Cause

When the jaw relationship allows the head of the lower jaw to push too far into the joint area,  there can be an impingement onto the delicate blood vessels and nerve bundles that form a rich complex around the ear. The cause is multi-factoral but commonly develops from birth and is related to breathing patterns, posture, tongue position and habits. Grinding heavily or habits such as nail biting and playing some musical instruments, or stress can  be an important factor in triggering the pain.

The cause can also be from trauma to the face and jaws from such things as car accidents or a fight.

Some patients have had chronic pain for years with related pain in the neck, back, hips and even the lower leg areas.

If the teeth bite together incorrectly, especially if the lower jaw is forced up and backwards  then the whole skeletal base is in a state of imbalance.

Symptoms

This results in muscular compensation which in itself can cause muscular pain elsewhere in the body. The jaw joint bones themselves can deform and become arthritic as the cartilaginous disc separating the head of the jaw ( the condyle) and the joint space becomes damaged or displaced resulting in painful clicks and pressure.

Hearing loss and ringing in the ears (tinnitus) is common, popping sounds and clicks can be very irritating as well as painful.

Bite irregularities can, of course, be the cause of excessive wear of the teeth and restorations as well as premature loss of crowns and bridges.

For most patients the main problem is chronic headaches which maybe debilitating. Pain often manifest itself as toothache and pain in the front area of the face. Hard foods maybe difficult to eat and the opening of the mouth is greatly reduced and even at times locked. Trigger pain spots are common around the face and neck.

Treatment

Most commonly  treatment involves drawing the lower jaw forwards and down, to relieve the pressure in the joint space. To do this, carefully designed splints are worn ( usually) full time, to re-program the jaw to sit in a better position which relieves the pain and is comfortable to eat and talk. This may be the only treatment necessary but can also be supported with some judicious manipulation. After about four months, the jaw is normally  set in a new position that maybe stable but may require the posterior teeth to be built up to stabilise the jaw and provide a comfortable chewing base. This may require either orthodontics or restorative procedures or both.

Occasionally the only possible treatment is surgical but this is rare and the more conservative treatments should always be tried first.

Before major restorative or orthodontic treatment is begun, the jaw position and the jaw joint should be carefully examined.