Pain in the lower jaw
Pain in the lower jaw is observed with periostitis, osteomyelitis, parotid abscess, fractures, tumors. It is provoked by some dental pathologies, bruxism, neuralgia, CHD. It can be constant, periodic, strong, non-intense, dull, acute, pressing, aching, bursting, tugging. The cause is determined based on the results of the survey, general and dental examination, visualization, electrophysiological, laboratory techniques. Therapy includes analgesics, antibiotics, glucocorticoids, and other medications. Sometimes operations are performed.
Why there is pain in the lower jaw
Purulent diseases
Traumatic injuries
Neuralgia
Muscle damage
Dental reasons
Tumors of the lower jaw
Coronary heart disease
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why there is pain in the lower jaw
Purulent diseases
The cause of the pain syndrome is inflammation of the bone, periosteum or nearby soft tissues. In 70-80% of cases, the disease has an odontogenic origin. Less often, the process is provoked by acute infections, jaw injuries. It is supplemented by edema, hyperemia, violation of the general condition, intoxication syndrome, regional lymphadenitis. Soreness is observed in the following pathologies:
Periostitis. The symptom is more pronounced in acute purulent periostitis. The pain is sharp, pressing or drilling, radiates into the eye, ear, temple, neck. It increases when opening the mouth. There is weakness, subfebrility, swelling of the cheek. With chronic periostitis, the pain is periodic, moderate or non-intense, pressing or bursting. The contours of the face are slightly changed.
Osteomyelitis. It is characterized by a sudden manifestation with a rapid rise in temperature to febrile numbers, chills, pronounced intoxication. Pain sensations shooting, pulsating, spilled, radiate into the neck, half of the face. They increase when swallowing, limits the opening of the mouth. The teeth are mobile, pus is released from the gums. The mucous membrane of the oral cavity, the skin of the chin becomes numb. In chronic osteomyelitis, the symptom increases after the closure of the fistula, decreases or disappears after the resumption of the outflow of pus.
Parotid abscess. The formation of an abscess is preceded by toothache. Then there is a dense swelling. The soreness is rapidly increasing, the effects of intoxication are increasing. The patient refuses to eat. After spontaneous autopsy, the manifestations disappear, in the absence of treatment, chronization is more often observed with periodic exacerbations, the resumption of pain and suppuration.
Parotid phlegmon. Typically acute onset with rapid progression of local manifestations, purulent-resorptive fever. The pain is twitching, it increases with talking, chewing, movements of the lower jaw, supplemented by increased salivation, the formation of a diffuse infiltrate with a fluctuation zone. The condition continues to deteriorate due to severe intoxication.
Traumatic injuries
Injuries to the lower jaw are most often the result of fights. Possible damage due to falls, car accidents, accidents at work. With a bruise, the asymmetry of the face is caused by swelling of soft tissues, the closure of teeth is normal. The symptom is expressed moderately, decreases rapidly, does not create serious obstacles to articulation, eating.
Among fractures, body injuries predominate, violations of the integrity of the angle and branch are less common. Half of the fractures are bilateral. At the moment of injury, there is a sharp explosive pain, only slightly decreasing over time, intensifying when talking, biting, chewing. Possible numbness of the chin, lower lip. Facial asymmetry, articulation disorders, dentition gradation, mobility, and sometimes dislocations of teeth are noted.
Fractures of the alveolar process of the lower jaw are less common than the upper one, develop with blows, falls from a height, etc. Accompanied by intense spontaneous pain, which increases when swallowing, trying to close teeth. The mouth is half-open, the protruding edge of the bone fragment can be determined under the mucosa. The bite is broken, the teeth are mobile, dislocations are possible.
Pain in the lower jaw
Pain in the lower jaw
Neuralgia
The symptom is accompanied by trigeminal neuralgia involving 3 branches (n.mandibularis). It is provoked by external factors (shaving, cold air, water), the load on the chewing muscles. Prosopalgia has a paroxysmal character, it is a series of painful impulses that are felt as a shot or a shock of current from the side of the face along the lower jaw to the chin. The pain is sudden, lasts for several minutes, reaches such intensity that the patient freezes, does not move, does not talk.
With neuralgia of the lingopharyngeal nerve, the pain impulse is caused by chewing, swallowing, talking, lasts from a few seconds to 3 minutes, occurs at the root of the tongue, spreads through the tonsils, palate, pharynx, ear. Pain in the lower jaw is radiating. In patients with ganglionitis of the submandibular node, pain is paroxysmal, burning, drilling, pulsating. They last from 1 minute to 1 hour. They begin in the tongue, spread to the lower jaw, temple, occiput, neck, shoulder.
Muscle damage
Bruxism is formed due to a spasm of the masticatory muscles. After night attacks, patients are concerned about pain in the jaws due to their clenching and intense movements relative to each other. Muscle, dental, headaches, dizziness, drowsiness are possible. With myofascial syndrome, soreness develops due to overload of the masticatory muscles. It is perceived as moderately pronounced, deep. At first it appears only under load (chewing, clenching of the jaws), then it increases, becomes constant.
Dental reasons
The symptom worries in the first days after tooth extraction. It is especially pronounced in the presence of an inflammatory process, removal of retinated or incorrectly erupted wisdom teeth. Some patients report soreness due to wearing braces and removable dentures. Aching, pressing or pulling pain in the jaw and chewing muscles, problems with chewing and swallowing, biting of the cheeks and tongue are detected in children with malocclusion.
The cause of severe progressive paroxysmal pain, which spreads to the entire lower jaw, increases at night, is acute diffuse pulpitis. Prolonged intense soreness under the action of external stimuli, spontaneous pain attacks are also noted during the exacerbation of chronic pulpitis. Irradiation along the course of the trigeminal nerve is typical. Between attacks, moderate or minor aching pains are possible, which increase when biting.
Tumors of the lower jaw
Pain syndrome is characteristic of a number of odontogenic and non-odontogenic benign neoplasms. Distinctive features of such neoplasias are slow growth, lack of germination of surrounding tissues:
Odontogenic fibroma. It is more often diagnosed in children. The pain is aching, not intense, does not occur in all patients. It can be combined with retention of teeth, inflammation in the affected area.
Cementoma. As a rule, it is localized in the area of the molars or premolars of the lower jaw. The course is asymptomatic or with minor pain, which increases with palpation.
Osteoma. Accompanied by pain, facial asymmetry, slowly increasing over months or years. Large tumors limit the mobility of the lower jaw.
Osteoid-osteoma. Unlike other neoplasms, the pain is sharp, intense, increasing at night, when eating. The face is asymmetrical, there is a bulge in the area of premolars or molars in the oral cavity.
Osteoblastoclastoma. It is more common in adolescence and adolescence. Facial asymmetry, tooth mobility, aching, bursting pains gradually progress. Over time, fistulas form over neoplasia. Pathological fractures are likely.
Malignant neoplasms of the lower jaw are found less often than benign ones. Cancer is characterized by a rapid increase in pain, irradiation in the cheek, ear, eye, temporal region. It is accompanied by mobility, tooth loss, germination of masticatory muscles, salivary glands, ulceration. Osteogenic sarcomas are rapidly progressing, soft tissues are rapidly infiltrating. Pain for several months from moderate, pressing, aching or bursting increases to constant, unbearable, eliminated only by narcotic analgesics.
Coronary heart disease
Irradiation to the lower jaw can be observed in angina pectoris and myocardial infarction. Pain is caused by the propagation of impulses from the heart to the upper thoracic segments of the spinal cord, from there, along other nerves – to the face, neck, left arm, left shoulder blade. The main symptom is considered to be burning, pressing, squeezing or bursting pain behind the sternum.
An attack of angina lasts for several minutes, is eliminated after the cessation of physical activity, taking nitroglycerin. With a heart attack, the pain is undulating, very intense, lasts for more than 30 minutes, does not disappear when using the methods listed above. With an atypical course of infarction and coronary artery disease, chest pains may be absent, only reflected ones are observed, including in the jaw.
Diagnostics
Diagnostic measures are carried out by a dentist or a maxillofacial surgeon. According to the indications, a neurologist, a cardiologist, and other specialists are involved in the examination. The doctor determines the nature of the symptom, its change from the moment of occurrence, dependence on external factors. Identifies other complaints, conducts a general and dental examination to detect objective changes (hyperemia, edema, destroyed teeth, asymmetry). To make a final diagnosis, data from studies such as:
Radiography. It is informative for injuries, purulent processes (except for the acute stage), tumors, and some dental pathologies. It helps to confirm the presence of a fracture, identify other bone changes, differentiate osteomyelitis and periostitis from inflammation of the surrounding soft tissues, distinguish benign and malignant neoplasms.
Computed tomography. CT of the jaw provides more accurate data on the state of solid structures compared to radiography. It is carried out with insufficient diagnostic value of X-rays, the need to clarify the location of fistulas, the nature of injuries and neoplasms. CT scan of the skull makes it possible to determine the narrowing of the holes, which causes nerve compression with the development of neuralgia.
Magnetic resonance imaging. It is recommended to exclude the tumor and vascular genesis of compression of the nerve trunk. Detects cysts, neoplasias, aneurysms, tortuosity of vessels passing near the nerve.
Electrophysiological studies. Electromyography allows to confirm the pathological activity of muscles in myofascial pain, bruxism, to assess the quality of neuromuscular transmission in neuralgia. Electroneurography makes it possible to determine the scale and level of nerve damage. Patients with suspected coronary artery disease are shown an ECG.
Invasive techniques. A lymph node biopsy is performed when the submandibular or cervical lymph nodes are enlarged in patients with tumors. With parotid phlegmon with a deep location of the purulent focus, a diagnostic puncture may be required to verify the diagnosis.
Laboratory tests. The causative agent of purulent processes is determined by sowing the separated on nutrient media. In neoplasms, morphological examination is performed to establish the type and degree of malignancy of neoplasia.
Consultation of a maxillofacial surgeon
Consultation of a maxillofacial surgeon
Treatment
Conservative therapy
Therapeutic tactics are determined by the cause of the symptom. Local treatment is indicated for patients with dental pathologies. Removable prostheses and orthopedic structures are being replaced, and other types of prosthetics are being selected. With pulpitis, the cavity is treated with antiseptics, antibiotics, proteolytic enzymes, pastes are applied to eliminate inflammation and stimulate regeneration, after a few days, filling is performed. For other diseases, the following methods are recommended:
Inflammatory processes. Antibiotic therapy is carried out in the pre- and postoperative period. At the initial stage, broad-spectrum drugs are administered parenterally. After receiving the results of sowing, the medication is replaced taking into account antibiotic sensitivity. Bandages are performed, rinses are performed. To reduce pain, analgesics are prescribed.
Traumatic injuries. In case of fractures of the angle, the body of the lower jaw without displacement, conservative immobilization is carried out by double-jaw wire splinting. Antibacterial agents are used to prevent inflammation, and painkillers are used to reduce pain.
Neuralgia. Anticonvulsants are used to eliminate pain attacks. To enhance the effect, the treatment program is supplemented with antispasmodics, antihistamines, and microcirculation correctors. Blockades of trigger points are carried out with a mixture of glucocorticoids and local anesthetics. They give directions for ultraphonophoresis, galvanization with novocaine.
Pathology of muscles. With bruxism, an integrated approach is effective, including medication, dental, physiotherapy, psychotherapeutic methods, the use of protective mouthguards. Patients with myofascial syndrome are prescribed muscle relaxants, NSAIDs, antidepressants.
CHD. As part of drug therapy, antianginal agents, beta-blockers, calcium channel blockers, antioxidants, antiplatelet agents, antisclerotic drugs are indicated.
Surgical treatment
The choice of surgical technique depends on the cause of the symptom:
Inflammatory diseases: autopsy, drainage of abscesses and phlegmon, sequestrectomy for osteomyelitis.
Injuries: open osteosynthesis using bone sutures, polyamide thread, mini-plates.
Neoplasms: curettage, excision of benign neoplasia within healthy tissues (often with extraction of teeth), resection or exarticulation of the lower jaw with a malignant tumor.
Neuralgia: microsurgical decompression, percutaneous radiofrequency destruction, stereotactic radiosurgery.
Coronary artery disease: thrombolysis, emergency coronary angioplasty in the acute period of infarction; planned coronary artery bypass grafting, balloon angioplasty in angina pectoris, postinfarction conditions.
