Tooth Pain v Jaw Muscle Pain
Distinguishing Dental Distress from Musculoskeletal Pain
Recently, we sat down with Dr. Bojana Aboud, a Doctor of Dental Surgery (University of Melbourne), Bachelor of Pharmacy (Monash University) & mother of three at Box Hill South Dental. She discussed some of differences between dental pain and jaw/TMJ/ muscle pain. Below is the summary of our chat, the video of our full chat can be found below.
The "Dead Giveaways" of Dental Pain
If the issue is truly dental, the symptoms usually follow a specific pattern:
Localized Precision: Unlike muscular pain, which tends to radiate across a large area, dental pain is often "pinpoint."
The Midnight Surge: A hallmark of dental infection or pulpitis is pain that intensifies at night. If you find yourself waking up in the middle of the night with a throbbing sensation that "comes back with a vengeance" after your evening dose of ibuprofen wears off, the culprit is likely a tooth.
Thermal Sensitivity: While jaw muscles aren't particularly bothered by a scoop of gelato, a "sick" tooth will react sharply to temperature extremes. Lingering pain after consuming hot coffee or cold water is a significant diagnostic red flag.
Functional Triggers: Pain elicited by the mechanical pressure of chewing specific foods is a classic indicator of a structural issue, such as a crack or a cavity.
When the Problem Isn't the Teeth
What happens when your "whole face hurts" or the pain feels more like a general, heavy ache? This is where the diagnosis shifts toward musculoskeletal or sinus issues.
The Sinus Connection: Particularly during hay fever season or winter, referred pain from the maxillary sinuses can mimic a toothache. Dr. Bojana notes that if the discomfort is bilateral (occurring on both sides) and located high up near the cheekbones, it may be a respiratory rather than a dental issue.
Stress and Somatic Responses: We often carry our stress in our chewing muscles. Clenching while working at a computer or grinding during sleep (bruxism) can lead to jaw muscle symptoms.
The "Ankle" Analogy: Dr. Bojana compares a strained jaw joint to a sprained ankle. "If you have a sore ankle, you’re not going to walk on it," she explains. Treatment often involves behavioral changes, rest, and occasionally a structural "crutch"—a rigid acrylic night guard—to offload the pressure.
The Diagnostic Process: Conversation Before Clinicals
A common fear among patients is that a visit to the dentist involves immediate, painful prodding. Dr. Bojana’s approach prioritises the patient narrative over immediate intervention.
"Your experiences as a patient is sometimes far more important than what I can see or what I can test."
Before any tools are used, a thorough "chat" establishes the history of the pain. When the clinical exam does begin, it is targeted and conservative:
Visual Inspection: Looking for obvious caries (holes) or fractures.
Percussion Testing: Gently tapping on teeth to compare the response of a suspected "sick" tooth against a healthy one.
Thermal Testing: Using a cold cotton pellet to gauge the nerve response.
Radiography: Utilizing X-rays only when an infection is suspected and more "under-the-surface" data is required.
A Note on Patient Comfort
For those suffering from jaw dysfunction (TMJ/TMD), the prospect of holding one's mouth open for a procedure is daunting. Dr. Bojana emphasizes a "bare minimum" approach during acute flare-ups.
In fact, she often finds herself telling patients they are opening too wide. By working within the patient’s physical limitations, the goal is to diagnose and stabilise the issue without exacerbating the underlying muscular tension.
Is that nagging ache pinpointed or pervasive? If you’re unsure, the best first step is a conversation with a professional who looks at the person, not just the smile.