeth. Symptoms can also include a restricted opening, fatigue, and stiffness. Signs include tenderness of the muscles with a limited range of motion.
Masticatory myospasm, or muscle cramp, is an acute condition resulting from a sudden, involuntary, and continuous tonic contraction of a single muscle. It may lead to trismus (lockjaw), pain on movement, and a severely limited range of motion of the mandible.
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Temporomandibular joint (TMJ) disorder
Muscle pain can indeed cause tooth pain, and one of the reasons for this could be Temporomandibular joint (TMJ) disorder. TMJ refers specifically to the temporomandibular joint itself, and people have two of these joints, one on each side of the jaw.
TMJ disorder, or TMD (Temporomandibular disorder), is a group of more than 30 conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. TMDs can be classified into three main types: myofascial pain, internal derangement of the joint, and degenerative joint disease. Myofascial pain is the most common form of TMD, resulting in discomfort or pain in the muscles that control the jaw, neck, and shoulder function. Internal derangement of the joint refers to a dislocated or displaced jaw, or injury to the condyle (the rounded end of the jaw bone). Degenerative joint disease includes osteoarthritis or rheumatoid arthritis in the jaw joint.
TMDs can be caused by excessive strain on the jaw joints and the muscle group that controls chewing, swallowing, and speech. This strain may be a result of bruxism, the habitual, involuntary clenching or grinding of the teeth. Trauma to the jaw, head, or neck may also cause TMDs, as can arthritis and displacement of the jaw joint disks. TMDs are twice as common in women as in men, especially between the ages of 35 and 44. In many cases, the exact cause of TMDs may not be clear, but research suggests that a combination of genes, psychological and life stressors, and individual pain perception may play a role.
TMD headaches are often described as a ring of tension and pain, and they can trigger migraines. TMD pain can affect the entire head and neck, including the teeth. Tooth-specific pain can occur when the TMJ muscles are working improperly, but it can also be caused by cavities, enamel erosion, and more. TMDs can be differentiated from standard headaches by the fact that they rarely respond to at-home treatments, and usually require a specialist's intervention. Treatment options include massage therapy, oral appliance therapy, jaw exercises, and more.
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Triggers and treatment
Triggers:
Myofascial pain with referral is considered the most common cause of secondary toothaches. Myofascial pain syndrome (MFP) is caused by hypersensitive bands within muscles that create trigger points. When a muscle knots up, it can cause referred pain in another part of the body, setting off a nerve located elsewhere. Up to 25% of facial and tooth pain is thought to be caused by MFP. Taut bands, known as trigger points, are usually present within the involved muscles. The masseter muscle is the most common painful muscle in temporomandibular disorders.
TMJ tooth pain is another common trigger for muscle pain. TMJ issues can cause muscle spasms and twitching, and the pain can radiate from the jaw to outlying parts of the body. TMJ issues can be caused by tooth extraction, particularly wisdom tooth extraction, which can cause inflammation of the tendons and facial muscles.
Treatments:
If the pain is muscular, applying heat or cold to the affected area will not increase the pain. Percussion and biting pressure on the tooth will also not consistently increase the pain. However, trigger point injections with local anaesthesia into the affected muscle will decrease the pain.
For TMJ pain, treatments include splint therapy, physical therapy for the jaw and neck muscles, short-term muscle relaxants, oral appliance therapy, jaw exercises, massage therapy, or injections of Botox to help alleviate muscle contractions.
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Differentiating between tooth and muscle pain
Muscle pain can cause tooth pain, and it can be hard to differentiate between the two. Myofascial pain affects an estimated 85% of the general population at some point in their lives. Myofascial pain syndrome (MPS) is caused by hypersensitive bands within your muscles that create trigger points. When a muscle knots up, it can cause referred pain in another area of the body, setting off a nerve located elsewhere. Up to 25% of facial and tooth pain is thought to be caused by MPS.
Trigger points in masticatory (chewing) muscles can refer pain to the teeth. With referred pain, the site where the patient feels pain is different from the actual source of pain. Taut bands, known as trigger points, are typically present within the involved muscles.
To differentiate between tooth and muscle pain, the following strategies can be used:
- Application of heat or cold to the tooth will not increase the pain if it is muscular in origin.
- Percussion and biting pressure on the tooth will not consistently increase the pain if it is muscular.
- Infiltration of local anaesthesia around the painful tooth will not decrease the pain if it is muscular.
- Palpation of the trigger point in the muscle will increase the toothache because this is the actual source of the pain.
- Trigger point injection with local anaesthesia into the affected muscle will decrease the toothache.
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Frequently asked questions
Yes, muscle pain can cause tooth pain. This is known as myofascial pain with referral, which is considered the most common cause of secondary toothaches. It is caused by hypersensitive bands within the muscles that create trigger points, leading to referred pain in areas of the body distant from the muscle.
Myofascial pain syndrome (MPS) affects an estimated 85% of the general population and is caused by hypersensitive bands within the muscles that create trigger points. These trigger points can set off a pain response in nerves located elsewhere in the body, resulting in referred pain.
Toothaches of muscular origin typically present as constant and non-pulsating with a dull, aching quality. The pain may be exacerbated by movement or provocation, but it will not respond to local anaesthesia or infiltration around the tooth. However, anaesthesia placed at the muscle trigger point will usually provide relief.
Treatment options include warm compresses, muscle relaxants, anti-inflammatory medications, physical therapy, and massage. In some cases, dental restorations or a bite plate/night guard may be necessary to bring balance back to your bite.
Yes, tooth pain can cause muscle pain, particularly in the jaw, neck, and face. This is often associated with temporomandibular joint disorder (TMJ), which can result from dental issues such as tooth extraction or grinding your teeth. Treatment options for TMJ include massage therapy, oral appliance therapy, jaw exercises, and more.
