TMJ/Trigeminal Neuralgia

TMJ Pain/Trigeminal Neuralgia
TMJ Pain/Trigeminal Neuralgia

Orofacial Pain

Orofacial pain is pain felt in any of the following areas: the mouth, jaws, face, sides of the head, ear, or behind the eyes. It includes aching teeth that are not decayed or in poor repair. The pain can vary from mild to severe. It can impact on work, family, and social activities. People often describe the pain as a tingling, throbbing, or burning sensation.

Other symptoms:

  • Sore or aching neck muscles
  • Pain or tenderness, clicking or popping of the jaw joint in front of the ear
  • Difficulty with chewing and talking
  • Migraines or headaches
  • Sleep disorders
  • Loss of appetite
  • Increased sensitivity to noise, temperature, touch, vibration, or pressure on the face or scalp

Diagnosis of orofacial pain

Your dentist will discuss the most appropriate diagnostic tests for your symptoms. The shifting nature and different causes of orofacial pain may make some cases difficult to diagnose. If this is misdiagnosed, you may receive a treatment that does not relieve the symptoms and cannot be reversed.

Your dentist will take a detailed history of the pain and any other symptoms or conditions related to the pain such as problems of the sinuses, the TMJ, or salivary glands. Often with orofacial pain, teeth feel painful and sore but are not the cause of pain. Listen carefully to your dentist who may advise against treatment of teeth.

Common Causes of Orofacial Pain

  • Bruxism – excessive grinding or clenching of the teeth often causes damage and chronic facial pain
  • Cracked tooth syndrome
  • Trauma or disease of the gums or of the periodontal ligaments
  • Jaw muscle pain linked to trauma, inflammation, jaw overuse, and fatigue
  • Referred pain – this is pain from one area of the body that is felt in a different area which may be far from the source of pain. Heart pains can be referred to the left shoulder or left arm and also the teeth and jaws. Sinus congestion can refer pain to the teeth, mouth, and face.

Treatments for Orofacial Pain

The aim of treatment is to identify and correct the cause of the pain. After you are diagnosed, your dentist will discuss treatment options with you. Some cases of orofacial pain may require treatment by a healthcare professional other than your dentist.

Pain is often perceived as being more severe when a patient has a dietary imbalance, is fatigued, or is feeling anxious, upset, or depressed. You may be referred to a dietitian, social worker, or counsellor. You may be prescribed antidepressants or anti-anxiety drugs.

Mouth splints also help with protecting the teeth’s surfaces from further damage and may relieve any pressure on the TMJ and teeth.


Excessive clenching or grinding can lead to wear on the teeth and permanent damage to the teeth and jaw joints. It may occur during the day or at night. Some people do it during sleep so they have no conscious control over it.

Bruxism is caused by any of the following:

  • Physical stress such as illness, nutritional deficiencies or dehydration, particularly in children
  • Psychological stress, anxiety, and tension in adults and children
  • Studies have shown that night bruxism is a sleep disorder
  • Other abnormal anatomy of the teeth or jaws such as “high spots” on fillings

Signs and symptoms

  • Pain in the teeth and sensitivity to heat and cold
  • Chronic facial pain with tension headaches
  • Noise when teeth are ground together, noticed by others
  • Flattened and worn tooth surfaces
  • Microfractures of the tooth enamel
  • Broken or chipped teeth
  • Loose teeth with possible damage to tooth sockets
  • Stiffness and pain in jaw joint muscles
  • Earache or pain in jaw joint

Before treatment, your dentist will need to know your medical history to plan the best treatment. Tell him any health problems you have had, if you have any allergic reactions to any medicine especially antibiotics or anaesthetics, previous treatment related to bruxism or jaw surgery, or a psychological illness. Give him a list of all medicines you are taking or have previously taken.


To confirm if you have bruxism your dentist will note the following:

  • Location of the pain, stiffness, or soreness
  • Rang of jaw movement
  • Any noises in the jaw joint
  • Your bite, tooth wear, and movement of teeth

To assist diagnosis your dentist may recommend wearing a plaster mould of your teeth if your bite is correctly balanced.

Treatment of bruxism

There is no one cause for bruxism. If it’s because of general health problems, your dentist will recommend an examination by a medical practitioner. If it’s due to stress, he may recommend counselling. Treatment aims to:

  • Remove causes of bruxism
  • Change of the behaviour that causes bruxism
  • Repair the damage that bruxism often causes

You may be prescribed painkillers or muscle relaxants.

Changing bruxism behaviour

These options help patients rest their mouth:

An occlusal splint or a night guard to be worn at night to prevent further wear of tooth surfaces
Biofeedback used electronic monitors to measure tension in jaw muscles

Repair of damage to teeth

Dental fillings, crowns, or inlay can replace damaged tooth surfaces. Root canal treatment may be required where tooth fractures extend into the pulp. In extreme cases, extraction may be the only option.

Partial dentures, dental bridges, or dental implants can replace missing teeth.