Pain In The Lower Jaw : Causes, Symptoms, Diagnosis & Treatment

• Why There Is Pain In The Lower Jaw
• Purulent Diseases
• Traumatic Injuries
• Neuralgia
• Muscle Damage
• Dental Causes
• Tumors Of The Lower Jaw
• Cardiac Ischemia
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Pain in the lower jaw is observed with periostitis, osteomyelitis, maxillary abscess, fractures, tumors. It is provoked by some dental pathologies, bruxism, neuralgia, coronary artery disease. It can be constant, intermittent, strong, non-intense, dull, sharp, pressing, aching, bursting, twitching. The cause is determined based on the results of the survey, general and dental examination, imaging, electrophysiological, laboratory techniques. Therapy includes analgesics, antibiotics, glucocorticoids, and other medications. Sometimes operations are performed.

Why there is pain in the lower jaw

Purulent diseases

The cause of the pain syndrome is inflammation of the bone, periosteum or nearby soft tissues. In 70-80% of cases, the disease has an odontogenic origin. Less commonly, the process is provoked by acute infections, jaw injuries. Supplemented by edema, hyperemia, violation of the general condition, intoxication syndrome, regional lymphadenitis. Soreness is observed in the following pathologies:

• Periostitis. The symptom is more pronounced in acute purulent periostitis. The pain is sharp, pressing or boring, radiating to the eye, ear, temple, neck. It gets worse when you open your mouth. Weakness, low-grade fever, swelling of the cheek are noted. In chronic periostitis, pain is recurrent, moderate or non-intense, pressing or arching. The contours of the face are slightly changed.
• Osteomyelitis. Characterized by a sudden manifestation with a rapid rise in temperature to febrile figures, chills, severe intoxication. Pain sensations are shooting, pulsating, diffuse, radiating to the neck, half of the face. Increased when swallowing, limits the opening of the mouth. The teeth are mobile, pus is secreted from the gums. Numbness of the oral mucosa, the skin of the chin. In chronic osteomyelitis, the symptom increases after the closure of the fistula, decreases or disappears after the resumption of the outflow of pus.
• Periorbital abscess. The formation of an abscess is preceded by a toothache. Then there is a dense edema. Morbidity quickly increases, the phenomena of intoxication increase. The patient refuses food. After spontaneous opening, the manifestations disappear, in the absence of treatment, chronicity is more often observed with periodic exacerbations, resumption of pain and suppuration.
• Periomaxillary phlegmon. Typically acute onset with rapid progression of local manifestations, purulent-resorptive fever. Jerking pains, aggravated by talking, chewing, movements of the lower jaw, are supplemented by increased salivation, the formation of a diffuse infiltrate with a zone of fluctuation. The condition continues to worsen due to severe intoxication.

Traumatic injuries

Injuries to the lower jaw are most often the result of fights. Possible damage due to falls, car accidents, accidents at work. With a bruise, the asymmetry of the face is due to swelling of the soft tissues, the closing of the teeth is normal. The symptom is expressed moderately, quickly decreases, does not create serious obstacles to articulation, food intake.

Among the fractures, damage to the body predominates, violations of the integrity of the angle and branch are less common. Half of the fractures are bilateral. At the moment of injury, a sharp explosive pain occurs, only slightly decreasing over time, aggravated by talking, biting, chewing. Possible numbness of the chin, lower lip. Asymmetry of the face, articulation disorders, staggering of the dentition, mobility, and sometimes dislocations of the teeth are noted.

Fractures of the alveolar process of the lower jaw are less common than those of the upper jaw; they develop with impacts, falls from a height, etc. They are accompanied by intense spontaneous pain, aggravated by swallowing, trying to close the teeth. The mouth is half-open, under the mucosa, the protruding edge of the bone fragment can be determined. The bite is broken, the teeth are mobile, dislocations are possible.

Pain in the lower jaw

neuralgia

The symptom accompanies trigeminal neuralgia involving 3 branches (n.mandibularis). It is provoked by external factors (shaving, cold air, water), a load on the masticatory muscles. Prosopalgia has a paroxysmal character, it is a series of pain impulses that are felt as a backache or electric shock from the side of the face along the lower jaw to the chin. The pain is sudden, lasts several minutes, reaches such intensity that the patient freezes, does not move, does not speak.

With neuralgia of the glossopharyngeal nerve, the pain impulse is caused by chewing, swallowing, talking, lasts from several seconds to 3 minutes, occurs at the root of the tongue, spreads through the tonsils, palate, pharynx, ear. Pain in the lower jaw radiating. In patients with ganglionitis of the submandibular node, pain is paroxysmal, burning, boring, pulsating. Last from 1 minute to 1 hour. They begin in the tongue, spread to the lower jaw, to the temple, back of the head, neck, and shoulder girdle.

Muscle damage

Bruxism is formed due to spasm of the masticatory muscles. After nocturnal attacks, patients are worried about pain in the jaws, due to their squeezing and intense movements relative to each other. Muscular, dental, headaches, dizziness, drowsiness are possible. With myofascial syndrome, pain develops due to overload of the masticatory muscles. It is perceived as moderately pronounced, deep. At first, it appears only during exercise (chewing, clenching of the jaws), then it increases, becomes constant.

Dental causes

The symptom worries in the first days after tooth extraction. It is especially pronounced in the presence of an inflammatory process, the removal of impacted or improperly erupted wisdom teeth. Some patients report soreness due to wearing braces and removable dentures. Aching, pressing or pulling pain in the jaw and chewing muscles, problems with chewing and swallowing, biting of the cheeks and tongue are detected in children with malocclusion.

The cause of severe progressive paroxysmal pain, which spreads to the entire lower jaw, intensifies at night, is acute diffuse pulpitis. Prolonged intense pain under the action of external stimuli, spontaneously occurring pain attacks are also noted during the period of exacerbation of chronic pulpitis. Typical irradiation along the trigeminal nerve. Between attacks, moderate or slight aching pains are possible, aggravated by biting.

Tumors of the lower jaw

Pain syndrome is typical for a number of odontogenic and non-odontogenic benign neoplasms. Distinctive features of such neoplasia are slow growth, lack of germination of surrounding tissues:

• Odontogenic fibroma. More often diagnosed in children. The pain is aching, not intense, and does not occur in all patients. It can be combined with tooth retention, inflammation in the affected area.
• Cementoma. As a rule, it is localized in the zone of molars or premolars of the lower jaw. The course is asymptomatic or with minor pain, aggravated by palpation.
• Osteoma. Accompanied by pain, asymmetry of the face, slowly increasing over months or years. Large tumors limit the mobility of the lower jaw.
• Osteoid osteoma. Unlike other neoplasms, the pain is sharp, intense, aggravated at night, when eating. The face is asymmetrical, in the oral cavity there is a bulge in the zone of premolars or molars.
• Osteoclastoma. It is more common in adolescence and youth. Facial asymmetry, tooth mobility, aching, bursting pains gradually progress. Over time, fistulas form over the neoplasia. Possible pathological fractures.

Malignant neoplasms of the lower jaw are less common than benign ones. Cancer is characterized by a rapid increase in pain, irradiation to the cheek, ear, eye, and temporal region. Accompanied by mobility, loss of teeth, germination of masticatory muscles, salivary glands, ulceration. Osteogenic sarcomas are rapidly progressing, quickly infiltrating soft tissues. Pain within a few months from moderate, pressing, aching or bursting increases to constant, unbearable, is eliminated only by narcotic analgesics.

Cardiac ischemia

Irradiation to the lower jaw can be observed with angina pectoris and myocardial infarction. Pain is caused by the spread of impulses from the heart to the upper thoracic segments of the spinal cord, from there, through other nerves - to the face, neck, left arm, left shoulder blade. The main symptom is a burning, pressing, squeezing or bursting pain behind the sternum.

An attack of angina pectoris lasts several minutes, is eliminated after the cessation of physical activity, taking nitroglycerin. With a heart attack, the pain is undulating, very intense, lasts more than 3 minutes, does not disappear when using the above methods. With an atypical course of infarction and coronary artery disease, retrosternal pain may be absent, only reflected ones are observed, including in the jaw.

Diagnostics

Diagnostic measures are carried out by a dentist or maxillofacial surgeon. According to indications, a neurologist, cardiologist, and other specialists are involved in the examination. The doctor establishes the nature of the symptom, its change since the onset, dependence on external factors. Identifies other complaints, conducts a general and dental examination to detect objective changes (hyperemia, edema, decayed teeth, asymmetry). To make a final diagnosis, data from such studies as:

• Radiography . Informative for injuries, purulent processes (with the exception of the acute stage), tumors, and some dental pathologies. It helps to confirm the presence of a fracture, to identify other changes in the bone, to differentiate osteomyelitis and periostitis from inflammation of the surrounding soft tissues, to distinguish between benign and malignant neoplasms.
• Computed tomography . CT of the jaw provides more accurate data on the state of solid structures compared to radiography. It is carried out with insufficient diagnostic value of x-rays, the need to clarify the location of fistulas, the nature of injuries and neoplasia. CT of the skull makes it possible to determine the narrowing of the holes, which causes nerve compression with the development of neuralgia.
• Magnetic resonance imaging. It is recommended to exclude tumor and vascular genesis of nerve trunk compression. Detects cysts, neoplasia, aneurysms, tortuosity of vessels passing near the nerve.
• Electrophysiological Research . Electromyography allows you to confirm the pathological activity of muscles in myofascial pain, bruxism, to assess the quality of neuromuscular transmission in neuralgia. Electroneurography makes it possible to establish the scale and level of nerve damage. Patients with suspected coronary artery disease are shown an ECG.
• Invasive techniques . A lymph node biopsy is performed with an increase in the submandibular or cervical lymph nodes in patients with tumors. In case of perimaxillary phlegmons with a deep location of the purulent focus, a diagnostic puncture may be required to verify the diagnosis.
• Laboratory tests . The causative agent of purulent processes is determined by sowing the discharge on nutrient media. With neoplasms, a morphological study is performed to establish the type and degree of malignancy of neoplasia.

Maxillofacial Surgeon Consultation

Treatment

Conservative therapy

Therapeutic tactics is determined by the cause of the symptom. Patients with dental pathologies are shown local treatment. Removable dentures and orthopedic structures are replaced, other types of prosthetics are selected. With pulpitis, the cavity is treated with antiseptics, antibiotics, proteolytic enzymes, pastes are applied to eliminate inflammation and stimulate regeneration, and filling is performed after a few days. For other diseases, the following methods are recommended:

• Inflammatory processes . Antibiotic therapy is carried out in the pre- and postoperative period. At the initial stage, broad-spectrum drugs are administered parenterally. After receiving the results of sowing, the medication is replaced taking into account antibiotic sensitivity. Perform dressings, produce washings. Analgesics are prescribed to reduce pain.
• Traumatic injuries . In case of fractures of the angle, the body of the lower jaw without displacement, conservative immobilization is carried out by double-jaw wire splinting. Antibacterial agents are used to prevent inflammation, and painkillers are used to reduce pain.
• Neuralgia . Anticonvulsants are used to relieve pain. To enhance the effect, the treatment program is supplemented with antispasmodics, antihistamines, microcirculation correctors. Blockade of trigger points is carried out with a mixture of glucocorticoids and local anesthetics. They issue a referral for ultraphonophoresis, galvanization with novocaine.
• Muscle pathologies . With bruxism, an integrated approach is effective, including medical, dental, physiotherapeutic, psychotherapeutic methods, the use of protective mouthguards. Patients with myofascial syndrome are prescribed muscle relaxants, NSAIDs, antidepressants.
• ischemic heart disease . As part of drug therapy, antianginal agents, beta-blockers, calcium channel blockers, antioxidants, antiplatelet agents, antisclerotic drugs are indicated.

Surgery

The choice of surgical technique depends on the cause of the symptom:

• Inflammatory diseases : opening, drainage of abscesses and phlegmons, sequestrectomy for osteomyelitis.
• Injuries : open osteosynthesis using bone sutures, polyamide thread, mini-plates.
• Neoplasms : curettage, excision of benign neoplasia within healthy tissues (often with extraction of teeth), resection or disarticulation of the lower jaw in case of a malignant tumor.
• Neuralgias : microsurgical decompression, percutaneous radiofrequency destruction, stereotactic radiosurgery.
• IHD : thrombolysis, emergency coronary angioplasty in the acute period of infarction; planned coronary artery bypass grafting, balloon angioplasty for angina pectoris, post-infarction conditions.