TOOTHACHE (Pain that can spread right across the face)

Common symptoms and causes
Infection of a tooth
Pain starts as a mild throb, but within hours seems to involve half of your face and several teeth; the affected tooth is tender when you bite on it and sensitive to hot or cold drinks; after a few hours, the part of your jaw or face nearest to the affected tooth swells.

A feeling of pressure and pain across the upper face following a cold; worse on bending forwards; often accompanied by aching in several upper teeth and the loss of smell and taste.

People under stress often clench their teeth during sleep, and wake with discomfort in several teeth rather than pain in a single tooth.

Less likely symptoms and causes
Toothache is usually unmistakable; neuralgia is a possibility if there is recurrent, stabbing pain that lasts only a few seconds each time. Gingivitis (inflammation of the gums) causes recurrent tenderness of the gums and bleeding when the teeth are brushed.
FACIAL PAIN (Pain affecting the whole face)

Common symptoms and causes
Sudden pain is easier to diagnose than recurrent chronic pain. Nagging pain without other symptoms.
Pain above, below or behind the eyes, accompanying a cold; worse on leaning forwards.
Dental pain
Recurring facial ache, followed by nausea, headache, flashing lights in the eyes - migraine. Tender teeth or gums; throbbing pain.
Tempero-Mandibular joint pain
Pain when biting or chewing in the joint where the upper and lower jaws hinge together in front of the ear.
A crusted rash forms across the face after several days of pain and tingling.
Less likely symptoms and causes
Facial nerve palsy (Bell's palsy): the face suddenly droops on one side, there is an ache rather than pain. Trigeminal neuralgia: recurrent brief pains shoot across face. Tumours of the sinuses, nose or ears: pain lasts for weeks, the face swells.

T M J    D I S O R D E R S

The jaw joint or TMJ is the joint by which the lower jaw bone is connected to the upper jaw. The joint movement can be felt by placing a finger infront of the ear while opening and closing the mouth.The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side and base of the skull) and the mandible (lower jaw). Mastication (chewing) muscles connect the lower jaw to the skull, allowing you to move your jaw forward, sideways, and open and close. The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. Temporomandibular Disorder (TMD) may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

What is Temporomandibular Disorder?
TMD describes a variety of conditions that affect jaw muscles, temporomandibular joints, and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men and is the most common non-dental related chronic orofacial pain.

  • Locked or stiff jaw when you talk, yawn or eat.
  • Jaw pain or soreness that is more prevalent in the morning or late afternoon.
  • Jaw pain when you chew, bite or yawn.
  • Clicking when opening and closing your mouth.
  • Difficulty opening and closing your mouth.
  • Sensitive teeth when no dental problems can be found.
  • An earache without an infection.
DIAGNOSIS These disorders are diagonised by X-Rays, Arthography and MRI (Magnetic Resonance Imaging).

This is considered normal but if it becomes painful or the sound becomes too loud, then requires to be treated. Clicking is due to displacement of Miniscus disc within the joint. Pain can be referred to nearby structures such as ear, nose, teeth, temple and eyes.
  • Injury to the jaw.
  • Long standing TMJ muscle dysfunction
  • Jaw deformity
  • Loss of many posterior teeth
  • Bruxism
  • Mental stress and anxiety

  • Surgical - Repositioning of Miniscus disc.
  • Medicinal - By giving Analgesics (pain killers), Muscle relaxants and Anti-inflammatory drugs.
  • TMJ Exercises
  • Wearing of Night Guards
  • Treatment of Mental Stress and Anxiety
  • Dentures wearers should ensure that they wear a properly fitted prosthesis with a perfect bite.

When the mouth opening is less than 35mm it is considered abnormal.

  • Inflammatory - a. Juvenile, b. Rheumatoid Arthritias
  • Trauma
  • Infection

TREATMENT - Arthroscopy.

When the jaw opens far too wide and cannot be closed, it is known as Open Lock or Dislocation of TMJ.It can be corrected by the patients on their own or by the dentist. But in cases of pain surgical intervention is needed i.e. Arthroscopy.In recurrent dislocation cases Injection of BOTULINUM TOXIN TypeA (BTA)are given in external pterygoid muscle and the superficial part of the masseter muscle.