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ULY CLINIC

11 Septemba 2025, 08:07:57

Jaw pain

Jaw pain may originate from the maxilla (upper jaw), mandible (lower jaw), or the temporomandibular joint (TMJ) where the mandible meets the temporal bone. Pain may develop gradually or abruptly, ranging from mild to excruciating. Causes include dental, soft tissue, or glandular disorders, local trauma or infection, and systemic conditions affecting musculoskeletal, neurologic, cardiovascular, endocrine, immunologic, metabolic, or infectious systems. Life-threatening disorders such as myocardial infarction (MI) and tetany can also present as jaw pain. Jaw pain is rarely a primary indicator but may sometimes signal a medical emergency.

Emergency interventions

Assess onset, severity, and progression of pain.
Sudden severe jaw pain with chest pain, dyspnea, or arm pain may indicate MI.
Initiate ECG and measure cardiac enzymes.
Administer oxygen, morphine sulfate, and vasodilators as indicated.

History and physical examination

Document character, intensity, frequency, location, and radiation of pain.
Differentiate sharp/burning (superficial, trigeminal nerve involvement) from dull/aching/throbbing (muscle, bone, joint) pain.
Identify aggravating or alleviating factors.
Ask about recent trauma, surgery, dental procedures, and associated symptoms: chest pain, dyspnea, palpitations, fatigue, headache, malaise, anorexia, weight loss, diplopia, and hearing loss.
Inspect jaw for redness, edema, facial asymmetry.
Examine TMJ: palpate anterior to external auditory meatus while asking patient to open/close, protrude, and retract jaw; note crepitus, clicks, range of motion (<3 cm or >6 cm abnormal).
Palpate parotid glands for swelling/pain; inspect oral cavity for lesions, masses, or tongue elevation.

Medical causes

Cause	Key Features
Angina Pectoris	Jaw pain radiates from substernal area; triggered by exertion/stress/meal; relieved by rest/nitroglycerin; may have SOB, nausea, diaphoresis, palpitations.
Arthritis	Osteoarthritis: TMJ crepitus, pain increases with activity, improves with rest, stiffness on awakening. Rheumatoid arthritis: symmetrical joint involvement including jaw, tenderness, warmth, limited ROM, fatigue, weight loss, mild fever, rheumatoid nodules; usually women 36–50 yrs.
Head and Neck Cancer	Insidious jaw pain; leukoplakia, oral ulcers, palpable masses, dysphagia, bloody discharge, drooling, trismus, lymphadenopathy.
Hypocalcemic Tetany	Jaw/mouth muscle contractions, paresthesia, carpopedal spasm, hyperreflexia, positive Chvostek/Trousseau signs, laryngeal spasm in severe cases.
Ludwig’s Angina	Acute submandibular/sublingual infection; severe jaw pain, tongue elevation, sublingual edema, drooling, fever; can progress to airway obstruction.
Myocardial Infarction (MI)	Intense crushing substernal pain radiating to jaw, left arm, neck, back, shoulders; pallor, diaphoresis, dyspnea, nausea, anxiety, arrhythmias, murmurs, crackles.
Sinusitis	Maxillary: intense, boring pain in maxilla/cheek radiating to eye, fullness, tooth tenderness, fever. Sphenoid: chronic mandibular ramus/temporal pain, scant nasal discharge, headache, malaise.
Suppurative Parotitis	Staphylococcus aureus infection; abrupt jaw pain, fever, chills, erythema, swelling, tender gland, pus from Stensen’s duct.
Temporal Arteritis	Older women (>60); sharp jaw pain with chewing/talking, unilateral frontotemporal headache, nodular/tender temporal arteries, fever, fatigue, weight loss.
TMJ Syndrome	Pain at TMJ, masticatory muscle spasm, clicking/popping/crepitus, restricted movement, radiates to head/neck; associated with bruxism, stress, teeth clenching.
Tetanus	Rare; jaw stiffness, difficulty opening mouth, progressing to generalized muscle spasms, laryngospasm, respiratory distress, seizures.
Trigeminal Neuralgia	Paroxysmal, unilateral jaw pain along trigeminal nerve branches, triggered by light touch, heat/cold, or eating; lasts 1–15 minutes, hypersensitivity in mouth/nose.

Other causes

Certain drugs (e.g., phenothiazines) causing extrapyramidal effects or jaw tetany secondary to hypocalcemia.

Special considerations

With severe pain, withhold food, liquids, oral medications until diagnosis confirmed.
Administer analgesics; apply ice packs for swelling.
Prepare patient for diagnostic tests: jaw X-ray, labs, imaging.
Advise limited jaw movement until etiology identified.

Patient counseling

Educate on the disorder, treatments, and trigger avoidance.
Teach correct use of mouth splints if indicated.
Discuss stress-reduction techniques.

Pediatric pointers

Observe nonverbal cues: rubbing area, wincing while talking/swallowing.
Infants: early hypocalcemia may present as apnea, jitteriness, facial grimacing, progressing to rigidity and seizures.
Pediatric causes include mumps, parotiditis from cystic fibrosis, trauma (consider abuse).

References

Chang, E. I., Leon, P., Hoffman, W. Y., & Schmidt, B. L. (2012). Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the University of California San Francisco. Head & Neck, 34(2), 207–212.
Hewson, I. D. (2011). Bisphosphonate-associated osteonecrosis of the jaw: A six-year history of a case. New Zealand Dental Journal, 107, 97–100.