Facial Pain

Guess what? It’s not always a tooth. Facial pain comes in two categories:

  1. Tooth Pain and
  2. Non-tooth Pain.

1. Tooth Pain:

Tooth pain from a bad nerve can be very specific. You can put your finger on the tooth and say “This is the tooth that hurts!”

We also may have what we call “Referred Pain”. A bad tooth can send radiating pain to other distant sites. This would include another tooth, skin of your face, your eye, ear and your sinuses. Lower teeth tend to send pain to the ear. Upper teeth tend to send pain to those “Headache” areas.

Some of your symptoms (What you tell us) will be:
I have pain to cold, and the pain lingers after the cold is gone.

I have pain to hot, and the pain lingers after the heat source is gone.
I get a sharp pain every time I bite a certain way.
It woke me up last night.
The tooth hurt while I was exercising.
The tooth hurt while I went on a plane flight.
It just throbs all the time.
The Advil was working, but now I take a bottle a day and it is not helping anymore.

Point:

Referred pain never crosses the midline of your face! A toothache on the bottom jaw can make your ear or upper teeth hurt, but only on that side. Pain will not refer from right to left or left to right, only up or down.

2. Non-tooth Pain:

It feels like it is in the tooth area, but it is not from the tooth. This type of pain may not be as specific, shorter duration, diffuse and not consistent. So where is it coming from? There are many avenues:

Periodontal problems-

The gum and surrounding bone tissue can get infected and make a tooth hurt.

Neuralgias-

The nerve that goes to your teeth, also travel to the other facial structures. There may be a “trigger point” on the gum or cheek. Touching the spot gives you a pain episode that can be sharp and last a few seconds. There are viral infections (cold sores, shingles) that may set off a neuralgia typical situation.

Ear Infections-

Pain can be referred to the jaw area from an infection stemming from the middle ear. Positional changes of the head may make the tooth feel worse.

Sinus -

The roots of your upper teeth can be right next to your sinuses. How close? Blow up a balloon, now place your fingers into the balloon, this may give you some idea. Sinus problems come from infection and allergies. The pain can be dull to severe; can last for hours and days. Head positioning can make it worst. Also a key symptom is that you are “stuffed”. Typically you will not be telling us of temperature sensitivity and sharp pain from a stimulus.

Headache pain-

Migraines and cluster headaches. The pain from this is severe; pain can last for minutes to hours. The pain in your teeth or jaw may change due to head position, and room surroundings.

Heart-

Left posterior jaw pain is not uncommon with heart conditions, angina, and carotid artery problems. Pain may last for minutes and can be associated with exercise or physical situations. In these situations it is important that there is good communication between patient, dentist and physician.

TMD/TMJ -

This pain tends to be low grade, and go on for a long time, months. The two joints the open and close your jaw located in front of your ears can be damaged from arthritis, accidents, trauma, grinding and prolonged opening of your jaw. The muscles that open and close your jaw attach to the bone surrounding your teeth. You may have a dull ache in the posterior of the jaw.

Neoplasia and benign growths-

Things that can grow in your jaw that encroach and push on teeth and nerve endings in the jaw. Many cancer and non-cancer growths can occur in the jaw.

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