In my practice, most patients are referred by their dentist, physician, or other healthcare professionals because they are experiencing facial pain, persistent tooth pain, or the common symptoms of TMJ/TMD, which can include one or more of the following: ear pain, jaw pain, limited jaw motion, joint noise, the inability to bring teeth together, facial tightness, and headaches often focused in the temples.
At times, however, the patients’ description of their symptoms and the history of their problem indicates that though their complaints are familiar, the origin of their problem may be related to an underlying medical disease or condition that has yet to be discovered. In other words, things are not what they seem to be!
For instance, the following medical conditions (a small sample) can produce Facial Pain, Persistent Tooth Pain, or TMJ/TMD symptoms:
• Sinus Disease
• Cranial Arteritis
• Thyroid Pathology
• Lyme Disease
• Pathology/Tumors in the Salivary Gland
• Cardiovascular Pathology
• Facial Neuralgias
• Oromandibular Dystonias
• Migraine headaches
Though these conditions occur much less frequently than a common jaw ailment, they must be considered when a patient’s history is unrevealing or their TMJ symptoms are not responding to common therapies and/or progressing over time. When making an accurate diagnosis is delayed, and the TMJ structures (muscles or joints) / teeth are treated instead of the real problem, symptoms will not only continue but more significant concerns may develop.
Clues that suggest the cause of facial/toothache and jaw pain or mechanical dysfunction is a problem unrelated to muscles: TM joints or teeth are often subtle, but they usually reveal themselves over the course of time. Several factors that may distinguish a common facial pain / TMD problem from one associated with a more serious medical issue include the following:
1. Facial pain that is constant, but does not necessarily increase with eating, opening and closing of the mouth, or head movements requiring contraction of the neck muscles.
2. Persistent ear pain that never eases and is unresponsive to treatment.
3. Exacerbation of facial pain with talking, smiling, or exertional actions, such as sneezing or coughing.
4. Facial pain that is described with the words “excruciating,” “sickening,” or “twitching.”
5. Facial pain that is accompanied by visual changes, deficits in hearing, and changes in taste and/or smell.
6. Facial pain that is accompanied by a profound and persistent sense of numbness or tinging in the tongue, lower lips, or face.
7. Vague facial pain on the left or right side of the jaw and upper neck that does not increase with jaw function but does increase with physical activity or efforts.
8. A quick onset of extreme jaw muscle fatigue and a sense of weakness within moments of starting to chew.
9. A marked, gradual change in the way the teeth come together without apparent cause.
10. Absence of any type of response after 6-8 weeks of treatment directed at the jaw and neck muscles.
11. The presence of facial swelling, with or without accompanying pain.
Certainly if the care you’ve rendered to date to address TMD or facial pain has not been successful, it may be time to broaden the investigation.