There can be many reasons why a person experiences jaw pain. This type of pain can be debilitating in its severity, as well as its impact on your ability to eat and speak. Most jaw pain is due to an abnormality or injury to the joint of your jaw, but there are other possible causes as well. Orthodontic treatment can improve some types of jaw pain.
Bruxism is a condition where you grind or clench your teeth. Most people with bruxism either grind/clench unconsciously during the day or while they sleep. Bruxism is typically either a response to stress and anxiety or indicative of something wrong with your bite or tooth alignment. Because clenching and grinding the teeth exert such strong force on your jawbones (your facial muscles can exert up to 600 pounds of force per square inch), it can lead to jaw pain that can be anywhere from mild to severe.
Treatment for daytime bruxism can include a soft-food diet (similar to the diet of those wearing braces), anti-inflammatory medications, and topical treatments that apply heat or cold. The most common treatment for nighttime bruxism is the use of a night guard to prevent clenching from damaging your teeth. Night guards are available over-the-counter, but your dentist or orthodontist can customize one for you that fits perfectly over your teeth. A professional also can help you decide whether to place the guard over the top teeth, bottom teeth or just the front teeth.
Unfortunately, retainers that are prescribed following orthodontic treatment will not substitute for a night guard, as it does not have the necessary thickness to withstand the pressure of clenching or grinding and can damage easily. Similarly, a night guard also cannot be used in place of a retainer. If you need both a retainer and a night guard, you will need to wear both simultaneously. Your orthodontist can help design a method to make this workable.
Temporomandibular joint and muscle disorder (TMD/TMJ)
The temporomandibular joint acts like a hinge that connects your skull and your jawbone. Pain or disorder specifically related to the temporomandibular joint is commonly known as TMJ, while TMD refers to disorders that occur anywhere along the jaw, jaw joint, or surrounding muscles.
Symptoms typically include:
- An aching face or jawline
- Soreness in or near the ear
- Tenderness of the jaw
- Locking of the joint, preventing the opening or closing of the mouth
- Pain while chewing
- Clicking or grating when the mouth is opened
These symptoms in the joint can be due to a combination of factors, such as genetics, arthritis or trauma. However, the leading cause of TMD/TMJ pain is bruxism. Your doctor will diagnose TMD/TMJ by listening to your description of when and where the pain occurs, and how severe or limiting it is. She also will listen to and feel your jaw as you open and close your mouth. You may also need to get dental X-rays, a CT scan to provide detailed images of the bones involved in the joint, and/or an MRI to reveal problems with the joint’s disk or surrounding soft tissue. However, your doctor may diagnose a TMD/TMJ disorder based on symptoms alone even if tests do not reveal a structural problem.
Treatment for TMD/TMJ often involves over-the-counter or prescription-strength non-steroidal anti-inflammatory medications. Tricyclic antidepressants–an older generation of medications used to treat depression–have been shown in some cases to reduce jaw pain as well as bruxism.
Your doctor might suggest non-drug therapies as well, including applying hot compresses to the jaw joints, soft or firm devices worn over the teeth, and night guards for patients who grind or clench their teeth during sleep. He may also refer you to a physical therapist to stretch and strengthen the jaw muscles. Braces can be an option to treat TMD, especially in cases that do not respond to typical treatments.
The most common types of bite misalignments include:
- crowding, where the teeth do not have enough room to grow in properly
- underbite, where the lower teeth and jaw extend beyond the upper front teeth
- overbite, where the upper front teeth extend over the lower front teeth
- crossbite, where one or more of the upper teeth fit inside the lower teeth, and
- open bite, where a large space exists between the upper and lower teeth.
Any of these alignment problems can contribute to chronic jaw pain if they prevent the jaw from functioning properly. Unfortunately, this pain can extend beyond just the actions of opening and closing the mouth. Depending on the type and severity of the misalignment, it also can cause difficulty with eating, breathing, sleeping and speech. The good news is that in most cases orthodontic correction can relieve the problem.
Jawbone correction through orthodontic treatment offers an advantage to younger patients whose bones are still malleable. Adults with significant jaw misalignments or irregularities might require surgical correction, possibly in addition to orthodontic care. In fact, jaw surgery is not appropriate until after the bones have completely finished growing, which usually occurs between ages 14-16 in girls and 17-21 in boys.
The goal of corrective jaw surgery is to realign these bones to affect the way they work, and hopefully reduce or eliminate pain as a result. It is performed by an oral and maxillofacial surgeon (OMS). This type of specialist has undergone extensive training in treating problems related to the hard and soft tissues of the mouth, face and jaws. In addition to completing dental school, an OMS goes on to spend four years in a hospital-based residency training, including instruction in the techniques of emergency medicine, general surgery and anesthesiology.
Depending on your situation, you might wear braces during and/or after surgical treatment. Your orthodontist will work with the surgeon to coordinate a treatment plan that involves surgical correction of jaw dysfunction, the alignment of teeth and routine dental issues. The OMS will be instrumental in determining what type of jaw surgery is needed and how it is performed.
You might not think of a cavity as having a possible relation to jaw pain. But left untreated, a growing cavity can impact the jaw, especially if it is one of the molars. Tooth decay begins at the outermost layer of the tooth: the enamel. If a cavity is treated early, it stops and does not progress. But if the cavity isn’t filled, decay can spread to the inner layers of the tooth and can cause an abscess. Once bacteria invade the root of the tooth, they can begin to cause significant jaw pain.
Though an abscess usually originates at the tip of the tooth’s root, it can spread and lead to serious infection in the jaw bone, teeth and surrounding tissues. If you don’t seek treatment early enough, cysts can also begin to appear in the jaw bone. Antibiotics are often used to treat an abscessed tooth, but they typically will not be enough to eradicate the infection. Often this type of infection requires a root canal to correct–a procedure where a dentist or endodontist extracts bacteria, decay and infection from the tooth’s pulp, root and nerves, and cleans and reseals the inside of the tooth.