Pain in the upper jaw is provoked by injuries, purulent processes, ganglioneuritis, some dental and otolaryngological diseases, tumors, masticatory muscle pathologies, and temporal arteritis. It can be weak, intense, constant, short-term, pressing, aching, pulling, shooting, or bursting. The cause of the symptom is established based on complaints, examination data, imaging methods, and laboratory tests. Treatment is carried out using painkillers, antibiotics, local manipulations, and surgical interventions.
Damage occurs as a result of household, street, sports, automobile, and industrial injuries. A bruise is characterized by moderate soreness, passing after a few days. Fractures of the upper jaw are accompanied by extremely intense acute pain, rapidly increasing edema, facial asymmetry, and stepped dentition. In the case of fractures of the alveolar process, lacerations are visible on the mucous membrane, sometimes the end of the displaced bone fragment is determined. Occlusal contact is sharply broken, and the teeth are mobile.
With an isolated fracture of the walls of the maxillary sinus, there is a strong aching pain in the upper jaw, infraorbital zone, significant swelling, and hemorrhages. Nasal breathing is difficult. With combined injuries to the bone walls of the sinuses, a clinic of concussion and profuse nosebleeds are detected. Perforation of the maxillary sinus occurs during dental procedures. If the damage was not detected, subsequently swelling of the cheek, a nasal tone of speech, pressing or arching pain in the jaw, and projections of the sinuses appear.
In some cases, radiating pain in the jaws is determined in patients with subluxation of the cervical vertebra. Irradiation to the back and shoulders is also possible. The clinical picture includes a forced position of the head, pain in the neck, muscle tension, sometimes dizziness, weakness, convulsions, and paresthesia in the hands.
Discomfort and mild pain may be associated with the use of removable dentures, and orthodontic structures. Drawing, pressing, and aching pains occur in children against the background of malocclusion, including those caused by deformation of the upper jaw with a cleft lip and cleft palate. Some soreness is normal after extractions of teeth, especially molars and wisdom teeth.
With the development of alveolitis, the pain disappears, and then reappears 3-5 days after tooth extraction. Intense pulsating sensations are noted in the projection of the socket, intensify with the progression of inflammation, and sometimes cover the upper jaw, half of the face. Attacks of severe pain, spreading along the trigeminal nerve, are characteristic of acute diffuse pulpitis. More local pain sensations are observed in acute periodontitis.
Pain in the upper jaw
Intense jerking, tearing, and bursting pains occur with purulent inflammation of the upper jaw, and nearby soft tissues. Combined with hyperthermia, deterioration of the general condition, and intoxication syndrome. The most striking clinical picture unfolds in acute osteomyelitis. The disease begins suddenly, the symptom progresses rapidly, and the temperature rises too high numbers. A fetid odor emanates from the mouth, pus accumulates in the gum pockets.
Periostitis is characterized by less pronounced symptoms. With the high intensity of the pain syndrome, the general condition is slightly disturbed, and the temperature is subfebrile. In patients with a maxillary abscess, the abscess is limited, located in soft tissues, and the condition is moderate or closer to satisfactory. With premaxillary phlegmon, the infection spreads rapidly and jerking, and shooting pains are aggravated by the slightest movements of the jaw, the condition is serious.
With abscesses of the salivary glands, the first symptoms are dryness of the mucous membrane and an unpleasant aftertaste in the mouth. Hyperthermia up to 40°C is noted. The maximum soreness is determined in the projection of the affected salivary gland, complemented by severe edema. Irradiation to the upper jaw, neck, and ear is noted.
With ganglions of the pterygopalatine node, a clinical picture of trigeminal nerve neuralgia is observed in the zone of innervation of its 2nd branch - n.maxillaris. An attack of intense shooting pain develops spontaneously and often occurs at night. Pain is predominant in the upper jaw, eye, and hard palate, at the base of the nose, spreading to nearby anatomical zones. The episode lasts from several minutes to several hours and is supplemented by vegetative disorders: lacrimation, profuse salivation, and hyperemia of half of the face.
As another possible cause of the symptom, atypical facial neuralgia is considered, which is more often detected in middle-aged women. Pathology is provoked by dental manipulations. Pain is dull, sometimes burning. Do not reach the intensity typical of other neuralgias. They quickly transform from paroxysmal to permanent.
In otolaryngology, the manifestation is more often provoked by odontogenic sinusitis against the background of injuries, dental diseases, and endodontic treatment. The acute form is characterized by heaviness, bursting unilateral pain in the upper jaw, aggravated by lowering the head, and a throbbing headache. There is sharp pain when chewing food, and a subjective feeling of elongation of the teeth. In chronic sinusitis, the clinic unfolds gradually. The symptom is also combined with a headache, which gives to the forehead, temple, and orbit.
Radiating pain in the upper jaw, orbit, and temporal region can be observed in acute purulent otitis media, due to irritation of the trigeminal nerve during infiltration of the mucous membrane of the tympanic cavity. Complemented by a sharp pain in the ear, intoxication syndrome. Similar irradiation is found in mastoiditis, which develops simultaneously with otitis or a few days later, and is manifested by profuse suppuration from the ear, and throbbing pain behind the ear.
Against the background of benign neoplasia of the upper jaw (fibromas, cementum, osteomas, osteoblastoclasts), pain is usually mild, dull, and aching. Does not occur in all patients. Slowly increase for a long time in parallel with the growth of the neoplasm. Sometimes complemented by the progressive asymmetry of the face. An exception is osteoid osteoma, which is characterized by an intense pain syndrome that is aggravated by eating and at night.
With malignant tumors of the upper jaw (cancer, sarcomas), pain appears already in the early stages. First intermittent, dull, aching, or pressing. Rapidly intensify, become constant, acute, painful, intolerable. Irradiate to neighboring anatomical zones. They are supplemented by tooth loss, infiltration of nearby tissues, decay with the formation of ulcers, and an increase in regional lymph nodes.
Aching, at first paroxysmal, then - constant pain in the upper and lower jaws are observed with bruxism and myofascial syndrome. In both cases, the cause is a constant excessive load on the masticatory muscles. In patients with Horton's disease, the symptom is due to irradiation, combined with a dull headache, gradually increasing over several weeks, more pronounced in the temporal region.
Determination of the causes of the symptom is the responsibility of the dentist. Patients may need to see an ENT and maxillofacial surgeon. Less often, consultations with a neurologist, traumatologist, or rheumatologist are shown. The doctor collects complaints, examines the dynamics of the development of the disease, finds out possible provoking factors, and establishes the nature of pain, their relationship with the time of day, food intake, and other circumstances.
Based on the survey data, general and dental examinations, a plan of diagnostic measures is drawn up, which may include the following procedures:
Treatment planning
Pain is relieved with analgesics. A treatment plan is drawn up taking into account the cause of the symptom. The following methods are used:
Taking into account the etiology of the pain syndrome, the following interventions are possible: