Dominic Stone
Toothaches can be caused by a variety of issues, including decayed or fractured teeth, gum infections, or even problems with the muscles in the face and neck. In some cases, trigger points in the muscles can refer pain to the teeth, causing toothaches that are not actually tooth-specific. This referred pain can be caused by taut bands in the muscles, known as trigger points, which can result from parafunctional behaviors such as bruxism (teeth clenching or grinding). While toothaches are typically associated with dental issues, it is important to consider the role of muscles and other structures in the head and neck when diagnosing and treating tooth pain.
| Characteristics | Values |
|---|---|
| Tooth pain | Can be caused by trigger points in the muscles of the neck and face |
| Can be caused by myofascial pain syndrome | |
| Can be caused by cavities, enamel erosion, gum infection, or other dental issues | |
| Muscle spasms | Can be caused by temporomandibular myofascial pain syndrome |
| Can be relieved using botulinum toxin | |
| Treatment for tooth pain and muscle spasms | TMD therapy, massage therapy, oral appliance therapy, jaw exercises, analgesics, muscle relaxants, behavioural therapy, physical therapy |
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What You'll Learn
Myofascial pain syndrome
The condition can be challenging to diagnose as the perceived pain is often in the teeth, leading dental clinicians to be involved in the diagnosis and management of the pain. Myofascial pain can mimic toothache symptoms, and it is often misdiagnosed by dentists. A diagnosis of myofascial pain syndrome is typically based on the patient's history, a physical examination, and, in some cases, radiographs or other tests to rule out other conditions.
The symptoms of myofascial pain syndrome can include toothache and muscular pain in the mouth or jaw. The pain may be felt in the upper or lower arch and temporomandibular joint (TMJ). In addition, patients may experience jaw or facial pain and tightness, restricted jaw movement, and changes in bite ability. The pain can be intense and spread up and around the sides of the head, resembling a tension headache.
The treatment for myofascial pain syndrome typically involves conservative approaches such as analgesics, muscle relaxation techniques, and the modification of parafunctional behaviours like teeth clenching and grinding. Oral appliances, benzodiazepines, or muscle relaxants during sleep may also be recommended. In some cases, behavioural modalities and physical therapy may be appropriate.
It is important to note that tooth pain can also have dental causes, such as cavities, enamel erosion, gum infections, decayed or fractured teeth, or other disorders. Therefore, a thorough evaluation by a dental professional is necessary to determine the underlying cause of tooth pain and muscle spasms.
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Trigger points
In the case of tooth pain, trigger points in the masticatory (chewing) muscles can refer pain to the teeth. The anterior temporalis muscle can refer pain to the maxillary (upper) incisors, while the posterior temporalis can refer pain to the maxillary molars. The masseter muscle can also refer pain to the maxillary or mandibular (lower) molars, and the anterior belly of the digastric muscle can refer pain to the mandibular incisors.
Palpation of these trigger points will increase the toothache because it is the actual source of the pain. Trigger point injections with local anesthesia into the affected muscle can be used to decrease the toothache. Other treatments for trigger points include transcutaneous electric nerve stimulation (TENS) and "spray and stretch," where the jaw is stretched open after the skin over the painful area has been chilled with ice or a refrigerant spray.
Bruxism, or teeth grinding and clenching, is a common cause of trigger points and referred pain. It can lead to temporomandibular myofascial pain syndrome, which is characterized by pain and tenderness of the masticatory muscles, limited jaw movement, and sometimes headaches.
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Bruxism
The causes of bruxism are not fully understood, but multiple factors are believed to contribute to its development. Certain medications, such as those used to treat depression, seizures, and ADHD, may increase the likelihood of bruxism. Additionally, stress is considered a potential factor, and stress reduction techniques like yoga, meditation, and counselling may be beneficial. Other recommended lifestyle changes include avoiding caffeine, alcohol, and smoking.
While many cases of bruxism are mild and may not require intervention, severe bruxism can result in significant dental damage. Over time, teeth can wear down completely if left untreated. Therefore, it is essential to recognise the signs and symptoms and seek regular dental care. Bruxism can be challenging to diagnose, especially in cases of sleep bruxism where individuals are unaware of their nocturnal habits.
To differentiate between primary toothaches (odontogenic) and muscular toothaches, specific strategies can be employed. For instance, applying heat or cold to the affected tooth would not increase pain in cases of muscular origin. Similarly, percussion, biting pressure, and infiltration of local anaesthesia around the tooth would not consistently affect pain levels. However, palpation of the trigger point in the muscle will increase toothache because it is the actual source of the pain. Trigger point injections with local anaesthesia into the affected muscle can provide relief from muscular toothache.
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Temporomandibular myofascial pain syndrome
Toothaches can be caused by tooth decay, fractures, gum infections, or enamel erosion. However, sometimes the pain doesn't originate from the teeth and gums but from trigger points in the muscles of the neck and face, causing radiating pain to the jaw. This is known as referred pain, where the site of pain differs from the source.
The symptoms of TMPDS include pain and tenderness in and around the masticatory muscles and referred pain in other locations in the head and neck. Jaw mobility may be abnormal, with restricted movement and joint noise. Headaches are also common, and sleep bruxism can result in more severe headaches upon awakening that gradually subside during the day.
Diagnosis of TMPDS is primarily based on patient history and physical examination. Treatment typically involves conservative management, including analgesics, muscle relaxation, behavioural changes such as avoiding teeth clenching, and the use of oral appliances. Physical therapy, craniosacral therapy, and injections at the trigger points may also be beneficial.
In summary, tooth pain can be caused by various factors, including tooth decay and gum issues, but it can also be referred pain from trigger points in the muscles. TMPDS is a common condition characterised by pain and tenderness in the masticatory muscles, jaw abnormalities, and headaches. Treatment focuses on managing pain and addressing behavioural factors.
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Non-dental toothaches
A toothache is typically indicative of a problem with a tooth, such as decay, a fracture, or gum disease. However, in some cases, the pain may not originate from the teeth and gums, but from a different source. This is known as "referred pain", where pain signals are transmitted along nerves from one part of the body to another.
Sinuses
The sinuses in your face sit directly above the nerves that transmit sensation to your upper row of teeth. Therefore, any pain or pressure in your sinuses can be felt in your teeth.
Muscular Origin
Trigger points in the muscles of the face and neck can cause radiating pain in your upper or lower jaw. Taut bands, known as trigger points, are present within the involved muscles. Applying pressure to these trigger points can increase the toothache because they are the actual source of the pain. Injecting local anaesthesia into the affected muscle will decrease the toothache.
TMD
TMD (Temporomandibular Disorders) can cause toothaches due to strain in the jaw joints, even when tooth alignment is normal. This can be caused by a blow to the face or head, or by tooth misalignment or bruxism (chronic tooth grinding). TMD headaches are described as a ring of tension and pain, and can be a trigger for migraines.
Other Causes
- Abscessed tooth
- Cracked tooth
- Damaged dental restoration (e.g. filling or crown)
- Gum disease
- Soda consumption, which can lead to poor dental health
- Alzheimer's and other forms of dementia, which can negatively impact oral health
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Frequently asked questions
Yes, tooth pain can cause muscle spasms. Tooth pain can be caused by parafunctional behaviour such as bruxism (teeth clenching or grinding) which can lead to muscle spasms.
Treatment options include oral appliances, benzodiazepines, muscle relaxants, and botulinum toxin injections.
Symptoms include jaw or facial pain and tightness, restricted jaw movement, changes in bite ability, and headaches.
To differentiate between primary (odontogenic) toothache and muscular toothache, you can try applying heat or cold to the tooth. If the toothache is muscular, this will not increase the pain. Percussion and biting pressure on the tooth will also not consistently increase the pain.
