Sometimes a Toothache Isn’t Really a Toothache

man holding jawIf your teeth hurt, it usually means that you have a dental issue. But “usually” isn’t always. Sometimes tooth pain can have nothing to do with the teeth at all.

One of the most common causes of non-dental toothache is pain from the muscles involved in chewing. These are some of the most used muscles in your body, and they can be traumatized in a number of ways, including injury, over-opening of the jaw, or prolonged jaw opening.

Similarly, problems with the temporomandibular joints (TMJ) can manifest as tooth pain. TMJ disorders are common, often resulting from nighttime bruxing.

Another non-dental culprit of tooth pain, especially in the upper back teeth, is sinus infection. There are sinuses immediately above these teeth, and infection can put pressure on them, making it seem as if the pain is coming from the teeth themselves.

Problems with your salivary glands, such as a blocked salivary duct, can also present as a toothache. In this case, the pain will be worse after eating.

Other problems which can mask themselves as toothaches include inflammation of various blood vessels or nerves within the head. Jaw cancers can also first manifest themselves through tooth pain.

In all these cases, the source of pain is actually tissues near the teeth, but in other cases, the pain can come from a more distant part of the body. This is known as “referred pain.”

The nerves that relay pain signals to the brain all come together as they enter the spinal cord and brain. Sometimes, the signals can get crossed, causing the brain to interpret pain in one part of the body as actually coming from somewhere else. This most commonly happens when nerve fibers from areas of low sensory input such as the internal organs follow the same paths as nerves from areas such as the skin or mouth, which are more sensitive.

Heart disease and heart attacks are an especially common source of referred pain. The pain from the heart ends up being felt in the arms, back, neck, and other areas of the body. In fact, pain in the teeth or jaws can be one of the first signs of a heart attack.

Of course, not every toothache is a heart attack in progress. But if the toothache is accompanied by other signs such as dizziness or shortness of breath, you should contact your physician promptly.

Tooth pain can even stem from emotional issues or stress. At the recent meeting of the California Dental Association, UCLA orofacial pain and sleep medicine experts Kenneth Moore and John Orsi described the phenomenon:

“Pain is a physical sensation and an emotional experience,” Dr. Moore said. “Whether it’s physical pain or a broken heart, it’s all pain to the brain.”

That’s why hidden traumas, such as childhood abuse, post-traumatic stress disorder, sexual assault, or drug abuse, can sometimes trigger tooth and jaw pain.

“Patients that have multiple pain issues … what happens is that it’s like a traffic jam in there, and the pain gets shot out to other areas,” Dr. Orsi said.

Stress can even cause dental pain, and Dr. Moore notices an uptick in stress-related toothaches around the beginning and end of the school year.

“Anytime around the beginning of a school year and the end of the school year, we get a flood of healthy 20-something-year-olds complaining about jaw and tooth pain,” he said. “But when it’s around spring break, we never hear from them.”

If you have a tooth that’s bothering you, the most important thing is to seek help from a biological dentist as soon as possible. They can determine whether the source of pain is dental or not. If it is, they can treat it and keep the problem from getting worse. If it isn’t, they can refer you to a physician who can investigate further and get to the source of your pain so you can get back to feeling better.

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