Another toothache that's not a toothache?

   A 56 year old female saw me as a weekend emergency due to severe pain. The pain radiated along Here is another guest post by my friend, David Dane. He is an endodontist who practices in Manhattan and also has a talent  for writing!

 

A 56 year old female saw me as a weekend emergency due to severe pain. It extended to the ear and even radiated to her neck. She was certain that the back most tooth, her second molar, was the culprit.

   I examined the tooth. It had a large filling, but there was no evidence of decay or a fracture. I examined all the other teeth on the right side of both jaws. They responded normally to temperature and percussion tests (where I tap each tooth to determine if the surrounding ligament and bone are inflamed). X-rays of the teeth revealed no evidence of decay or infection.

   I then palpated (used my finger to exert mild pressure) around the tooth, and there was no pain. Palpating the muscles of the right Temporomandibular Joint ("T.M.J.) caused SEVERE pain. I asked the patient if she was aware of clenching or grinding her teeth. She said that she was aware that she clenched her teeth, and that she hasn't worn her night guard lately. She also mentioned that she was very anxious lately.

   I reassured her that she did not need endodontic ("root canal") therapy. Her pain was due to muscle spasms of her T.M.J. I prescribed muscle relaxants and anti-inflammatory medications. I also advised her to wear her night guard.

   The T.M.J. muscles are just in front of, below and above the ear. So, it's easy to understand how the pain radiated to her ear. But, how, you may wonder, did they cause neck pain?

   Think of a fine Swiss watch. Each part is carefully calibrated to work in harmony with every other part. If just one part malfunctions (or is slightly "off,") the balance and harmony of the entire system is disrupted. So it is with the muscles of the head and neck. Grinding and clenching of the teeth irritates the T.M.J. muscles. This can cause slight changes in the person's posture. These postural changes, however slight, cause straining of the neck muscles and results in pain.

   So, you see, proper dental diagnosis requires understanding not just of the teeth, but of the fine-tuned, complex relationship of the oral cavity to the rest of the body.