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Toothaches are usually associated with tooth or gum issues, such as decay, fractures, or infections. However, in some cases, toothaches can be of muscular origin, resulting from trigger points in the masticatory (chewing) muscles. This is known as myofascial pain with referral, a type of muscle pain disorder where pain is referred from a muscle group to a distant site, often non-muscular tissue. This phenomenon can lead to toothaches being misdiagnosed or mistreated, as the source of pain differs from where the patient experiences it. Myofascial pain can also manifest as headaches, jaw pain, or facial pain, further complicating accurate diagnosis and treatment. Therefore, it is crucial to consider a comprehensive range of factors, including psychological, social, and sleep health, to effectively manage oral and facial pain.
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What You'll Learn
Myofascial pain is a common cause of toothache
Oral pain can be primary or secondary, with the latter being referred from other sources, such as muscles, joints, or intracranial structures. Myofascial pain with referral, a sub-classification of myalgia or pain of muscle origin, is considered the most common cause of secondary toothache. This type of pain is characterised by pain in a muscle group that, when palpated, refers pain beyond the boundary of the muscle being palpated.
Trigger points in the masticatory (chewing) muscles can cause toothaches of muscular origin. Taut bands, known as trigger points, are typically present within the involved muscles. Trigger points are tender spots found in taut bands of muscle tissue, often described as "knots". When provoked, they can refer pain to distant sites, including non-muscular tissues.
In the case of myofascial pain, the masseter muscle is the most common painful muscle in temporomandibular disorders (TMD). Tooth pain resulting from myofascial pain will typically present as a constant and non-pulsatile dull ache. Movement or provocation may exacerbate the pain, and it will not respond to local anaesthetic infiltration of the tooth. However, administering anaesthesia at the muscle trigger point will usually provide relief.
It is important to differentiate between primary (odontogenic) toothaches and muscular toothaches. For instance, applying heat or cold to the affected tooth will not increase pain in cases of muscular origin. Similarly, percussion, biting pressure, and infiltration of local anaesthesia around the painful tooth will not consistently increase or decrease the pain, respectively. In contrast, palpation of the trigger point in the muscle will increase the toothache because it is the actual source of the pain. Injecting local anaesthesia into the affected muscle at the trigger point will decrease the toothache.
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Toothaches can be of muscular origin
Myofascial pain is one cause of toothaches that have nothing to do with the teeth. In such cases, the pain may be felt in the teeth, but the trigger point is located in the muscles. For example, the anterior belly of the digastric muscle can refer pain to the mandibular incisors. Applying heat or cold to the affected tooth would not increase the pain in such cases. Similarly, percussion, biting pressure, or infiltration of local anaesthesia around the painful tooth will not increase or decrease the pain. Palpation of the trigger point in the muscle will, however, increase the toothache because this is the actual source of the pain. Anesthetic placed at the muscle trigger point will often provide relief.
Tooth extraction, in particular, wisdom tooth extraction, may contribute to Temporomandibular Joint Disorder (TMD) issues. TMD headaches are described as a ring of tension and pain and can be a trigger for migraines. TMD pain can affect the entire head and neck, including the teeth. While tooth-specific pain can occur when the TMJ muscles are working improperly, it can also be the result of cavities, enamel erosion, and more.
Teeth grinding can also cause jaw pain, headaches, and tenderness in the mouth that might feel like a toothache.
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TMJ headaches can cause tooth and jaw pain
TMJ, or temporomandibular joint, is the hinge that connects your jaw to your skull. It allows you to talk, chew, laugh, and move your jaw up and down and side to side. TMJ disorders (TMD) can cause pain, clicking, headaches, and trouble chewing. TMD headaches are often described as a ring of tension and pain, and can be difficult to differentiate from standard headaches. They can also lead to jaw or facial pain and tightness, restricted jaw movement, and changes in bite ability.
TMD headaches are typically accompanied by other symptoms, such as facial pain, a "clicking" sound in the jaw, or restricted jaw movement. TMD can be caused by various factors, including teeth grinding, osteoarthritis, joint hypermobility, or osteoporosis. While TMD headaches do not specifically cause migraines, the tension could be a trigger. Relieving tension through TMD therapy, such as massage therapy, oral appliance therapy, or jaw exercises, can help reduce the frequency of headaches.
Toothaches can also be of muscular origin, resulting from trigger points in the masticatory (chewing) muscles. This is known as myofascial pain with referral, a type of muscle pain disorder. The pain is typically constant and non-pulsatile with a dull, aching quality, and may be exacerbated by movement. Anesthetic placed at the muscle trigger point can provide relief.
It is important to note that toothaches and jaw pain can have various causes, and a thorough evaluation by a healthcare professional is necessary to determine the underlying issue and provide an accurate diagnosis.
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Tooth extraction can cause TMD issues and muscle pain
Tooth extraction, especially wisdom tooth extraction, may contribute to TMD issues and muscle pain. TMD, or temporomandibular disorders, affect the joints of the jaw as well as the surrounding muscles and ligaments. During a tooth extraction, the jaw has to be kept open wide for a long period, causing the jaw muscles to work overtime. This can lead to a TMJ flare-up.
The typical issue after tooth extraction is inflammation of the tendons and facial muscles from opening the mouth wide during the procedure. This inflammation can cause pain and discomfort, which can sometimes feel like a toothache. The pain may be mild or severe and may worsen with jaw movement. Individuals with TMD may experience difficulty opening and closing their mouths completely.
Tooth extraction can also cause the remaining teeth to shift, disrupting the balance and alignment of the jaw and leading to TMD. The healing process after tooth extraction is critical, as swelling and stiffness are common post-surgical side effects that can affect the TMJ. If left untreated, TMD symptoms generally resolve within a few hours to a few days after the dental procedure. However, in some cases, they may last for weeks or progress to long-term TMD if not properly treated.
TMD headaches are often described as a ring of tension and pain and can be a trigger for migraines. They can affect the entire head and neck, including the teeth. TMD pain can be relieved with massage therapy, oral appliance therapy, jaw exercises, and other treatments recommended by a specialist.
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Teeth grinding can cause toothache and jaw pain
Toothaches can be puzzling, as the pain can be felt in the teeth when the source of pain is elsewhere. This is known as referred pain, and it can be caused by trigger points in the masticatory (chewing) muscles. Taut bands, or trigger points, in the muscles can refer pain to the teeth, and this is known as myofascial pain with referral. This type of pain is typically constant and non-pulsatile, often described as a dull ache, and it may be exacerbated by movement.
Teeth grinding, or bruxism, can be a cause of toothache and jaw pain. It usually happens subconsciously during sleep, although it can also occur when awake. The grinding action puts extra strain on the teeth and jaw, leading to dental damage and pain. The enamel of the teeth can be worn down, exposing the sensitive dentin underneath and causing extreme sensitivity to hot and cold. This can result in further issues such as fracturing, erosion of the bite, increased decay, and even tooth loss. The constant grinding can also cause headaches, facial pain, and soreness in the jaw muscles, as well as tinnitus and difficulty eating or opening and closing the mouth.
The causes of bruxism can vary and include stress, anxiety, sleep disorders, and certain medications. It is most common during childhood, adolescence, and young adulthood, which are often stressful times. Awake bruxism may not require treatment if the individual can find ways to increase awareness and reduce stress. However, severe cases may require a custom mouthguard to protect the teeth and reduce strain on the jaw muscles.
It is important to note that toothaches can also be odontogenic, or primary toothaches, caused by issues with the teeth themselves. These can include cavities, enamel erosion, and other dental issues. An accurate diagnosis is crucial to determine the appropriate treatment.
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Frequently asked questions
Yes, toothaches can cause muscle pain, especially in the jaw. Tooth extraction, for example, can lead to inflammation of the tendons and facial muscles.
A toothache is typically caused by a problem with a tooth, such as decay, a fracture, or infection. However, it is important to note that sometimes the pain may be coming from outside the tooth and gums.
Muscle pain in the jaw is often referred to as TMJ or TMD, which stands for Temporomandibular Joint Disorder.
TMD can cause jaw or facial pain and tightness, restricted jaw movement, and changes in bite ability. It can also lead to headaches that may trigger migraines.
There are a few ways to differentiate between a primary (odontogenic) toothache and a muscular toothache. For example, applying heat or cold to the tooth will not affect muscular tooth pain, and anaesthetising the tooth will not relieve the pain. However, anaesthetising the trigger point in the muscle will reduce the pain.
